A 45 year old
female presented with the chief complaint of trauma while brushing in the lower
anterior region reported to the outpatient of Department of Periodontology,
Sardar Patel Postgraduate Institute of Dental & Medical Science, Lucknow. On
intraoral examination it was found that patient had Millers grade I mobility with
reduced width of attached gingiva in the lower anterior region along with grade
II recession in 31, 41. Width of attach gingiva was severly reduced , measuring
2mm. (Fig.1)

Phase I therapy
was initiated with patient education and motivation, full mouth scaling and
root planing, home plaque care measures and oral hygiene instructions were reinforced
to the patient. Vestibular extension of the patient’s mandibular labial
vestibule to increase the width of attached gingiva was planned. Routine blood investigations
(haemoglobin, total and differential leukocyte counts, blood glucose- fasting
and post-prandial, bleeding and clotting time) were carried out.

Fig 1. Preoperative                                                     Fig 2. Vertical & Horizontal
incision made   

Fig 3. Suture placed  
                                                  Fig 4. Mesurements made after 15
days

SURGICAL TECHNIQUE:

Pre-surgical
preparation was done by scrubbing of the facial skin all around the oral cavity
with povidine iodine solution and the patient was made to rinse with 0.2%
Chlorhexidine digluconate mouthrinse for 30 seconds. The patient was
anesthetized using 2% Lidocaine

with Adrenaline
concentration of 1:80000.

The surgical
procedure Lip switch technique as described by Edlan and Mejchar was followed. With
the help of BP blade no. 15 vertical incisions were given on mesial aspect of the
both mandibular canines and starting at the junction of the attached and free
gingiva. An incision was made for a distance of 11 to 12 mm extending on to the
lower lip. These two incisions were joined by a horizontal incision across the
midline. A split thickness flap was then separated the loose labial mucosa from
the underlying muscle. Now periosteum was visible. The incision of the
periosteum was extended in a vertical direction at its ends. Periosteum was separated
from the bone. Then interrupted sutures were placed on the inner surface of the
periosteum, which was separated from the bone.

After
surgical procedure a periodontal dressing (Coe Pac) was placed to protect the
operated area. The patient was prescribed Cap Amoxicillin 500 mg TID for 5 days
and anti-inflammatory Tab Diclofenac 50 mg BD for 5 days for post-operative
pain. Patient was instructed to have soft diet for 1 week along with other
post-operative instructions. The patient was recalled after two weeks for removal
of sutures. No postoperative
complications were created. At two weeks the width of
attached gingiva recorded was 7 mm approximately. The patient was recalled
after every month and 3 months follow up was recorded and it was observed that
the achieved width attached gingiva remained constant throughout.