PMC7518494_01
Fan-shaped buccinator muscle attachment at the crest of the alveolar ridge
NJMS-11-140-g001.jpg
PMC7518494_01_NJMS-11-140-g001.jpg
F1
The vestibular depth was almost nonexistent in that area [Figure 1].
Acrylic surgical stent was prepared on the cast
NJMS-11-140-g002.jpg
PMC7518494_01_NJMS-11-140-g002.jpg
F2
Approximating the anticipated loss of tissue resulting from the surgical procedure, the patient's cast was marked and scored to ensure close contact of the acrylic surgical stent with the alveolar ridge [Figure 2].
Smoothed and highly polished acrylic surgical stent with the final adjustments
NJMS-11-140-g003.jpg
PMC7518494_01_NJMS-11-140-g003.jpg
F3
The stent was then smoothed and highly polished to minimize the accumulation of plaque [Figure 3].
Crestal incision was made slightly buccal
NJMS-11-140-g004.jpg
PMC7518494_01_NJMS-11-140-g004.jpg
F4
Local anesthetic (2% lignocaine with 1:80,000 epinephrine) was administered, and a crestal incision was made, keeping the incision slightly buccal [Figure 4].
Surgical detachment of buccinator and vestibular extension
NJMS-11-140-g005.jpg
PMC7518494_01_NJMS-11-140-g005.jpg
F5
The vestibular depth and muscle repositioning were checked by retracting the cheek [Figure 5].
Bleeding controlled and the surgical stent stabilized in the surgical area
NJMS-11-140-g006.jpg
PMC7518494_01_NJMS-11-140-g006.jpg
F6
After adequate depth was achieved, the surgical area was irrigated with normal saline, the bleeding controlled, and the surgical stent stabilized in the surgical area [Figure 6].
One week postoperative
NJMS-11-140-g007.jpg
PMC7518494_01_NJMS-11-140-g007.jpg
F7
The patient was recalled after 7 days for reevaluation [Figure 7].
Two months postoperative
NJMS-11-140-g008.jpg
PMC7518494_01_NJMS-11-140-g008.jpg
F8
Adequate vestibular depth was achieved after 2 months of healing [Figure 8], there was the significant gain in vestibular depth, and the muscle was relocated to an apical position, thus allowing the toothbrush head to be positioned properly for maintenance of proper oral hygiene.