FRENECTOMY

AND
FRENOTOMY

Techniques

Conventional (Classical) frenectomy

Miller's technique
V-Y Plasty
Z Plasty
Frenectomy which was done by using
electrocautery

Conventional technique

Introduced by Archer (1961) and Kruger (1964).

Indications

Midline diastema cases with an aberrant

frenum

Removal of the muscle fibres which were

supposedly connecting the orbicularis oris with
the palatine

Millers technique

Miller PD in 1985. This

Indications
Post-orthodontic diastema cases.
The ideal time for performing this surgery is
after the orthodontic movement is complete
and about 6 weeks before the appliances are
removed.

Z plasty

Introduced by Schuchardt
Indications
Hypertrophy of the frenum with a low
insertion, which is associated with an interincisor diastema,
lateral incisors have appeared without
causing the diastema to disappear and also in
cases of a short vestibule

V-Y Plasty

Introduced by Dieffenbach
Indications
Maxillary midline frenum
Lengthening the localized area
Broad frenum in the premolar-molar area

Electrosurgery

Electrosurgery is recommended in cases of

patients with bleeding disorders, where the
conventional scalpel technique carries a
higher risk which is associated with problems
in achieving a haemostasis
non-compliant patients.
Armamentarium: An electrocautery unit with
the loop electrode and a haemostat

Healing

unilateral pedicle flap shows complete healing

with zone of attached gingiva
no scar and colour of gingival tissue was
comparable to the adjacent tissue
(Hungund et al., Dentistry 2013, 4:1)

The classical technique leaves a longitudinal

surgical incision and scarring, which may lead to
periodontal problems and an anaesthetic
appearance.

simple excision and a modification of Vrhomboplasty fail to provide satisfactory

aesthetic results in triangular pedicle of attached
gingiva with its free end as the apex and its
base continuous with the alveolar mucosa.
(Kambalyal P, Kambalyal P(2013,4:1)

Z plasty
inability to achieve a primary closure at the
centre, consequently leading to a secondary
intention healing at the wide exposed wound.
It achieved both the removal of the fibrous band
and the vertical lengthening of the vestibule.
(Archer WH (1975) Oral surgery- a step by step atlas of operative
techniques. (3rdedn)

The Millers technique offers the following advantages:

1. Post-operatively, on healing, there is a continuous

collagenous band of gingiva across the midline, that

gives a bracing effect than the scar tissue, thus
preventing an orthodontic relapse.

2. The transseptal fibres are not disrupted surgically and

so, there is no loss of the interdental papilla.

3. Obtaining an orthodontic stability without an aesthetic

sacrifice.
( Miller PD. Frenectomy, combined with a laterally positioned pedicle

Thus, the Millers technique results in no loss of

the interdental papilla and no scar tissue.
Thereby, it is best suited to prevent an
orthodontic relapse.