Labial Frenectomy Using Conventional Scalpel Technique: A Case Report.

Frenum morphology is of pivotal concern while treating patients who desire improved aesthetics and for treating patients with midline diastemas, as it may lead to failure or relapse of orthodontic treatment. Frenum, a thick band of muscle fiber, may present with abnormalities in the shape, size, form, number, and thickness, which may cause gingival recession along with poor oral health. Frenectomy is adopted as the plan of action while treating abnormal frenum cases by resecting the frenum attachment to provide closure of the spacing between the upper anterior teeth, as in the case of midline diastema. Various forms and techniques of frenectomy have been adopted according to the type of frenum attachment and aesthetic concerns of the patients. Amidst the various treatment options available, conventional frenectomy using a scalpel has emerged as a viable solution for treating patients. The surgeons value and praise its exceptional precision and ease of use, and the patients prefer it for its affordability; hence, a functional and aesthetic outcome is achieved via this treatment. This report provides a comprehensive overview of a case of conventional frenectomy with a one-week follow-up.

Electrocautery-Assisted Management of Aberrant Frena Causing Midline Diastema: A Case Report.

Various oral complications such as gingival recession, restricted lip movement and tooth malalignment are the result of an abnormal frenum. Management of these types of frenum is either frenectomy or frenotomy. Methods for performing frenectomies include the conventional scalpel technique, Z-plasty, Miller's technique, V-Y plasty, lasers, and electrocautery. This case report details the successful management of an abnormal frenum attachment using electrocautery to ease and reduce discomfort to the 19-year-old female patient, causing aesthetic concerns. For its precision, minimal bleeding and post-operative discomfort, electrocautery was chosen. This procedure was performed under local anaesthesia. There were favourable post-operative outcomes as the patient experienced minimal pain and rapid recovery from the surgical site. Significant improvement in gingival health was seen in the follow-up examination. This case demonstrates the efficacy of using electrocautery in managing abnormal frenum attachment while highlighting its benefits over traditional surgical methods for ease and reduced discomfort.

The lingual frenulum, ankyloglossia, and breastfeeding. / Frenillo lingual, anquiloglosia y lactancia materna.

Between 1997 and 2012, the diagnoses of ankyloglossia and the indication for frenotomy increased by ˃800%. About 38% of diagnosed cases are surgically treated. Breastfeeding promotion includes evaluating maternal hereditary and personal history of breastfeeding, breast structure, endocrinological physiology, emotional well-being of the mother, breastfeeding technique, quality and quantity of milk, and the newborn's ability to latch on and suckle. Frenotomy would be indicated when restriction of tongue function causes difficulties that have not resolved after thorough evaluation and counseling to correct other causes. Frenotomy can have complications: feeding and respiratory difficulties, pain, weight loss, vascular or nerve damage, and delayed diagnosis of other underlying pathologies. It does not always solve breastfeeding difficulties. Interdisciplinary teamwork reduces the frequency of unnecessary frenotomies.

Entre 1997 y 2012 los diagnósticos de anquiloglosia y la indicación de frenotomía aumentaron ˃800 %. Alrededor del 38 % de los casos diagnosticados son intervenidos quirúrgicamente. La promoción de la lactancia materna incluye la evaluación de antecedentes hereditarios y personales maternos de lactancia, estructura mamaria, fisiología endocrinológica, equilibrio emocional de la madre, técnica de amamantamiento, calidad y cantidad de leche, capacidad del recién nacido de prenderse y succionar. La frenotomía estaría indicada cuando la restricción de la función lingual provoca dificultades que no se han resuelto luego de una evaluación exhaustiva y del asesoramiento para corregir otras causas encontradas. Las frenotomía puede tener complicaciones: problemas en la alimentación, respiratorios, dolor, pérdida de peso, daños vasculares o nerviosos, y retraso en el diagnóstico de otras patologías subyacentes. No siempre soluciona las dificultades de la lactancia. El trabajo en equipo interdisciplinario disminuye la frecuencia de las frenotomías innecesarias.

Midline Diastema Closure Following Frenectomy Using M-spring: A Case Report.

Midline diastemas are one of the most prevalent dental malocclusions. In young adults this may create aesthetics problems, especially in individuals marked by a gap between central incisors higher than 4 mm. This case report demonstrates the treatment of a patient with Angle's Class I malocclusion and midline diastema with the M-spring appliance resulting in complete closure within four months. The case included a frenectomy for correction of the abnormal labial frenal attachment followed by an M-spring orthodontic appliance. This "M" shaped device, with specific activation points, provides control over tooth movement and consequently achieves this site closure in a short duration of time by tipping the crowns of central incisors in a mesial direction. This procedure aimed to resolve aesthetic issues while also enhancing and ensuring functional occlusion.

Assessment and Management of Maxillary Labial Frenum-A Scoping Review.

BACKGROUND: The maxillary labial frenum (MLF) is a soft tissue fold connecting the upper lip to the alveolar process. Abnormal attachment can cause periodontal, functional, and esthetic problems. Differential diagnosis is important and can prevent unnecessary interventions. This study aims to summarize the current evidence on the assessment and management of abnormal MLF. METHODS: A thorough review of the literature was conducted. Five online databases were searched for relevant peer-reviewed human studies. Article screening and data extraction were performed independently by two reviewers using predefined inclusion/exclusion criteria. Information about article type, study design, participants' characteristics, interventions, and outcomes was extracted and synthesized. RESULTS: 52 articles met the review criteria. MLF is a dynamic structure characterized by a wide normal morphological variation. MLF assessment in infants has not been standardized. Studies in pre-adolescents reported a change in the thickness and position of the MLF observed over time, resulting in a lower prevalence of abnormal MLF morphology. Studies in adolescents and adults reported variable differential diagnosis criteria. Lasers appear as the most advantageous frenectomy modality. CONCLUSIONS: There is a need for more objective MLF diagnostic protocols and treatment guidelines, which could prevent unnecessary surgical interventions.

Pediatric High Labial Frenum Management: Utilizing a Diode Laser for the Transformation of the Smile of an Eight-Year-Old Child.

Median diastema is a physiological occurrence that is frequently seen in the maxillary jaw. Therefore, a median diastema has been associated with a wide range of etiological variables, including thumb sucking, supernumerary teeth, tongue thrusting, some dentoalveolar discrepancy, and hypodontia. Patient esthetic and function demands are both negated by the labial frenum's abnormal location in relation to the maxillary anterior teeth, which results in diastema and gingival recession. Lasers are now being used in several fields of dentistry as an alternative to conventional scalpel operations. Frenectomy can be done through the use of electrosurgery, laser surgery, or the classic scalpel technique. This pathological frenum can be very well excised with a diode laser. Due to its applicability, sufficient coagulation, lack of suture requirements, and reduced discomfort and inflammation, the diode laser can be utilized in pediatric dentistry. High-connected midline diastema has remained a subject of debate when it comes to management and the right time to intervene and treat it. Both orthodontists and pediatric dentists agree that frenectomy should not be done after the closure of the orthodontist gap or before the appearance of the permanent canine teeth. However, several conditions, including the child's psychological status, parents' concerns, the closure's unpredictable effects on the future, and the expense of combined therapies, may lead to an early intervention for therapy during the primary or mixed dentition. In this specific scenario, a child who was eight years old underwent a diode laser frenectomy. After seven days, a follow-up examination showed normal position and attachment of the frenum and no signs of infection at the site of surgery.

Maxillary Labial Double Frenum Frenectomy Using a Diode Laser: A Case Report.

Maxillary labial frenectomy is a surgical procedure aimed at addressing midline diastema, where a strip of tissue creating a gap between two upper front teeth is removed. Typically, this strip extends from the vestibule of the gingivobuccal sulcus to the attached gingiva. The procedure is often performed using a diode laser, offering benefits including simplicity and safety for the patients. It can remarkably improve overall aesthetics and decrease the chances of gingival recession. This case report highlights the successful management of a female patient who arrived complaining of double frenum attachment leading to poor musculature support due to which she experiences poor aesthetics and hampered oral hygiene maintenance.

Management of Aberrant Frenum and Gingival Overgrowth in Orthodontic Patients: A Case Report.

The frenum, a fold of mucous membrane, connects the lip and cheek to the alveolar mucosa, gingiva, and underlying periosteum. When the frenum is positioned excessively near the gingival margin, it has the potential to compromise gingival health, impeding plaque control efforts and inducing muscular stress. A frenectomy is a commonly employed corrective measure for anomalous frenum attachments. In a recent clinical case, a 21-year-old female patient was referred from the Department of Orthodontics to the Department of Periodontics due to a papillary-type aberrant labial frenum attachment and excessive gingival tissue surrounding the upper right and left central incisors. The patient underwent a frenectomy, gingivectomy, and gingivoplasty procedures under local anesthesia to address the abnormal frenum attachment and gingival overgrowth using a scalpel. This approach has been demonstrated to yield optimal outcomes in orthodontic therapy for patients exhibiting elevated frenum attachment and gingival overgrowth. Following the achievement of hemostasis, a periodontal pack was applied to facilitate healing and preserve the soft tissue.

Maxillary labial frenectomy: a randomized, controlled comparative study of two blue (445 nm) and infrared (980 nm) diode lasers versus surgical scalpel.

BACKGROUND: This study aimed to compare the intra and postoperative complications of frenectomy procedure with a surgical scalpel versus 445 nm and 980 nm diode lasers. METHODS: This randomized controlled clinical trial was conducted on 174 patients requiring maxillary labial frenectomy. After completion of fixed orthodontic treatment and primary closure of maxillary diastema, the patients were randomly assigned into three groups (n = 58): group 1 (frenectomy via 445 nm diode laser, continuous-wave, 1.5 W), group 2 (frenectomy via 980 nm laser, continuous-wave, 1.7 W), and control group (V-Y plasty technique via scalpel). Intra-operative bleeding, discomfort in chewing and speaking, pain, and tissue healing were compared among the groups immediately, at 7 and 30 days postoperatively using the Kruskal-Wallis, Mann-Whitney, and Chi-square tests. RESULTS: Pain scores were significantly lower in group 1 compared to group 2 (immediately and day 7, P < 0.05). Significant faster tissue healing at days 7 and 30 were observed in group 1 compared to group 2 (P < 0.05). Group 1 was superior to the control group regarding lower intraoperative bleeding, discomfort in chewing and speaking (immediately and day 7), lower pain (immediately and day 7), and tissue healing (day 7) (P < 0.05 for all). Group 2 was significantly superior to the control group in lower intraoperative bleeding, discomfort in chewing and speaking (immediately and day 7), and better tissue healing (day 7) (P < 0.05 for all). CONCLUSIONS: In conclusion, diode laser frenectomy resulted in significantly lower intra and postoperative complications compared to the scalpel. Moreover, 445 nm diode laser showed significantly superior effects compared to 980 nm diode laser. TRIAL REGISTRATION: The study protocol was registered on 29.10.2022 at the Iranian Registry of Clinical Trials ( www.irct.ir ) (registration number: IRCT20220630055326N1).

Conventional Scalpel Technique for Frenectomy During Orthodontic Treatment: A Case Report.

Frenum aberrations in the maxillary and mandibular regions are pivotal concerns, particularly regarding midline diastema and gingival health. The frenum is composed predominantly of collagenous and elastic fibers. There are various frenal attachment anomalies that may result in gingival recession. Amidst treatment options, conventional scalpel frenectomy emerges as a viable solution, showcasing its efficacy in addressing deviant frena. Ultimately, our findings underscore the imperative for personalized interventions to alleviate aesthetic apprehensions and uphold periodontal integrity in adult populations.

Laser-Assisted Lingual Frenectomy: A Case Report.

A lingual frenectomy is a surgical procedure aimed at addressing "tongue-tie" or ankyloglossia, where a strip of tissue restricting tongue movement is removed. Typically, this strip extends from the bottom of the mouth to the underside of the tongue. The procedure, often performed using a diode laser, offers several advantages including simplicity and safety for patients. It can significantly improve speech articulation and eating for individuals with ankyloglossia. This case report highlights the successful treatment of a female patient experiencing speech difficulties with diode laser therapy for tongue-tie.

Diode Laser Frenectomy: A Torch of Freedom for Ankyloglossia.

Ankyloglossia, also known as tongue-tie, is a rare congenital anomaly of the oral cavity that not only causes difficulties in breastfeeding and teeth cleaning but also causes difficulty in speech articulation. Our patient faced difficulty in freely moving his tongue because of the short lingual frenulum wherein laser lingual frenectomy was indicated. The patient was treated successfully with a soft tissue diode laser having a wavelength of 445 nanometers. The use of a low-wavelength diode laser becomes relatively complimentary to standard scalpel surgery because of patient consolation, offers a blood-free area, reduces inflammation and edema, and is less damaging to thermal tissues.

Management Using V-Y Plasty Approach for Abnormal Frenal Attachment: A Case Report.

The mucous membrane fold, which facilitates the attachment of the gingiva, alveolar mucosa, and the periosteum surrounding the lips and cheek, is known as the frenum. The frenal attachment at the gingival or papillary level may comprise periodontal health due to difficulty with plaque adherence or muscle pull. The management of such aberrant frenal attachment becomes necessary to avoid the associated future problems, such as midline diastema and periodontal attachment loss, which might lead to aesthetic problems and tooth mobility. The treatment modalities involve frenectomy using Miller's technique, conventional technique, Z-plasty, and V-Y plasty types of frenectomy procedures. The patient's requirements, specific indications, and intended results determine the method. This case report illustrates the utilisation of the V-Y plasty technique for the frenectomy of a papillary-type labial frenal attachment in a 19-year-old female patient. V-Y plasty proved to be an efficient technique for removing the aberrant labial frenum attachment, and the results were highly satisfactory, with less scar formation. V-Y plasty is reliable for covering defects and elongating the frenum area, giving desired clinical outcomes.

Conventional Frenectomy With Topical Ozonated Oil Application.

The frenum is a mucous membrane fold that connects the lip and cheek to the gingiva, periosteum, and alveolar mucosa. When the frena are linked too closely to the gingival border, there may be issues with plaque removal, and the overall gingiva may be affected. In addition, the maxillary frenum may provide aesthetic difficulties or interfere with the aesthetic outcome in cases of midline diastema, which may result in a recurrence after treatment. A labial frenectomy, a frequently performed surgical operation in the specialty of dentistry, is used to address such an abnormal frenum. This article describes a case study of a maxillary labial frenectomy using a traditional scalpel approach and topical application of ozonated olive oil.

Comparison of pain and healing period after frenectomy using diode laser and Er:YAG laser: a randomized controlled trial.

OBJECTIVES: The frenum is a mucous membrane fold that attaches the lip and the cheek to the alveolar mucosa, the gingiva, and the underlying periosteum. Frenectomy is the surgical removal of the whole frenum, including the area connected to the bones. The purpose of this study was to compare the healing period and postsurgical pain experienced by patients operated with diode and Er:YAG lasers. METHOD AND MATERIALS: Twenty referred patients requiring excision of the abnormal upper labial frenum were included in the study. Patients were randomly assigned into two groups: diode group (810 nm, 2W, continuous emission, initiated tip) and Er:YAG group (2,940 nm, 2W, 200 mJ, 10 Hz). Both lasers were applied in contact mode. Postoperative pain was assessed using a numerical rating scale at 3 hours postoperatively and every day during the first postoperative week. The epithelialization process of the wound surface was evaluated using hydrogen peroxide solution applied to the wound on postoperative days 7, 14, 30, 60, and 90. RESULTS: The results showed the mean values of Pain Index after 3 hours (diode group 2.1 ± 2.0, Er:YAG group 2.6 ± 1.4), day 1 (diode group 1.1 ± 1.1, Er:YAG group 1.9 ± 1.4), and day 2 (diode group 0.0 ± 0.0, Er:YAG group 0.9 ± 1.1), with no significant difference after 3 to 7 days (P = 1.00). For the Healing Index there was a significant difference between the diode group and the Er:YAG group (7 days, P = .029; 14 days, P = .001), with no significant difference after 30/60/90 days (P = 1.00). CONCLUSIONS: The Er:YAG laser had better clinical results in healing wounds, whereas the diode laser resulted in better decreasing pain levels after frenectomy during the follow-up periods.

Speech Outcomes of Frenectomy for Tongue-Tie Release: A Systematic Review and Meta-Analysis.

OBJECTIVE: Tongue-tie, which is also known as ankyloglossia, is a common condition where the lingual frenulum is unusually tight or short. While most literature investigates the impact of tongue-tie on breastfeeding, recent articles have examined its role in speech production in children. However, these have not previously been reviewed systematically. This study aims to determine the impact of tongue-tie on speech outcomes and assess whether frenectomy can improve speech function. METHODS: In this systematic review, we conducted a comprehensive search of PubMed/MEDLINE, Cochrane Library, Embase, and speechBITE to analyze primary studies investigating the impact of frenectomy for tongue-tie on speech outcomes. We extracted data regarding patient age, male to female ratio, procedure type, follow-up time, and speech outcomes and ran statistical analyses to determine if frenectomy for tongue-tie leads to improvement in speech issues in pediatric patients. Speech outcomes extracted were subjectively measured based on the interpretation of a speech and language pathologist or parent. RESULTS: Our analysis included 10 studies with an average patient age of 4.10 years, and average cohort size of 22.17 patients. Overall, frenectomy for tongue-tie was associated with an improvement in speech articulation (0.78; 95% CI: 0.64-0.87; P < .01). Increasing patient age was found to be negatively correlated with post-frenectomy speech outcomes (P = .01). However, this relationship disappeared in the adjusted model. CONCLUSION: Overall, we conclude that frenectomy is a suitable treatment to correct speech issues in select patients with tongue-tie if caught early in childhood. Despite the limited investigations around speech outcomes post-frenectomy, these results are informative to providers treating tongue-tie.

Frenotomy Provides Improved Direct Laryngoscopy Exposure in Select Adult Patients With Ankyloglossia.

Objective: To analyze the effects of lingual frenotomy on adults with restrictive ankyloglossia and difficult direct laryngoscopy exposure. Methods: A case series study was conducted. Restriction of tongue protrusion due to ankyloglossia was identified in 2 patients who had a history of suboptimal true vocal fold (TVF) exposure on direct laryngoscopy for phonomicrosurgery. Inadequate exposure of the vocal folds was achieved on direct laryngoscopy attempts with manual tongue protrusion. Mandibular tori were not present in these patients. An intraoperative lingual frenotomy was performed in both patients. Results: After frenotomy and with manual tongue protrusion, direct laryngoscopy exposure was substantially improved allowing for considerably more visualization of the anterior TVFs. Conclusion: Lingual frenulum procedures with manual tongue protrusion should be considered in select adult patients with restrictive ankyloglossia affecting optimal direct laryngoscopy exposure.

Management of Aberrant Frenum by Z-plasty Procedure: A Case Report.

During or after the orthodontic closure, persistent diastemas are frequently the result of a high frenum attachment. A labial frenectomy is a complete removal of the frenum attachment, which typically attaches to the space between the upper two anterior teeth and the centre of the upper lip. It might be required if there is space between the teeth due to a frenulum positioned too high on the gums. Many surgical technique modifications, including Miller's technique, Z-plasty, and V-Y-plasty, have been established since the conventional classical frenectomy procedure was initially presented to cope with the difficulties associated with an aberrant labial frenum. This case report demonstrates that a Z-plasty approach was used to remove the 21-year-old female patient's high papillary-type labial frenum attachment and how orthodontic treatment led to the closure of the midline diastema. For several reasons, the frenectomy procedure with Z-plasty proved to be reliable and yielded outstanding aesthetic outcomes for the removal of the aberrant labial frenum connection. Understanding Z-plasty will enable primary intention-based tissue healing, reduce the risk of tissue contractures, shorten the patient's recovery, and enhance the patient's aesthetic outcomes.

Effects of topically administered 0.6% hyaluronic acid on the healing of labial frenectomy in conventional and 940-nm indium gallium arsenide phosphide (InGaAsP) diode laser techniques in pediatric patients: a randomized, placebo-controlled clinical study.

This study aimed to investigate the effects of 0.6% hyaluronic acid (HA) gel on the healing process and postoperative pain levels after diode laser-assisted labial frenectomy in pediatric patients. Ninety-six pediatric patients (females, 50 and males, 46) aged 8-14 years were randomly divided into four groups as follows: (1) conventional frenectomy with 0.6% topically administered HA (CFH, n = 24); (2) conventional frenectomy with placebo gel (CFP, n = 24); (3) frenectomy performed by diode laser with 0.6% topically administered HA (DLH, n = 24); and (4) frenectomy performed by diode laser with placebo gel (DLP, n = 24). HA application was continued for 1 week thrice daily after the frenectomy. Visual analog scale forms were collected from patients 1 week after the operation. In addition, the plaque index, gingival index, periodontal probing depth, and keratinized tissue width and thickness were recorded. This process was repeated 1 and 3 months after the first visit. The DLH group revealed significant differences in the probing depth, bleeding on probing, keratinized gingiva width, and attached gingiva width according to dual comparisons of the initial, first, and third-month values (p = 0.010, p = 0.007, p<0.001, and p = 0.001, respectively). Significant differences were observed between the CFP and CFH groups according to the initial and initial third-month values with regard to the bleeding on probing (p=0.019 and p = 0.019, respectively). The attached gingival thickness revealed significant differences between the CFP and CFH groups for the initial and initial-third-month comparisons (p = 0.005 and p = 0.007, respectively). The mean values of the initial and initial-third-month differences were significantly higher in the CFH group than those in the CFP group. HA- and laser-assisted labial frenectomies revealed better outcomes in terms of the probing depth, attached gingiva width, keratinized gingiva width, healing process, and postoperative comfort.

An extremely rare case of Oro-facial digital syndrome: A case report.

BACKGROUND: Oro-facial digital(OFD) syndrome is a rare anomaly which is often missed out as just cleft lip and palate.It is an X-linked dominant condition with lethality in males. It however results from the pleotropic effect of a morphogenetic impairment affecting almost invariably the mouth, face and digits and it also includes lower IQ and mental retardation. 14 different variations of these syndrome can be seen with the majority of cases of type 1 and 2 based on characteristic clinical manifestations. CASE REPORT: Present case report describes a 9 year old girl patient who was mis-diagnosed with partial cleft palate and was later diagnosed as orofacial digital syndrome based on the clinical and oral features. CONCLUSION: Not much literature is present regarding this topic and with no relevent family history makes this case a one in a million case of OFD. Therefore, this case report is a complete insight on Oro-facial digital syndrome.