Case Report On Maxillary Labial Frenectomy

Dr.
Varghese Et Al: Maxillary Labial Frenectomy
Case report on Maxillary Labial Frenectomy

Dr. Abin Varghese*, Dr. Deepa Davis**, Dr. Sujo Mathew***
*PG Student, Dept. of Oral & Maxillofacial Surgery
**PG Student, Dept. of Conservative Dentistry & Endodontics
RKDF Dental College & Research Centre, Bhopal, MP
***Reader, Dept. of Pedodontics & Preventive Dentisty,
Indira Gandhi Institute of Dental Sciences, Kothamangalam, Kerala
Abstract
The frenum is defined as a mucous membrane fold which attaches the lip and
the cheek to the alveolar mucosa, the gingiva, and the underlying
periosteum.1The frena may jeopardize the gingival health when they are
attached too closely to the gingival margin, either due to an interference in the
plaque control or due to a muscle pull. In addition to this maxillary labial
frenum with deep attachments may prodce an esthetic compromise by creation
of a midline distema , relapse of the orthodontic treatment for midline diastema,
prosthetic problems such as displacement of the dentures during function,
www.wjasr.in World J Adv Sci Res Vol. 3 Issue 4 July – August 2020 Page 37
Dr. Varghese Et Al: Maxillary Labial Frenectomy
multiple ulcerations on the frenal attachments due to impingement etc.2 The

management of these problems are performing a frenectomy. This case report
emphasize on the surgical management of a high level attachment frenum.
Keywords – Frenectomy, Maxillary Labial Frenectomy, Classical technique
Introduction
Aesthetic concerns of the patient are one of the most common reasons that
brings a patient to a dentist. A perfect smile is everyones desire. The presence of
an abberant frenum can hamper the gingival levels and can cause a gingival
recession, recurrent displacement of dentures , etiological factor for causing a
midline diastema and relapsing of the orthodontic treatment . Labial frenal
attachments are thin folds of mucous membrane with enclosed muscle fibres
originating from orbicularis oris muscle of upper lip that attach at the lips to the
alveolarmucosa and underlying periosteum.3 The diagnosis can be done visually
by applying tension over the frenum to see the movement of the papillary tip or
the blanch which is produced due to ischaemia in the region.1,3
According to Placek et al (1974)4 the labial frenal attachment levels are

classified as Mucosal ,Gingival, Papillary and Papillary penetrating. The
abberant frena can be treated by frenectomy or frenotomy procedures.
Frenectomy is the complete removal of the frenum , including its attachment to
the underlying bone, while frenotomyis the incision and the relocation of the
frenal attachment.5The techniques for frenectomy are Classical technique,6,7
Millers technique,8 V-Y plasty9, Z plasty10 and frenectomy using electrocatery
or laser techniqe.3Here in this case report we demonstrate the Classical
frenectomy technique.
Case report
A 21 year old male patient reported to Department of Oral and Maxillofacial

Surgery, RKDF Dental College and Research Centre, Bhopal (M.P) with the
chief complaint of recurrent dislocation of his removable partial denture during
function. Past medical history was non contributing. Past dental history revealed
extraction of both maxiullary central incisors were done 1 year before due to
caries and thereon he is wearing a removable partial denture. The patient was
moderately build and nourished. The patient was well oriented. On clinical
examination maxillary central incisors were missing and high level frenal
attachment was noted. A diagnosis of papillary level frenal attachment was
made. Impant procedures were explained to the patient but refused due to the
cost and fear of surgery. Classical frenectomy procedure was explained to the
patient then an informed consent was obtained from the patient even after
discussing the other treatment modalities, the benefits and other possible
complications.
Classical frenectomy procedure
Standard painting and draping done following strict and aseptic protocol.
Lignocaine with 2% Adrenaline was injected to anesthetise the operating site.
Curved mosquito forceps are clamped facing away from each other on the upper
and lower border of the frenum. (Figure 1,2)Bard Parker Blade 15 no is used to
excise the frenum. Release of the fibrous bands are made further by blunt
dissection in the area using a periosteal elevator. Tissue tags were removed and
hemostasis achieved by using cautery at multiple bleeding points.(Figure 3) The
site is then irrigated with betadine and saline. Interrupted sutures using 4-0
black silk done for the wound closure.(Figure 4)Intraoral pressure pack placed
over the surgical site. Post operative instructions including the placement of ice
packs for several hours, avoidance of brushing at the surgical site, vigoruos
gargling and soft gargling with warm saline after 24 hours thrice dailyadvised.
Post operatively regular antibiotics and analgesics were prescribed. Patient is
recalled after 7 days for the suture removal. Patient reported back on the 8th day
postoperatively for suture removal. Healing of the tissues were
acceptable.(Figure 5) After irrigation with saline the sutures were removed and
checked again for the frenal attachment and was found satisfactory.(Figure 6)
Discussion
In patients with high frenal attachment frenectomy is the treatment of choice for
the correction of multiple problems such as midline diastema prior to
orthodontic treatment, relapse of midline diastema due to high frenular
attachment, reccurrent displacement of removable dentures during function,
gingival recession due to high frenular attachment etc. The various frenectomy
techniques are classical technique by Archer and Kruger, Millers technique,
Schuchardt Z plasty technique, V-Y plasty, frenectomy using electrocautery and
lasers. The use of electrocautery can be justified over the laser technique.
Electrocautery technique offers advantages such as bloodless field, reduced time
of operation and eliminating the need for sutures and thereby reducing the risk
of postoperative infection.1,3
Conclusion
In cases with chronic dislocation of dentures, relapsing midline diastema post
orthodontic treatment, gingival recession etcfrenectomy is the treatment of
choice. Sound diagnosis and careful case selection is the key of success.
Figure 1: Preoperative image showing papillary attachment of frenum
Figure 2: Clamped forceps at the upper and lower border
Figure 3: Intraoperative image after frenectomy
Figure 4: Suturing done using 4-0 silk
Figure 5: postoperative wound healing after 7 days
Figure 6: Surgical site after suture removal
References
1.Devishree et al.Frenectomy: Use of electrocautery can be justified over the

laser technique.Journal of Clinical and Diagnostic Research. 2012 November,
Vol-6(9): 1587-1592
2.Textbook of Oral and Maxillofacial Surgery by Neelima Malik , 3rd edition

page-478
3. AmandeepBhullar et al. A comparison of Frenectomy using Electrocautery

and Scalpel Techniques. International Journal of Research in Health and Allied
Sciences |Vol. 4|Issue 4|July – August 2018
4. Placek M, Miroslav S, Mrklas L. Significance of the labial frenal attachment

in periodontal disease in man. Part1; Classification and epidemiology of the
labial frenum attachment. J Periodontol 1974;45:891- 4
5. Dibart S, Karima M. Labial frenectomy alone or in combination with a free

gingival autograft. In: Serge Dibart, Mamdouth Karima (eds) Practical
Periodontal Plastic Surgery. Germany: Blackwell Munksgaard: p53.
6. Archer WH (editor). Oral surgery - a step by step atlas of operative

techniques, 3 rd ed. Philedelphia: W B Saunders Co; 1961. p. 192.
7. Kruger GO (editor). Oral surgery, 2 nd ed. St. Louis: The C.V. Mosby Co;
1964. p. 146
8. Miller PD. Frenectomy, combined with a laterally positioned pedicle graft -

functional and esthetic considerations. J Periodont 1985;56:102-6.
9. Kruger GO. Acquired defects of the hard and soft tissues of the face. In:
Gustav O Kruger (ed) Oral and maxillofacial surgery. St.Louis: Mosby, 487-88
10. Puig JR, Lefebvre E, Landat F. The Z-plasty technic which was applied to
hypertrophy of the upper labial frenum. Rev StomatolChirMaxillofac
1977;78:351-6

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Dr.

Varghese Et Al: Maxillary Labial Frenectomy

Case report on Maxillary Labial Frenectomy

*PG Student, Dept. of Oral & Maxillofacial Surgery

**PG Student, Dept. of Conservative Dentistry & Endodontics

RKDF Dental College & Research Centre, Bhopal, MP

***Reader, Dept. of Pedodontics & Preventive Dentisty,

Indira Gandhi Institute of Dental Sciences, Kothamangalam, Kerala

multiple ulcerations on the frenal attachments due to impingement etc.2 The

Keywords – Frenectomy, Maxillary Labial Frenectomy, Classical technique

According to Placek et al (1974)4 the labial frenal attachment levels are

A 21 year old male patient reported to Department of Oral and Maxillofacial

Classical frenectomy procedure

Figure 1: Preoperative image showing papillary attachment of frenum

Figure 2: Clamped forceps at the upper and lower border

Figure 3: Intraoperative image after frenectomy

Figure 4: Suturing done using 4-0 silk

Figure 5: postoperative wound healing after 7 days

Figure 6: Surgical site after suture removal

1.Devishree et al.Frenectomy: Use of electrocautery can be justified over the

2.Textbook of Oral and Maxillofacial Surgery by Neelima Malik , 3rd edition

3. AmandeepBhullar et al. A comparison of Frenectomy using Electrocautery

4. Placek M, Miroslav S, Mrklas L. Significance of the labial frenal attachment

5. Dibart S, Karima M. Labial frenectomy alone or in combination with a free

6. Archer WH (editor). Oral surgery - a step by step atlas of operative

8. Miller PD. Frenectomy, combined with a laterally positioned pedicle graft -

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