Human Amniotic Membrane Graft used in Vestibuloplasty: A Case Report

Special Article – Periodontics

J Dent & Oral Disord. 2016; 2(7): 1038.

Human Amniotic Membrane Graft used in Vestibuloplasty: A Case Report

Bansal N¹* and Gupta ND²

¹Department of Periodontics & Implantology, Divya Jyoti College of Dental Sciences & Research, India

²Department of Periodontics & Community Dentistry, Dr Ziauddin Ahmad Dental College (AMU), India

*Corresponding author: Neha Bansal, Department of Periodontics & Implantology, Divya Jyoti College of Dental Sciences & Research, Uttar Pradesh, India

Received: August 29, 2016; Accepted: October 16, 2016; Published: October 18, 2016


Various grafting materials have been used for vestibuloplasty but all have met with variable results. Skin and mucosal grafts have disadvantages of need of second surgical site, limited amount of mucosa available for grafting, postoperative pain and risk of surgical complications at donor site. In contrast, Human Amniotic Membrane (HAM) does not have limitations as conventional grafts. Its several unique properties forge it as a suitable substitute for conventional skin and mucosal grafts. Aim of this article is to present a case report on treatment for vestibuloplasty using an amniotic membrane graft. We concluded that amniotic membrane can be used successfully as a mucosal graft substitute.

Keywords: Amnion; Vestibuloplasty; Graft; Atrophic mandible


Facial and oral rehabilitation of patients with extreme mandibular atrophy has always remained a challenging task and been attempted with variety of treatment procedures such as ridge augmentation and vestibuloplasty. Vestibuloplasty is a mucogingival procedure designed to restore alveolar ridge height and to increase the amount of attached gingiva and vestibular depth by lowering muscles attached to the buccal, labial, and lingual aspects of the jaws [1]. One of the major challenges after a vestibuloplasty procedure is to reduce post operative discomfort, scar contracture and subsequent loss in sulcular depth. A raw bony surface, as is obtained after Clark’s vestibuloplasty is vulnerable to infections, increased pain and scarring during the healing phase. Skin and mucosal grafts are most commonly used to cover the exposed periosteal surface; however they have drawbacks as limited amount of mucosa available for grafting, need of second surgical site, postoperative pain and risk of surgical complications at donor site [2]. There is a constant search for biocompatible membranes/materials which would satisfy most criteria required of a biological scaffold.

Human Amniotic Membrane (HAM) is the innermost layer of placenta and histologically resembles the skin. Guler et al. elaborated superiority of HAM as a graft over other graft materials [3]. The human amnion membrane is a biological graft which has unique properties like wound protection, healing promoter, bacteriostatic, pain reduction, antiscarring and epithelization effects. It may be a graft of choice due to its easy availability and low cost [4]. Here we present a case of human amniotic membrane used as a graft in Vestibuloplasty and discuss biological characteristics of amniotic membrane which most likely make it an ideal graft material.

Case Presentation

Clinical presentation

Sixty years old female patient was referred for treatment at Department of Periodontics and Implantology, Dr Z. A. Dental College, Aligarh with chief complains of instability of lower denture during functions as speech and chewing. The patient’s medical history was non-contributory. She informed of wearing full dentures for the last 10 years; dentures were ill adapted. Bone height and mucosal quality were assessed using radiographic and clinical methods. Patient was having Stage 4 atrophic mandible (Cawood & Howell) [5] with reduced bone height and obliteration of the buccal and the lingual sulcus. Mucosa was thin, healthy pink in color with reduced muscle tone. No bony prominence or undercut was noticed on palpation of ridge. Therefore, to increase the denture supporting area, we planned to go for vestibuloplasty along with amnion grafting followed by new denture fabrication. The procedure to be performed was explained to patient, followed by informed written consent & institutional ethical committee clearance.

Preoperative impression, cast and measurements were made (Figure 1a&1b). The cast was arbitrarily scraped till the desired depth. A splint was fabricated with clear acrylic (Figure 1c).