Management of the aberrant frenum and laser applications Flashcards
an … … is an abnormale insertion of labial, buccal or lingual frenula capable of retracting gingival margins, creating diastemas, and limiting lip and tongue movements
aberrant frenum
What is the etiology of an aberrant frenum?
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
4 classifications of labial frenums
mucosal
gingival
papillary
papillary penetrating
a …. labial frenum is when the insertion of frenum ends in mucosa or at most at the mucogingival junction
mucosal
a … labial frenum is when insertion of frenum ends in gingiva, between mucogingival junction and the base of the interdental papilla
gingival
a … labial frenum is when insertion of the frenum ends at the interdental papilla but does not penetrate to the palatal aspect of tissues
papillary
a …. labial frenum is when insertions of the frenum ends at the interdental papilla and penetrates to the palatal aspect of tissues
papillary penetrating
2 genetic syndromes associated with an aberrant max. frenum
Ellis-van Creveld syndrome
Orofacial-digital syndrome
2 genetic syndromes that are associated with absence of maxillary labial frenum
Ehlers-Danlos syndrome
Holoprosencephaly
which labial frenum is most common
gingival
a … labial frenum is more prevalent in children younger than 8 and is associated with a midline diastema
papillary penetrating
what is present histologically in a frena?
both orthokeratinized and parakeratinized epithelium
collagen fibers
chronic inflammatory infiltrate
presence of muscle fibers is inconsistent
4 issues that are associated with an aberrant labial frenum
frenal tension
interference with OH
gingival recession
midline diastema
4 indications for a frenectomy
1) recession
2) interference with OH (trauma, plaque reten)
3) diastema
4) denture fabrication
A … is the cutting of a frenulum especially the release of ankyloglossia (but not removing frenum)
frenotomy
A … is the excision (total removal) of a frenulum
frenulectomy (frenectomy)
4 surgical options for a frenectomy
V-shaped (simple)
Z-plasty (more demanding, less relapse, less scar tissue)
Lasers- better pt outcomes
Electrosurgery
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
ortho movement
… is a congenital oral anomaly characterized by an abnormally short lingual frenulum. M:F 3:1
Ankyloglossia (tongue tie)
Ankyloglossia does not always need correction but there are 4 anatomic indications
- 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
what does LASER stand for
Light Amplification by Stimulated Emission of Radiation
3 characteristics of laser light
monochromatic
directional
coherent
active medium of lasers
solid crystals (ruby or Nd:YAG)
liquid dyes (CO2 or helium/neon)
semiconductors such as GaAs
Lasers: excitation mechanisms pump energy into the active medium by one or more of these 3 basic methods:
optical, electrical, chemical
the … … mirror reflects essentually 100% of the laser light
high reflectance
the … … mirror reflects less than 100% of the laser light and transmits the remainder
partially transmissive
6 factors that dictate laser interaction with oral tissues
wavelength energy level waveform focused/defocused beam duration of exposure tissue characteristics
6 advantages of using a laser
1) hemostasis
2) accuracy
3) rapid healing
4) reduced inflammation
5) lack of scar tissue
6) low level of discomfort
5 disadvantages of LASER use
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
soft tissue surgery where you can use a laser
gingivectomy
implant recovery
frenectomy
uncovering soft tissue impactions
treatments of perio disease where you can use a laser
LANAP
PDT
advantages of a laser frenectomy
painless
anesthetic free
bloodless
disadvantages of laser frenectomy
recurrence
unpredictable healing
what does LANAP stand for and what is the basic concept of it?
Laser Assisted New Attachment Procedure
- remove sulcular epithelium
- modify root surface
- new attachment will occur
for LANAP protocol, what does the first pass of the laser do?
bactericidal
affect calculus
denature pathologic proteins
removes sulcular lining
leaves CT intact
release tissue tension
After first pass of Laser in LANAP what do you do ?
3 rounds of scaling with Piezo scaler
What does the 2nd pass of the laser do in LANAP?
- finishes debriding the pocket
- kills gram neg bacteria
- initiates stable fibrin clot
- creates closed system
- release stem cells from PDL and bone
for LANAP, … must be done one week before and at least 3 months after
periostat
LANAP … the mouth at a time and then systemic antibiotics for … days and 1/2 mouth ….
1/2
7
occlusal adjustment
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
nightguard
perio prophies
3 advantages of photo dynamic therapy (PDT)
useful for hard to reach areas
tissue specific
no antibiotic resistance
3 disadvantages of photo dynamic therapy (PDT)
- wavelength is narrow so big tumors or deep pockets cannot be penetrated
- light configuration is cumbersome
- photosensitivity can cause severe burn injuries
