Management of the aberrant frenum and laser applications

Question 1

an … … is an abnormale insertion of labial, buccal or lingual frenula capable of retracting gingival margins, creating diastemas, and limiting lip and tongue movements

Answer 1

aberrant frenum

Question 2

What is the etiology of an aberrant frenum?

Answer 2

after centrals erupt, the labial frenum will gradually transposition in an apical direction. inability of frenum to migrate apically during alveolar growth and tooth development will cause a persistent aberrant frenum

Question 3

4 classifications of labial frenums

Answer 3

mucosal
gingival
papillary
papillary penetrating

Question 4

a …. labial frenum is when the insertion of frenum ends in mucosa or at most at the mucogingival junction

Answer 4

mucosal

Question 5

a … labial frenum is when insertion of frenum ends in gingiva, between mucogingival junction and the base of the interdental papilla

Answer 5

gingival

Question 6

a … labial frenum is when insertion of the frenum ends at the interdental papilla but does not penetrate to the palatal aspect of tissues

Answer 6

papillary

Question 7

a …. labial frenum is when insertions of the frenum ends at the interdental papilla and penetrates to the palatal aspect of tissues

Answer 7

papillary penetrating

Question 8

2 genetic syndromes associated with an aberrant max. frenum

Answer 8

Ellis-van Creveld syndrome

Orofacial-digital syndrome

Question 9

2 genetic syndromes that are associated with absence of maxillary labial frenum

Answer 9

Ehlers-Danlos syndrome

Holoprosencephaly

Question 10

which labial frenum is most common

Answer 10

gingival

Question 11

a … labial frenum is more prevalent in children younger than 8 and is associated with a midline diastema

Answer 11

papillary penetrating

Question 12

what is present histologically in a frena?

Answer 12

both orthokeratinized and parakeratinized epithelium

collagen fibers

chronic inflammatory infiltrate

presence of muscle fibers is inconsistent

Question 13

4 issues that are associated with an aberrant labial frenum

Answer 13

frenal tension
interference with OH
gingival recession
midline diastema

Question 14

4 indications for a frenectomy

Answer 14

1) recession
2) interference with OH (trauma, plaque reten)
3) diastema
4) denture fabrication

Question 15

A … is the cutting of a frenulum especially the release of ankyloglossia (but not removing frenum)

Answer 15

frenotomy

Question 16

A … is the excision (total removal) of a frenulum

Answer 16

frenulectomy (frenectomy)

Question 17

4 surgical options for a frenectomy

Answer 17

V-shaped (simple)

Z-plasty (more demanding, less relapse, less scar tissue)

Lasers- better pt outcomes

Electrosurgery

Question 18

frenectomy can result in scar tissue between central incisors leading to resistance to … but if the frenum is wide and thick you may need to still prior to closure

Answer 18

ortho movement

Question 19

… is a congenital oral anomaly characterized by an abnormally short lingual frenulum. M:F 3:1

Answer 19

Ankyloglossia (tongue tie)

Question 20

Ankyloglossia does not always need correction but there are 4 anatomic indications

Answer 20

• notching of protruding tongue tip
• inability of tip of tongue to contact maxillary alveolar risge
• restriction of lateral movement
• restriction of tongue protrusion beyond mandibular alveolus

Question 21

what does LASER stand for

Answer 21

Light Amplification by Stimulated Emission of Radiation

Question 22

3 characteristics of laser light

Answer 22

monochromatic
directional
coherent

Question 23

active medium of lasers

Answer 23

solid crystals (ruby or Nd:YAG)

liquid dyes (CO2 or helium/neon)

semiconductors such as GaAs

Question 24

Lasers: excitation mechanisms pump energy into the active medium by one or more of these 3 basic methods:

Answer 24

optical, electrical, chemical

Question 25

the ... ... mirror reflects essentually 100% of the laser light

Answer 25

high reflectance

Question 26

the ... ... mirror reflects less than 100% of the laser light and transmits the remainder

Answer 26

partially transmissive

Question 27

6 factors that dictate laser interaction with oral tissues

Answer 27

``` wavelength energy level waveform focused/defocused beam duration of exposure tissue characteristics ```

Question 28

6 advantages of using a laser

Answer 28

1) hemostasis 2) accuracy 3) rapid healing 4) reduced inflammation 5) lack of scar tissue 6) low level of discomfort

Question 29

5 disadvantages of LASER use

Answer 29

1) technical difficulties 2) lack of precision of depth of cut 3) tissue not avail. for histopath. 4) hazardous 5) dispersal of viable virus particles in the plume

Question 30

soft tissue surgery where you can use a laser

Answer 30

gingivectomy implant recovery frenectomy uncovering soft tissue impactions

Question 31

treatments of perio disease where you can use a laser

Answer 31

LANAP | PDT

Question 32

advantages of a laser frenectomy

Answer 32

painless anesthetic free bloodless

Question 33

disadvantages of laser frenectomy

Answer 33

recurrence | unpredictable healing

Question 34

what does LANAP stand for and what is the basic concept of it?

Answer 34

Laser Assisted New Attachment Procedure - remove sulcular epithelium - modify root surface - new attachment will occur

Question 35

for LANAP protocol, what does the first pass of the laser do?

Answer 35

bactericidal affect calculus denature pathologic proteins removes sulcular lining leaves CT intact release tissue tension

Question 36

After first pass of Laser in LANAP what do you do ?

Answer 36

3 rounds of scaling with Piezo scaler

Question 37

What does the 2nd pass of the laser do in LANAP?

Answer 37

- finishes debriding the pocket - kills gram neg bacteria - initiates stable fibrin clot - creates closed system - release stem cells from PDL and bone

Question 38

for LANAP, ... must be done one week before and at least 3 months after

Answer 38

periostat

Question 39

LANAP ... the mouth at a time and then systemic antibiotics for ... days and 1/2 mouth ....

Answer 39

1/2 7 occlusal adjustment

Question 40

for LANAP, occlusal adjustments must continue post op and patient must wear ... and you need to splint mobile teeth and patient should have .... one month after and throughout the year

Answer 40

nightguard perio prophies

Question 41

3 advantages of photo dynamic therapy (PDT)

Answer 41

useful for hard to reach areas tissue specific no antibiotic resistance

Question 42

3 disadvantages of photo dynamic therapy (PDT)

Answer 42

1. wavelength is narrow so big tumors or deep pockets cannot be penetrated 2. light configuration is cumbersome 3. photosensitivity can cause severe burn injuries