fren ectomy

7/28/2019 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


4/28

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


19/28

Labial Frenectomy

Hold frenum with hemostat.


20/28

Surgical incision

with #15 blade Excise wedge of

tissue


21/28

Dissect fibers fromperiosteum


22/28

Interrupted gut sutureplaced


23/28

Lingual Frenectomy

I feel tongue tied.


24/28

Say

AHHHHHHH!


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27/28

1 week

post-op


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Summary

Whats a frenum? Frenum problems

Rules

Case presentation

Questions

fren ectomy

Documents