50. Surgical treatment of abnormal frenulum and gingival-buccal ligaments

Question 1

Frenum, and when it becomes problematic

Answer 1

• Fold of mucous membrane =>attaches lips and cheeks to alveolar mucosa or gingiva
• Problematic when attachment too close to marginal gingiva=>
• Genetics or gingival recession=>
• Plaque retention=>hygiene problems and periodontal issues

Question 2

Frenectomy and frenotomy, and how they differ

Answer 2

• Frenectomy=>complete removal of frenum
• Frenotomy=>relocating frenum=.
• Typically more apically, without complete removal

Question 3

Most commonly used surgical techniques for treating abnormal frenums

Answer 3

• V-Y advancement flap
• Z-plasty
• Diamond-shaped excision
• Laser Frenectomy=>remove or modify frenulum=>
• Minimal bleeding, reduced postoperative discomfort, faster healing

-Diamond-shaped technique generally provides best results =>effective reshaping and repositioning of frenum

Question 4

Diamond-shaped incision technique for frenectomy

Answer 4

• Local anesthesia=>mucosa next to frenum=>
• Avoiding direct injection into frenum to maintain anatomical landmarks
• Two hemostatic clamps placed on superior and inferior sections of frenum
• Using #15 scalpel, tissue between clamps resected in diamond shape
• Upper part of incision isutured, lower part left to heal naturally

-Provides best results due to its effective reshaping and repositioning of the frenum

Question 5

Z-plasty technique

Answer 5

• Frenums w/ wide crestal part and shorter alveolar height=>helps increase alveolar height less scarring
• Incision along length of frenum=>
• Superior and inferior incisions to form two triangular flaps
• Supraperiosteal undermining=>tissue mobility
• Rotating apex of inferior triangle upwards and suturing in place

Enhanced esthetic and functional outcomes

Question 6

Why direct injection of anesthesia into the frenum avoided during the diamond-shaped incision technique

Answer 6

• Cause anatomical borders of frenum to disappear=>
• Difficult to accurately identify and excise tissue

Question 7

Postoperative care following frenulum surgery

Answer 7

• Oral hygiene to prevent infection
• Antiseptic mouthwashes
• Managing pain and swelling w/ prescribed medications or over-the-counter
• Avoiding strenuous activities
• Soft diet=>avoid irritating the surgical area.
• Follow-up appointments=>monitor healing and remove sutures