Aberrant Frenum - Frenectomy Flashcards
Frenulum definition
A small and or fold of integument or mucous membrane that controls, curbs, or limits the movement of organ or part
Aberrant Frenum
Atypical/abnormal insertion of labial, buccal, or lingual frenula capable of retracting gingival margins, creating diastemas, and limiting lip and tongue movements
Frenectomy
The cutting of a frenum, especially the release of ankyloglossia
Frenulectomy
The excision (total removal) of a frenulum
What is the Etiology of an Aberrant Frenum
After eruption of central incisors, the labial frenum will gradually transpose in an apical direction
The inability of the frenum to migrate during alveolar growth and tooth development has been implicated in the persistence of aberrant frenum
What are the classifications of labial frenum
Mucosal
Gingival
Papillary
Papillary penetrating
Mucosal Labial frenum
Insertion of the frenum ends in the mucosa, or at the most at the MGJ
Gingival Labial Frenum
Insertion of the frenum ends in the gingiva between the MGJ and the base of the interdental papilla
Papillary Labial Frenum
Insertion of the frenum ends at the interdental papilla, but does not penetrate the palatal aspect of the tissue
Papillary Penetrating Labial Frenum
Insertion of the frenum ends at the interdental papilla, and penetrates to the palatal aspect of the tissues
What Genetic Syndromes are associated with Aberrant maxillary frenums?
Ellis-vanCreveld Syndrome
Orofacial-digital syndrome
What Genetic Syndromes are associated with absence of maxillary frenums?
Ehlers-Danlos syndrome
Holoprosencephly
Epidemeology of Papillary Penetrating Labial frenum
More prevalent in younger children
Least common in adults
Associated with Midline Diastemas
What is the most overall common type of aberrant frenum?
Gingival
What is the histology of frenums
Both orthokeratinized and parakeratinized epithelium
Collagen fibers
Chronic inflammatory infiltrate
What are the most common origins of trauma to children’s frenums?
Car accidents
Falls
Child abuse
What are the most common origins of trauma to adult’s frenums?
Denture-induced lesions
What are the indications for a frenectomy?
Recession
Interference with oral hygiene
Diastema
Denture fabrication
What are the different types of frenectomy surgical options?
V-shaped incision
Z-plasty incision
Lasers
Electrosurgery
Frenectomy scarring can lead to what?
Resistance to orthodontic tooth movement
Ortho treatment should be considered before the frenectomy
However, wide and thick frenums may require removal prior to space closure
Ankyloglossia
“tongue tied”
Congenital oral anomaly characterized by an abnormally short lingual frenum
Can be partial or complete
Ankyloglossia incidence
0.02-10.7%
M:F = 3:1
No racial prediction
How to diagnose ankyloglossia
Abnormally short tongue
Tongue may have a notched or heart shape upon protrusion - the tip of the tongue is stuck on the lingual of the teeth
T/F - The mere presence of ankyloglossia is insufficient to recommend surgical correction
True
Anatomic indications for ankyloglossia correction
Notching of the protruding tongue tip
Inability of the tongue tip to contact the maxillary alveolar ridge
Restriction of lateral tongue movement
Restriction of tongue protrusion beyond the mandibular alveolus
What are functional concerns regarding ankyloglossia?
Breastfeeding
Speech
What treatment via frenectomy improve?
Breastfeeding
Tongue mobility
Speech and articulation
