Frenectomy - Types, Techniques, Complications and Heal

Introduction:

Every tissue and cell in our body has its specific function. Likewise, the hard and soft tissues of the oral cavity not only help in just munching the food. But aids in swallowing, speech, esthetics, and oral movements. The appropriate attachment of tissues and muscles is essential in doing such functions. Any abnormalities in their bonding would lead to improper functioning and deteriorated esthetics. Read the article to understand the abnormal attachment of frenum and how to correct it.

What Are the Types of Frenal Attachments?

The labial frenum connects the lips to the respective gums and bone beneath it. It is also present below the tongue (lingual frenum) and stabilizes it to the floor of the mouth. The buccal frenum bonds the cheek to the gums and underlying bone. Depending upon the level of frenal attachment to the gingiva (gums), it is classified as follows:

• Mucosal - The frenal fibers connect to the junction between intraoral mucosa and the gingiva (mucogingival junction).

• Gingival - The frenal fibers attach to the middle portion of the gingiva (that firmly binds to the underlying jaw bone).

• Papillary - The frenal fibers join with the interdental gingiva (present in the space between two teeth).

• Papillary Penetrating - The frenum passes through the interdental gingiva to attach to the hard palate.

What Is a Frenectomy?

When the frenum is too short or is attached too high or too low in the gingiva, the oral surgeon completely detaches it from the gums and underlying bone by a procedure called frenectomy. Whereas, if the surgeon relocates the frenum to a different position, it is known as a frenotomy procedure.

What Are the Indications of Frenectomy?

• A frenectomy helps in resolving the restricted lip and tongue movements.

• Esthetic reasons - The attachment of the labial frenum to the interdental papilla leads to the spacing between two teeth (especially the upper teeth), which looks displeasing.

• Receding gums.

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• A lingual frenectomy is rarely done in babies due to breastfeeding and swallowing difficulties.

What Are the Syndromes Associated With Abnormal Frenal Attachments?

• Holoprosencephaly is a congenital disability that causes abnormal development of the forebrain. The characteristic features include a single front upper tooth (central incisor), small head, a single nostril, seizures, and lack of upper labial frenum.

• Ehlers-Danlos syndrome is a genetic disorder that affects the skin, blood vessels, and joints. It causes increased joint movements, weak muscle tone, and delayed motor skills development. The labial and lingual frenum are also absent in a few individuals.

• Oro-facial-digital syndrome is a genetic condition that affects the development of the face, digits, and parts of the oral cavity. It is characterized by cleft lip, cleft palate, and enlarged frenums abnormally attached to the lips and tongue.

What Are the Techniques Used in Frenectomy?

• Classical Frenectomy:

• Archer and Kruger were the first to describe classical frenectomy in 1961 and 1964, respectively.

• It is widely used in treating the frenum attached to the interdental papillae.

• In this procedure, 2 % Lignocaine with 1:80,000 Adrenaline is used for anesthetizing the surgical area. Later, an incision (cut) is made on the frenal site down the underlying bone (periosteum).

• The frenum and the interdental tissue are entirely detached from the periosteum and surgically removed.

• Z-Plasty:

• It is employed for the frenum attached very low in the gingiva and causes midline diastema (spacing between the front upper teeth).

• The surgeon places two cuts in Z-shape to remove the frenum and close the suture site.

• Minimal scar formation and improved esthetics are the advantages of Z-plasty.

• Miller’s Technique:

• Miller PD narrated a frenectomy technique in 1985.

• It is usually carried out in individuals with orthodontic relapse, where the spacing between upper teeth may occur after the orthodontic treatment.

• Once the complete tooth movement occurs and six weeks before removing fixed appliances, the Miller frenectomy technique is done to achieve the best results.

• Thus the appliance also aids in retaining the surgical dressing and in the healing process.

• The oral surgeon makes an incision on the frenum and separates it from the interdental gingiva. The frenum is removed from the gingiva and lips, and the surgical area is sutured. Medicaments are placed over the surgical site.

• The dressings are removed from the surgical site after one week.

• V-Y Plasty:

• It is used to reattach the papillary type of frenum.

• V and Y-shaped incisions are made under the surface of the frenum, then it is detached from the interdental gingiva and repositioned a little high on the gingiva.

• The surgical site is sutured, and periodontal dressing is placed.

• Electrosurgery: An electrode that delivers electric heat is used to remove the frenum. The pros include minor bleeding from the surgical site, quick healing, and suturing not required.

• Laser Treatment: Light-emitting diodes are used to remove the frenum altogether. The procedure produces heat on a localized area, minimizes the bleeding, and the surgical site heals fast.

Does Frenectomy Help?

The advantages of frenectomy are listed down:

• It enhances speech.

• Resolves the breastfeeding and swallowing problems.

• It improves esthetics.

• It helps in maintaining oral hygiene by reducing gum recession.

What Are the Surgical Complications of Frenectomy?

The swelling and mild pain may occur during the recovery phase, and there is no need to worry about it until it is severe.

• Trauma may occur to the nearby salivary gland ducts or nerves.

• Infection.

• Allergy.

• Severe bleeding.

How Long Does It Take To Heal After Frenectomy?

The surgical site completely heals within two to three weeks. The pain and swelling also subside; if not, visit your oral surgeon immediately. In addition, the electrocautery and laser techniques provide a quicker recovery compared to other classical methods.

Conclusion:

The abnormal frenal attachment poses swallowing and breastfeeding difficulties in infants. In adults, speech and esthetics are greatly affected. Various surgical options improve speech, esthetics, and related issues. The laser treatment is widely accepted as it reduces bleeding and enhances healing. Consult the oral and maxillofacial surgeons to get the best advice.