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Whats a Frenum?
Bands of muscle or fascia attaching the lips, cheeks, or tongue to alveolar ridges Role in function of tongue or muscles of facial expression appears to be minimal because significant problems are not seen when they are excised Less than 1% require surgical intervention
Frenum Problems
Localized gingival recession with frenum attachment on marginal gingiva (high frenum attachment) Midline diastema between two maxillary central incisors (low frenum attachment) Ankyloglosia Interfere with denture fabrication/wear
The RULE!!!
The presence of a maxillary diastema does not prompt early frenectomy. WAIT UNTIL THE CANINES AND LATERALS ERUPT Mandibular frenum problems should be treated when first noticed to prevent a mucogingival defect from developing.
SURGICAL TECHNIQUE
Accomplished under local anesthetic by infiltration of frenum site One hemostat technique Two hemostat technique Z-plasty technique Dissect muscle fibers from periosteum Undermine margins around wound Controversy for suture placement
ONE HEMOSTAT
TWO HEMOSTATS
Technique done to reduce loss of vestibular depth sometimes seen with linear incision
Sutures ????
Clinical experience has shown little difference in post operative management with or without sutures. Patients can be told they will have minor discomfort for approximately 2 weeks.similar to the discomfort of an apthous ulcer. Area undergoes secondary epithelialization without difficulty.
Case Presentation
29 YO Male presents for restoration of #11 following trauma and complaint of large frenum Multiple missing permanent teeth and retained deciduous teeth Probing depths range 3-5 mm, Pt oral hygiene satisfactory
Treatment Plan
OHI SC/RP Re-eval Crown Lengthen #11 Maxillary Labial Frenectomy Re-eval Prosthodontics-#11 Cast core and PFM crown (Definitive Pros plan after PCS) SPT maintenance 4 months
Labial Frenectomy
Lingual Frenectomy
I feel tongue tied.
Say AHHHHHHH!
1 week post-op
Summary
Whats a frenum? Frenum problems Rules Case presentation Questions