Modified frenectomy technique to eliminate the aberrant labial frenum - A report of two cases.

Introduction: A modified frenal treatment for aberrant frenum is presented in this report to reduce scar tissue formation and maintain the attached gingiva. Description: The case report describes two cases in which a V-shaped incision removed the aberrant frenum and then the flaps of the frenum were sutured at the mid line. Results: The results showed reduced scar tissue in the mid line and the tissue healed with adequate attached gingiva. Take-Away Lessons: The modified frenotomy technique presented here is ideal for a large frenum that could expose the underlying connective tissue that could reduce the scar tissue formation.

Maxillary labial frenum morphology and midline diastema among 3 to 12-year-old schoolgoing children in Sri Ganganagar city: A cross-sectional study.

INTRODUCTION: Dentofacial aesthetics plays an important role in social interaction and psychological well-being because it affects how people perceive themselves and how they are perceived by society. The maxillary labial frenum is a fold of tissue, usually triangular in shape, extending from the maxillary midline area of the gingiva into the vestibule and mid portion of the upper lip. Maxillary anterior spacing or diastema is a common aesthetic complaint of patients and is frequently seen in children especially in the mixed dentition stage. AIMS AND OBJECTIVES: 1. To estimate the prevalence of different morphologic types of maxillary labial frenum among children of age 3 - 12 years. 2. To find out the relationship between the level of insertion of the frenum and age of the child.3. To evaluate the correlation between frenum morphology, insertion and midline diastema in children. MATERIALS AND METHODOLOGY: The direct visual method under natural light was used and the upper lip was lifted with the index finger and thumb of both hands which allowed for the observation and classification of the labial frenum morphology according to Sewerin's typology and its attachment according to Placek et al. The midline diastema was determined by measuring the distance between the midpoints of the mesial surfaces of both central incisors with the help of divider and ruler. The values were recorded in the prepared schedule. SUMMARY AND CONCLUSIONS: The presence of an abnormal frenum can be a cause in persistent midline diastemas. Tooth movement usually is deferred until eruption of the permanent canines but can begin early in certain cases with very large diastemas.

Evaluation of patient perceptions after frenectomy operations: A comparison of neodymium-doped yttrium aluminum garnet laser and conventional techniques in the same patients.

BACKGROUND: The aim of the present study was to compare the level of postoperative discomfort between labial frenectomy done by neodymium-doped yttrium aluminum garnet (Nd: YAG) laser and the conventional technique and evaluate the differences in the levels of postoperative pain and functional complications such as eating and speaking between these two methods. MATERIALS AND METHODS: Forty patients requiring labial frenectomy in both jaws were included in the study. One side of each patient was treated with laser, whereas the other side was treated with the conventional technique and all surgeries were performed by the same surgeon. Postoperative pain and functional complications were evaluated for each patient and recorded using a visual analog scale on the operation day and postoperative 1, 3, 7 and 10 days. RESULTS: The results indicated that patients treated with the Nd: YAG laser had lower levels of postoperative pain and were more comfortable while chewing and speaking at the operation day and postoperative 1st day (P < 0.05). CONCLUSION: The results suggest that Nd: YAG laser application during oral soft-tissue surgery provides better patient perceptions and less postoperative pain compared to conventional surgery.

Ultrasonography of major salivary glands compared with parotid and labial gland biopsy and classification criteria in patients with clinically suspected primary Sjögren's syndrome.

OBJECTIVE: To assess the validity of ultrasound of major salivary glands (sUS) compared with parotid and labial gland biopsies, sialometry, anti-SSA/Ro antibody status and classification criteria in patients clinically suspected with primary Sjögren's syndrome (pSS). METHODS: 103 consecutive outpatients with clinically suspected pSS underwent sUS. Parenchymal echogenicity, homogeneity, hypoechogenic areas, hyperechogenic reflections and clearness of salivary gland border were scored according to the Hocevar scoring system. Total ultrasound score was calculated as the sum of these domains (range 0-48). RESULTS: Absolute agreement between sUS and parotid (83%) and labial (79%) gland biopsy outcome was good. Negative sUS predicts negative parotid gland biopsy, and positive sUS predicts positive labial gland biopsy. Compared with the American European Consensus Group (AECG) classification, sUS showed an absolute agreement of 82%, sensitivity of 71% and specificity of 92%. Compared with the American College of Rheumatology (ACR) classification, absolute agreement was 86%, sensitivity was 77% and specificity was 92%. Compared with the ACR-European League Against Rheumatism (EULAR) classification, absolute agreement was 80%, sensitivity was 67% and specificity was 94%. Positive sUS predicts classification, but negative sUS does not exclude classification. The combination of positive sUS with presence of anti-SSA/Ro antibodies or negative sUS with absence of anti-SSA/Ro antibodies showed a high predictive value for classification as pSS or non-pSS. CONCLUSION: In our prospective inception cohort study derived from daily clinical practice, absolute agreement between sUS and salivary gland biopsies was slightly higher for parotid compared with labial gland biopsies. The combination of positive sUS and presence of anti-SSA/Ro antibodies highly predicts classification according to the AECG, ACR and ACR-EULAR classification criteria.

Morphological variations of median maxillary labial frenum: A clinical study.

BACKGROUND: Median maxillary labial frenum (MMLF) appears as a fold of mucous membrane extending from the lining of the mucous membrane of the lips towards the crest of the alveolar ridge on the labial surface. MMLF can demonstrate certain variations in their shape, size and position, both among individuals and within the same individual at different ages. Many clinicians, not being aware of the normal variations of median maxillary labial frenum misinterpret them as pathological entities. OBJECTIVES: The objectives of the study were to determine the prevalence of morphologic variations of MMLF, to classify the morphological variations of MMLF on the basis of their location on the frenum and to compare the morphological variations of MMLF among different age groups and genders. MATERIALS AND METHODS: The study was conducted on 700 males and 700 females of age 5 to 74 yrs, chosen randomly. They were equally divided on the basis of age into 7 groups, each group having equal gender distribution. The morphological variations of MMLF were classified according to Sewerin's classification and the attachments on the freni were further sub-classified. RESULTS: The commonest type of frenum was found to be the simple type, whereas bifid frenum was not found at all. Statistically significant difference was found in proportion of types of frenum among the different age groups and also in proportion of types of frenum among the different sites of presence of frenal attachments. No statistically significant difference was found in proportion of types of frenum in male and female subjects. CONCLUSION: This study shows that MMLF presents with an array of morphological variations. These morphological variations may sometimes pose a complicating factor in maintaining oral hygiene, speech, mastication, esthetics, denture construction, etc. Hence, appropriate recognition of frenal variations and subsequent modification of treatment procedures are essential for a successful outcome of therapy.

Frenum-like oral synechiae of the lip and vestibule.

Two cases where aberrant tissue was attached to the lower lip mimicking the inferior labial frenum were reported. The frenum-like tissue extended from the gingival margin between the lower left deciduous central and lateral incisors in case 1 and between the lower right deciduous central and lateral incisors in case 2, to the dry lower lip. Histologically, the resected specimen was regarded as normal oral mucosa covered with stratified squamous epithelium, without a clear amniotic band. The frenum-like tissue of the lower lip found in both our patients was diagnosed as a category of oral synechiae, of unknown origin.

Labial salivary gland biopsy for diagnosing immunoglobulin light chain amyloidosis: a retrospective analysis.

Our goal was to evaluate the usefulness of labial salivary gland (LSG) biopsy for diagnosing immunoglobulin light chain (AL) amyloidosis, by comparing bone marrow and skin biopsies in the same patient population. This retrospective study included 34 consecutive patients who showed evidence of monoclonal proteins and symptoms considered to be due to amyloidosis, and who underwent a tissue biopsy from LSG between January 2005 and December 2012 at Nagoya City University Hospital. All samples of superficial tissues, including LSG, bone marrow, and skin, were independently evaluated as having amyloid deposits by a central review, which was blind to clinical information. An AL amyloidosis diagnosis was based on evidence of amyloid deposition in any biopsied tissue. Eighteen patients were diagnosed with AL amyloidosis. The sensitivity for detecting amyloid deposition was highest in biopsies of LSG at 89 %, followed by 77 % for bone marrow, and 72 % for skin. Amyloid deposition was detected in at least one superficial tissue of all the 18 patients. An LSG biopsy may be appropriate as a first-choice procedure to diagnose AL amyloidosis. Multiple biopsies of superficial tissues, including LSG, bone marrow, and skin, are recommended to increase the sensitivity for diagnosing AL amyloidosis.

Midline diastema and its aetiology--a review.

Maxillary midline diastema is a common aesthetic complaint of patients. Treating the midline diastema is a matter of concern for practitioners, as many different aetiologies are reported to be associated with it. The appearance of midline diastema as part of the normal dental development makes it difficult for practitioners to decide whether to intervene or not at an early stage. The aim of this article is to review the possible aetiology and management options which will help the clinician to diagnose, intercept and to take effective action to correct the midline diastema. The available data shows that an early intervention is desirable in cases with large diastemas. Treatment modality, timing and retention protocol depends on the aetiology of the diastema. Therefore, priority needs to be given to diagnosing the aetiology before making any treatment decisions. Clinical Relevance: This article aims to determine and evaluate the aetiology and possible treatment options of midline diastema.

Oral syphilis: a series of 5 cases.

Syphilis is an infectious, usually sexually transmitted, disease caused by Treponema pallidum, subspecies pallidum. Because of the increasing prevalence in Europe during the past few years, dentists could be confronted with patients with oral manifestations of syphilis. Because oral lesions are highly contagious, it is vital to make the correct diagnosis quickly to initiate the proper therapy and to interrupt the chain of infection. We present the cases of 5 patients with syphilis-related oral lesions. These cases are representative because of their clinical presentation, age, and gender distribution and the diagnostic approach. The aim of the present report is to emphasize the importance of the dentist knowing and identifying syphilis in different stages to diagnose the disease and institute treatment at an early stage.

Modified frenectomy: a review of 3 cases with concerns for esthetics.

The maxillary labial frenum is a normal anatomical structure in the oral cavity. An abnormal labial frenum causes localized gingival recession and midline diastema, both of which can interfere with oral hygiene procedures, and eventually affect esthetics. When the frenum maintains its high papillary attachment, frenectomy is the treatment of choice. Though this technique has undergone many modifications, the zone of attachment and esthetics in the anterior maxillary region have been neglected. This article highlights a new frenectomy technique that results in good esthetics, excellent color match, gain in attached gingiva, and healing by primary intention at the site of thick, extensive abnormal frena.

Palatally impacted maxillary canine with congenitally missing lateral incisors and midline diastema.

Multiple treatment options are available for patients who have impacted canines in addition to congenitally missing lateral incisors. This article describes the treatment of a 13-year-old postpubertal girl with bilaterally impacted permanent maxillary canines, missing lateral incisors, retained deciduous canines, and a midline diastema. The orthodontic treatment plan included extraction of the deciduous canines. A lingual and labial approach (1-couple force system) was used to move the permanent canines into the arch. Through a collaborative team effort, including an orthodontist and a periodontist, the outcome was excellent esthetically and functionally.

Facts and myths regarding the maxillary midline frenum and its treatment: a systematic review of the literature.

OBJECTIVE: To systematically review the current literature on the maxillary midline frenum and associated conditions and complications, as well as the recommended treatment options. METHOD AND MATERIALS: A detailed MEDLINE database search was carried out to provide evidence about the epidemiology, associated pathologies, and treatment options regarding the maxillary frenum. Of the 206 initially identified articles, 48 met the inclusion criteria. RESULTS: The maxillary frenum is highly associated with a number of syndromes and developmental abnormalities. A hypertrophic frenum may be involved in the etiology of the midline diastema. There is also a tendency by orthodontists to suggest posttreatment removal of the frenum (frenectomy). Studies on the cause of gingival recession due to the maxillary frenum are inconclusive. An injured frenum in combination with other traumas and doubtful history might point to child abuse. The involvement of hyperplastic frena in the pathogenesis of peri-implant diseases remains uncertain. There seems to be a clinical interest regarding lasers for surgery for treatment of maxillary frena. The superiority of laser treatment in relation to conventional surgical methods has not yet been demonstrated in the literature. CONCLUSION: A maxillary frenum is a clinical symptom in numerous syndromic conditions and plays a role in the development of the median midline diastema. Nevertheless, the contribution to gingival recession and peri-implant diseases in the region of the maxillary incisors is rather controversial. Laser techniques are reported as the method of choice for the surgical removal of frena; however, this needs to be substantiated by appropriate prospective controlled studies.

Chondroectodermal dysplasia (Ellis-van Creveld syndrome): a case report.

Ellis-van Creveld (EVC) syndrome is a form of skeletal and chondroectodermal dysplasia, occurring with and without systemic involvement. Taurodontism of permanent and primary molars and upper posterior supernumerary teeth are rarely associated with this syndrome. A 5-year-old girl presented with early childhood caries and hypodontia. She had labiogingival adhesion, labiogingival frenulum hypertrophy, accessory labiogingival frenula, and a serrated appearance of the gingiva. She was also short in stature. All major features of chondroectodermal dysplasia were present. EVC syndrome requires multidisciplinary therapeutic planning, and the dentist plays a fundamental role in management of the oral and dental manifestations.

Defining ankyloglossia: a case series of anterior and posterior tongue ties.

INTRODUCTION: Ankyloglossia is a congenital condition in which tongue mobility is limited due to an abnormality of the lingual frenulum. The impact of ankyloglossia on breastfeeding is poorly understood but there is a recent trend toward more recognition of this condition and early intervention when needed. Currently, there lacks clear definition of ankyloglossia and different subtypes have been proposed with no clinical correlation. OBJECTIVE: To determine the prevalence of anterior versus posterior ankyloglossia in a large series of consecutive patients and to assess clinical outcomes after frenotomy. METHODS: Retrospective chart review of patients from July 2007 to July 2009 who were diagnosed with ankyloglossia and underwent office frenotomy. Baseline characteristics, specific feeding issues, type of ankyloglossia, and clinical outcomes after frenotomy were reviewed. RESULTS: Of the 341 total patients, 322 (94%) had anterior ankyloglossia and 19 (6%) had posterior ankyloglossia. Median age at presentation was 2.7 weeks (range 1 day of life to 24 weeks); 227 were males and 114 were females. Revision frenotomy rates were significantly higher for the posterior ankyloglossia group (3.7% anterior and 21.1% posterior, p=0.008). CONCLUSION: Anterior ankyloglossia is much more common and readily managed when compared to posterior ankyloglossia. Posterior ankyloglossia is a poorly recognized condition that may contribute to breastfeeding difficulties. The diagnosis is difficult due to the subtle clinical findings but relevant health care providers should be aware of this condition. Frenotomy is a simple, safe, and effective intervention for ankyloglossia which improves breastfeeding.

980 nm diode lasers in oral and facial practice: current state of the science and art.

AIM: To evaluate the safety and efficacy of a 980 nm diode laser for the treatment of benign facial pigmented and vascular lesions, and in oral surgery. MATERIALS AND METHODS: 20 patients were treated with a 980 nm diode laser. Oral surgery: 5 patients (5 upper and lower frenulectomy). Fluence levels were 5-15 J/cm(2); pulse lengths were 20-60 ms; spot size was 1 mm. Vascular lesions: 10 patients (5 small angiomas, 5 telangiectases). Fluences were 6-10 J/cm(2); pulse lengths were 10-50 ms; spot size was 2 mm. In all cases the areas surrounding the lesions were cooled. Pigmented lesions: 5 patients (5 keratoses). All the lesions were evaluated by dermatoscopy before the treatment. Fluence levels were 7-15 J/cm(2); pulse lengths were 20-50 ms; spot size was 1 mm. All the patients were followed at 1, 4 and 8 weeks after the procedure. RESULTS: Healing in oral surgery was within 10 days. The melanoses healed completely within four weeks. All the vascular lesions healed after 15 days without any residual scarring. CONCLUSIONS: The end results for the use of the 980 nm diode laser in oral and facial surgery appears to be justified on the grounds of efficacy and safety of the device, and good degree of acceptance by the patients, without compromising their health and function.

Gingival recession: epidemiology and risk indicators in a university dental hospital in Turkey.

OBJECTIVE: Gingival recession is a common manifestation of periodontal disease, but is also associated with several risk factors. In this study, we investigated prevalence of gingival recession and assessed various risk indicators in a university dental hospital in Turkey. MATERIALS AND METHODS: The study group consisted of 831 persons (537 females, 294 males). Gingival recession, dental plaque, calculus, tobacco consumption, toothbrushing frequency, traumatic toothbrushing and high frenum were assessed. Gingival recession scored as present whenever the free gingival margin was apical to the cemento-enamel junction and root surface was exposed. RESULTS: Overall, the prevalence of gingival recession was 78.2%. The gingival recession for buccal surfaces measured approximately between 1 and 2 mm was 17.4%. The number of gingival recession site of male subjects was significantly higher than that of the female ones (P < 0.05). The dental calculus and plaque levels of mandibular teeth were significantly higher than those of the maxillary teeth (P < 0.05). The multiple regression analyses showed that age, smoking duration, traumatic toothbrushing and high frenum are significant contributors to gingival recession. CONCLUSIONS: Periodontal condition is very high in this population. High level of gingival recession in this population is significantly associated with a high level of dental plaque and calculus, male gender, smoking duration, toothbrushing frequency, traumatic toothbrushing and high frenum.

Evaluation of patient perceptions of frenectomy: a comparison of Nd:YAG laser and conventional techniques.

OBJECTIVE: The aim of the randomized controlled clinical trial described here was to determine the anxiety levels of patients prior to frenectomy using the Nd:YAG laser and conventional technique, and to compare the effects of these two methods on the degree of postoperative pain, discomfort, and functional complications (eating and speech). METHODS: Forty patients with mucogingival problems due to labial frenums (both maxillary and mandibular) were included in the study. Ratings of preoperative fear and postoperative pain and functional complications for each patient were recorded using a visual analog scale at 3 h, 1 d, and 1 wk post-surgery. RESULTS: The results indicated that patients treated with the Nd:YAG laser had less postoperative pain and fewer functional complications (p < 0.05). CONCLUSION: The results suggest that in the population studied, Nd:YAG laser treatment of soft tissue disorders provides better patient perceptions of success than those seen with conventional surgery.

Toxic epidermal necrolysis with a rare long-term oral complication requiring surgical intervention.

BACKGROUND: Toxic epidermal necrolysis (TEN) is a rare and potentially fatal adverse dermatologic reaction, often secondary to drug intake. METHODS AND RESULTS: We report a case of an adult male who developed TEN that was complicated by a sepsis-induced coma lasting a period of 3 months. Although the patient eventually recovered, severe oral mucosal involvement during the course of disease resulted in frenum-like fibrotic bands that connected movable oral mucosa (tongue and lips) to attached oral mucosa (gingiva). This complication was painful and also affected his ability to speak and maintain adequate oral hygiene, requiring surgical intervention to restore structure and function. CONCLUSIONS: This oral manifestation in relation to TEN is rarely reported in the literature and represents a preventable complication.

Frequency and location of traumatic ulcerations following placement of complete dentures.

PURPOSE: To determine the location of mucosal injuries that appear following placement of complete dentures, as well as the number of adjustments necessary to achieve patient comfort. The frequency of mucosal injuries in female and male patients and their connection with clinical anatomic features were also investigated. MATERIALS AND METHODS: Sixty-one completely edentulous healthy patients who wore dentures (47 women and 14 men) took part in the study; 122 newly fabricated complete maxillary and mandibular dentures were investigated. All patients were seen for a 1-week adjustment appointment. Areas where signs of denture-induced mucosal injuries appeared were marked on an anatomic illustration. The follow-up period was in 1-week increments as deemed necessary by the patient. Associations between variables were analyzed with analysis of variance. Results were recorded as mean + SD. Statistical significance was set at P < or = .05. RESULTS: Eighty-seven percent of the dentures required adjustment at week 1, 50% at week 2, and only 7% at week 3. No patients required a further visit. Most frequently injured maxillary areas were the vestibular sulcus (41%), maxillary tuberosity (21%), and hamular notch (12%). In the mandible, the most frequently injured areas were the retromylohyoid area (17%), lingual sulcus (14%), and vestibular sulcus (13%). Denture-induced irritations were detected in a higher ratio in the mandible (P < .001), especially in male denture wearers at the first adjustment (P < .05). Men had a higher ratio of lesions at the region of the maxillary vestibular sulcus between the labial and buccal frenum and at the mandibular vestibular sulcus of the buccal shelf region (P < .001). CONCLUSIONS: Denture-induced irritations appeared most often in the vestibular sulcus of the maxilla and mandible, indicating that it is necessary to evaluate the area of the facial seal of the prosthesis by applying a medium- or a heavy-pressure indicator paste to the borders, and to make adjustments at the delivery stage and subsequent adjustment appointments. Denture placement must not be the final patient-clinician encounter when treating with complete dentures. Denture adjustments are very important clinical phases of denture fabrication and essential in patient care.