Download frenectomy

FRENECTOMY
Dr. Stephen R. Gasparovich
Captain, USAF, Keesler AFB
What’s 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
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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
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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
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What’s a frenum?
Frenum problems
Rules
Case presentation
Questions