![Sewerin’s Classification
[ 1971 ]
CLASSIFICATION
Merko et al’s Classification
[ 1974 ]
Papilla – Penetrating Frenal
AttachmentPapillary Frenal Attachment
Mucosal Frenal Attachment Gingival Frenal Attachment
References : Sewerin I – 1997; Mirko P, Miroslav S, Lubor M - 1974
Normal Frenum Persistent Tectolabial Frenum With Appendix Frenum With Nodule
Duplication of Frenum Recess of the frenum Bifid Frenum](https://image.slidesharecdn.com/frenectomy-200320141138/85/Frenectomy-6-320.jpg)
Uploaded byRinisha Sinha
Frenectomy
The document discusses frenectomy procedures, their classifications, and indications for correcting aberrant frena affecting oral health and aesthetics. It outlines various surgical techniques including conventional methods, electrosurgery, and laser use, as well as the criteria for diagnosing abnormal frenal attachments. It also highlights associated syndromes and complications related to frenectomy procedures.
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Frenectomy
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- 2. CONTENTS Gaining anInsight What is a Frenum ? Etiology of an Aberrant Frenum Classification Diagnosing an Abnormal Frenum Syndromes and Frenal Attachments Indications for Frenal Correction Let’s Understand : Frenectomy or Frenotomy Conventional Frenectomy Electrosurgery Lasers References
- 3. References : AmericanAcademy of Periodontology; 1989, 1996 Surgical Procedures performed to correct or eliminate anatomic, developmental, or traumatic deformities of the gingiva or alveolar mucosa Surgical Procedures for the correction of relationships between the gingiva and the oral mucous membrane with reference to three specific problem areas GAINING AN INSIGHT Mucogingival Surgery Periodontal Plastic Surgery FRIEDMAN Attached Gingiva Shallow Vestibules Aberrant Frenum MILLER • Esthetic Surgical Corrections • Crown Lengthening • Ridge Augmentation • Reconstruction of papilla
- 4. A Frenum isa mucous membrane fold which contains muscle and connective tissue fibers that attach the lip and the cheek to the alveolar mucosa, the gingiva and the underlying periosteum. WHAT IS A FRENUM !? References : Jhaveri H. The Aberrant Frenum; 2006 Normal Frenal Attachment Apical to the Free Gingival Margin
- 5. ETIOLOGY OF ABERRANTFRENUM MAXILLARY LABIAL FRENUM MANDIBULAR FRENUM When the two central incisors erupt widely separated, no bone is deposited inferior to the frenum A V-shaped bony cleft between the two central incisors and an abnormal frenum attachment results. A decreased vestibular depth and an inadequate width of the attached gingiva Aberrant Mandibular Frenum References : Huang WJ, Creath CJ – 1995; Jhaveri H - 2006
- 6. Sewerin’s Classification [ 1971] CLASSIFICATION Merko et al’s Classification [ 1974 ] Papilla – Penetrating Frenal AttachmentPapillary Frenal Attachment Mucosal Frenal Attachment Gingival Frenal Attachment References : Sewerin I – 1997; Mirko P, Miroslav S, Lubor M - 1974 Normal Frenum Persistent Tectolabial Frenum With Appendix Frenum With Nodule Duplication of Frenum Recess of the frenum Bifid Frenum
- 7. Blanch Test DIAGNOSING ANABNORMAL FRENA Tension Test Detected visually by applying tension over the frenum to see the movement of the Papillary tip The lip is pulled superiorly and anteriorly (For maxillary frenum) and (For mandible) the lip is pulled outward and downward Midline Diastema The frenum is pathogenic when • unusually wide • no apparent zone of attached gingiva along the midline • the interdental papilla shifts when the frenum is extended Reference : Miller - 1985
- 8. References : DaFelice C, Toti P, Maggio G, Parinmi S, Bagnoli F; Martin RA, Jones KL; Kusiak A, Sadiak-Nowicka J, Limon J, Kochanska B; Ichida M, Komuro Y et al SYNDROMES AND FRENAL ATTACHMENTS Ehlers- Danlos Syndrome Infantile hypertrophic pyloric stenosis Holoprosencephaly Ellis-van Creveld Syndrome Oro-facial Digital syndrome Pallister-hall Syndrome
- 9. INDICATIONS Aberrant Frenal Attachment causing Midline Diastema AberrantFrenal Attachment causing Gingival recession Aberrant Frenal Attachment causing hindrance in maintaining oral hygiene Aberrant Frenal Attachment interfering with Speech ANKYLOGLOSSIA Aberrant Frenal Attachment indicating Shallow vestibule Aberrant Frenal Attachment visible as a pendulous piece of tissue in the midline of the upper lip
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- 11. • FRENECTOMY The completeremoval of the frenum, including its attachment to the underlying bone. LET’S UNDERSTAND • FRENOTOMY The incision and the relocation of the frenal attachment. References : Dibart S, Karima M
- 12. FRENECTOMY Scalpel Technique LasersElectrosurgery • Safe andeffective • Shorter duration of the surgery • Simplicity of the procedure • Absence of postoperative infections • Lesser pain, swelling • Small or no scar • Efficient • Mild bleeding • Absence of postoperative complications Disadvantages • Bleeding • Patient compliance • Conventional technique • Excision of the frenum through scalpel • Cost-effective Argon Beam Coagulation References : Dibart S, Karima M; Cunha RF, Silva JZ, Faria MD
- 13. CONVENTIONAL ( CLASSICAL) FRENECTOMY Archer (1961) and Kruger (1964)Indication For midline diastema cases Armamentarium • Haemostat • BP handle • Scalpel blade no.15 • Gauze sponges • 3-0 black silk sutures • Suture pliers • Scissors • A Periodontal dressing (Coe-pak) References : Jhaveri H. The Aberrant Frenum – 2006; Archer WH. Oral surgery for a dental prosthesis - 1975
- 14. MILLER’S TECHNIQUE Miller PD- 1985Indication : For the post-orthodontic diastema cases References : Miller PD. Frenectomy combined with a laterally positioned pedicle graft -functional and esthetic considerations. J Periodont, 1985 A Horizontal incision to separate the frenulum from the interdental papilla Excision of the frenulum and exposure of labial alveolar bone in the midline Laterally positioned pedicle graft taken to obtain primary closure across midline Gingivoplasty of any excessive interdental tissue labially or palatally
- 15. Z PLASTY TECHNIQUE Indication: Hypertrophic labial frenum with a low insertion, which is associated with an inter-incisor diastema and also in cases of a short vestibule Length of the frenum was incised with scalpel The sub - muscosal tissue were dissected beyond the base of each flap by using fine tissue forceps The resultant flaps were mobilized and transposed through 90º to close vertical incisions horizontally Absorbable 5-0 vicryl sutures were placed and a periodontal dressing was placed. No hypertrophic scar formation References : Howe GL; Puig JR, Lefebvre E, Landat F. The Z-plasty technique – 1977; Langdon JD, Patel MF. Reconstructive surgery - 1998 1 cm long Double rotation flaps were obtained
- 16. V-Y PLASTY TECHNIQUE Indication: For lengthening the localized area, like the broad frenum in the premolar-molar area A V-shaped Incision on the undersurface of the frenal attachment The frenum was relocated at an apical position Sutured with 4-0 silk suture and a periodontal pack was placed. After 1 month - Frenal attachment was found to be relocated at an apical position, with an uneventful healing References : Kruger GO. Acquired defects of the hard and soft tissues of the face The V-shaped incision was coverted into a Y
- 17. ELECTROSURGERY Armamentarium • An Electrocauteryunit with the loop electrode • A Haemostat Indication In cases of Patients with bleeding disorders In non-compliant Patients The frenum was held with the haemostat It was excised by using a loop electrode tip Advantages minimal procedural bleeding there was no need of sutures The healing was by Secondary intention, as the wound edges were not approximated with sutures References : Cunha RF, Silva JZ, Faria MD – 2008; Verco PJW. “A case report and a clinical technique: argon beam electrosurgery for the tongue ties and maxillary frenectomies in infants and children - 2010
- 18. LASERS 940 nm DiodeLaser removing Mandibular Frenum Robert N. Hall – 1962 DIODE LASER uses a combination of Gallium and Arsenide along with Aluminium and Indium changes Electro-magnetic energy into Heat DIODE LASER are highly absorbable by MELANIN and HAEMOGLOBIN, hence allows soft-tissue manipulations; accompanied by improved epithelization and wound healing. Carbon dioxide Laser
- 19. REFERENCES Carranza’s Clinical Periodontology: 10th Edition Periobasics : A textbook of Periodontics and Implantology Journal of Pharmaceuticals and Scientific Innovation Devi Shree, Sheela Kumar Gujjari, ShubhaShini P.v. – 2012 Frenectomy: A Review with the Reports of Surgical Techniques Puneet Sharma, Sanjeev Kumar Salaria, Ravi Kiran N Gowda, Sameer Ahuja, Sidharth Joshi, Deepak Kumar Bansal – 2016 Frenectomy- A Brief Review Dr. Manish Ashtankar, Dr. Mala Dixit Baburaj and Dr. Abhishek Singh – 2018 LABIAL FRENECTOMY- A REVIEW AND CASE REPORTS