fren ectomy
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FRENECTOMY
Dr. Stephen R. Gasparovich
Captain, USAF, Keesler AFB
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Whats 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
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Frenum Problems
Localized gingival recession with frenumattachment on marginal gingiva (high
frenum attachment)
Midline diastema between two maxillary
central incisors (low frenum attachment)
Ankyloglosia Interfere with denture fabrication/wear
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To CUT or NOT to CUT
Should a frenectomy be done in a youngpatient with a low frenum and diastema?
- In most cases, as the central incisors areforced together by the canine and lateralincisor eruption, the frenum will recede
apically and allow the diastema to close.
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To CUT or NOT to CUT
-When a diastema remains and the frenumattachment maintains its low attachment, it is more
likely the result of hereditary or anatomic factorssuch as microdontia or missing or peg lateral.
-A frenectomy in this case should be followed withorthodontic treatment.
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The RULE!!!
The presence of a maxillary diastema does notprompt early frenectomy.
WAIT UNTIL THE CANINES ANDLATERALS ERUPT
Mandibular frenum problems should be treatedwhen first noticed to prevent a mucogingivaldefect from developing.
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SURGICAL TECHNIQUE
Accomplished under local anesthetic byinfiltration 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
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ONE HEMOSTAT
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TWO HEMOSTATS
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OVERKILL
The Z Plasty
Make elliptical incision Excise fibrous tissue
Make 2 oblique incisions
Undermine pointed flaps Rotate points to close vertical
incision horizontally
Technique done to reduce lossof vestibular depth sometimesseen with linear incision
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Sutures ????
Clinical experience has shown littledifference in post operative managementwith or without sutures.
Patients can be told they will have minordiscomfort for approximately 2weeks.similar to the discomfort of an
apthous ulcer. Area undergoes secondary epithelialization
without difficulty.
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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
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Treatment Plan OHI
SC/RP Re-eval
Crown Lengthen #11
Maxillary Labial Frenectomy
Re-eval
Prosthodontics-#11 Cast core and PFMcrown (Definitive Pros plan after PCS)
SPT maintenance 4 months
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Labial Frenectomy
Hold frenum with hemostat.
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Surgical incision
with #15 blade Excise wedge of
tissue
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Dissect fibers fromperiosteum
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Interrupted gut sutureplaced
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Lingual Frenectomy
I feel tongue tied.
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Say
AHHHHHHH!
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1 week
post-op
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Summary
Whats a frenum? Frenum problems
Rules
Case presentation
Questions
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