Sulcoplasty Following removal of natural teeth, remodeling of the alveolar process result in a reduction in the height and width

of the residual ridge. As the basal seat area becomes smaller, denture stability and retention decrease. Ultimately many patients find themselves unable to wear dentures. Ideally, it would seem desirable to restore the alveolar ridge to its former size by implanting bone. However, since several methods of sulcoplasty are available to extend the denture foundation, bone grafting is indicated only when these methods of sulcoplasty will not provide satisfactory results. If denture flange is overextended in an attempt to gain added resistence to lateral displacing forces, the mucosa at the fornix of the vestibular or sublingual sulcus becomes traumatized, ulcerated, and secarred. The denture becomes easily displaced. Ultimately the flange must be shortened to physiologic limits. If an incision is made at the fornix of the sulcus to accommodate a longer flange, granulation and scar tissue form around the flange and the flange must be shortened. The incision heals and the sulcus returns to its former position with a scar in the fornix. For successful extension of the vestibular or sublingual sulcus both the osseous and the softtissue sides must be lined with epithelium. If the extended sulcus is to be an aid in denture construction, the mucosa of the sulcus must be free of scar tissue. To prevent relapse of the sulcus to its former condition there must be a minimum of connective tissue between the mucosa and the periosteum on the osseous side of the sulcus and the epithelial lining of the sulcus must be free of tension (Fig 8-1). The are three general methods of sulcoplasty, as follows: a. Mucosa adjacent to the sulcus can be advanced to line both sides of the extended sulcus. b. Neighboring mucosa can be advanced to line one side of the sulcus while the other side heals by granulation and secondary epithelization. c. Epithelium, either skin or mucosa, can be transplanted as afree graft to line one or both sides of the extended sulcus. In this chapter various techniques for extending the vestibular and sublingual sulci are presented.

Lingual sulcoplasty For the patient with a grossly resorbed mandible, extention of the lingual sulcus, or lowering of the floor of the mouth, can extend the denture foundation and improve the stability and retention of the mandibula denture. (fig 8-10). The mylohyoid and genioglossus muscles and the mucosa of the floor of the mouth can be repositioned inferiorly without undue impairment of function. Cooley (1952, Cit. ) suggested lingual frenetomy and transplantation of the superficial fibers of the genioglossus muscles to improve the contour of the anterior lingual sulcus (fig 8-11). Obwegesers technique. Obwegwser (1963, 1967), he combined a ridge skin-grafting vestibuloplasty, with a lingual sulcoplasty. Supraperiosteal dissections were made on the facial and lingual surfaces of the mandible (fig 8-14, A). The mylohyoid muscles were severed from the mandible according to Trauners technique. If the genioglossus muscles were to be repositioned, the medial and inferior fibers were left attached to the mandible so that muscular control of the tongue could be maintained (Fig 8-14, B). The labiobuccal and the lingual mucosal flaps were sutured to each other with chromic catgut under the mandible, by use of an awl from a submandibular approach. At this point the mandible had a strip of gingiva at the crest of the ridge and raw periosteum an the facial and lingual surfaces (Fig. 814, C). A previously prepared aplint was lined with impression compound and gutta-percha and an impression was made of the new mandibular contour. The stent was lined with a splintthickness skin graft, and the stent and graft were ligated to the mandible with circumferential sutures of heavy nylon (Fig 8-14, D). After a week the stent was removed. The skin had adhered to the raw periosteum but not to the gingiva on the crest of the ridge. The surplus skin was removed. The stent was used to maintain sulcus depth until a new denture could be constructed (fig 8-14, E).