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FRENECTOMY

Dr. Stephen R. Gasparovich Captain, USAF, Keesler AFB

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

To CUT or NOT to CUT


Should a frenectomy be done in a young patient with a low frenum and diastema? - In most cases, as the central incisors are forced together by the canine and lateral incisor eruption, the frenum will recede apically and allow the diastema to close.

To CUT or NOT to CUT


-When a diastema remains and the frenum attachment maintains its low attachment, it is more likely the result of hereditary or anatomic factors such as microdontia or missing or peg lateral. -A frenectomy in this case should be followed with orthodontic treatment.

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

OVERKILL The Z Plasty


Make elliptical incision Excise fibrous tissue Make 2 oblique incisions Undermine pointed flaps Rotate points to close vertical incision horizontally

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

Hold frenum with hemostat.

Surgical incision with #15 blade Excise wedge of tissue

Dissect fibers from periosteum

Interrupted gut suture placed

Lingual Frenectomy
I feel tongue tied.

Say AHHHHHHH!

1 week post-op

Summary
Whats a frenum? Frenum problems Rules Case presentation Questions

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