RESUMEN
The insufficiency of the edentulous mandibular alveolar ridge, for accommodation of a stable and retentive prosthesis, is a relatively common dental dilemma. To overcome this problem, various ridge augmentation and vestibuloplasty procedures have been employed. Ten male patients, 50-70 years of age, were selected for this study. They all were complaining from the inability to use their lower complete dentures satifactorily; because of the presence of flat lower ridge and very shallow vestibule, mainly in the anterior region. After meticulous pre-operative assessment and preparation, a combined ridge augmentation and labial vestibuloplasty were performed in the anterior region of the mandible. For ridge augmentation, a subperiosteal tunnel was prepared over the crest of the ridge, and filled with hydroxylapatite granules. At the same visit, labial vestibuloplasty was performed. A supraperiosteal labial mucosal flap was reflected and sutured at a new position, as deep as possible in the vestibular sulcus. The supraperiosteal raw area left, between the inferior limit of the tunnel and the new created vestibular fornix, was covered as much as possible by fenestrating the alveolar mucosa, stretching it and suturing it to the periosteum. A pre-fabricated acrylic template, lined with a soft liner, was placed immediatly post-operatively; for one week; and a new complete denture was fabricated after one month. The patients were followed-up for 6 months. The healing process of the surgical site was uneventful, since we had made every effort to satisfy the necessary factors needed for the success of the implantation procedure; and infection and pain were carefully controlled by the post-operative antibiotics, the frequent irrigation of the operative site and the regular use of mouth washes. We could obtain a mean increase in the depth of the anterior labial sulcus of about 14.2 mm [507% of the pre-opeative depth], with a mean loss of only about 0.9 mm within 6 monthes [6.3%]. This loss was satistically insignificant