Before we get into understanding the types and techniques of frenectomy, it is very important to know what is frenectomy. Frenectomy is a surgical procedure wherein a thin layer of tissue called frenulum or frenum observed on various parts of the body is removed. So far as the dental area is concerned, frenectomy is either performed inside the middle of upper lip , which is called labial frenectomy, or under the tongue, called lingual frenectomy. Frenectomy as it is a very common dental procedure in dental world and is performed both on children and adults.
Labial frenectomy is very common with patients undergoing denture treatment in order to get the proper fit of dentures or patients who have tissues attached to centre of upper lip and causing recession of gums or gap between the upper front teeth called central incisors.
In the case of lingual frenectomy, the dentist removes the tissues / lingual frenum developed too close to the tip of the tongue which is either causing speech problems or hindering the development of teeth. Lingual Frenectomy is quite common in the case of children diagnosed with tongue tie or clipping of tongue problem.
Here is some more details of labial and lingual frenectomy. In case the readers have some more questions, dedicated dentists on our panel will be more than happy to offer free dental advice online.
Standard Frenectomy - An incision is made across the base of the frenum at its attachment to the incisive papilla.The dissection is carried down to the periosteum,and the incision is then extended along both sides of the frenum to its attachment on the labial mucosa. The specimen is placed on traction and excised from the lip. This results in a bell shaped defect. Relaxing incisions are made at the mucogingival line. The labial flaps are advanced. The diamond shaped defect is allowed to heal.
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Laser Frenectomy - The lip is streached to delineate the frenum using a carbon dioxide laser,the frenum is outlined. Then the band is excised to the periosteum. Relaxing incisions are made at the mucogingival line. Hemostsis is achieved by defocusing the beam.
Mandibular Labial Frenum - The midline mandibular labial frenum is normal. But when it attaches on the interdental papilla ,between the lower incisors, it creates an adverse periodontal environment. This leads to food and plaque accumulation. The patient may develop chronic inflammation, a periodontal pocket and a recession of the attached gingival. Failure to eliminate this abnormal frenum pull may lead to bone loss and mobility of the lower central incisors.
Techniques
Excision -The frenum is excised. The wound edges are undermined, relaxing incisions are made and wounds closed. (As shown in the diagram)
Excision and Z-Plasty Closure - The band is excised and the wound closed using a “Z” Plasty rotational flaps
Lingual Frenum or TongueTie - A prominent lingual frenum, attached high on the lingual alvelor ridge, is seen commonly in infants. This causes decreased tongue mobility and the fear of future speech impairment. The lingual frenum becomes less prominent during the first 2-5 years of life. Children in mixed dentition may complain of difficulty moving their tongue. A lingual frenum with high attachment on the alveolus may contribute to gingival inflammation and recession in relation to the central incisors. Lingual frenectomy is performed more commonly for one of the above reasons than for speech articulation problems.
Techniques
Excision and V-Y Closure - The frenum is cut from the attach menton the alveolar ridge. Then a traction is applied with forceps. Parallel incisions extending along the floor of the mouth and ventral surface of the tongue are made and the band of tissues is removed. Relaxing incisions are then made at a junction of the floor of the mouth and the ventral surface of the tongue converting a straight line defect to a ‘V’. The defect is then closed as ‘Y’ with 4-5 chromic catgut sutures. This process accomplishes excision of the frenum and simultaneous lengthening of the lingual sulcus.
Excision and Z-plasty Closure - An alternative is frenectomy with single or multiple Z-plasties to lengthen the ventral surface of the tongue.Two large triangular flaps are created on the ventral surface of the tongue. The flaps are transposed as ‘Z’ plasty. This improves the tongue’s mobility without endangering the submandibular ducts.
Laser Excision - Tongue Tie may also be corrected using Carbon dioxide laser. Traction is applied to the tongue to identify the frenum. With the laser set at 7watts in the pulsating mode, the frenum is outlined. Then, using a continuous mode, the frenum is excised. Relaxing incisions are made at the junction of the floor of the mouth and the ventral surface of the tongue. Hemostasis is achieved by defocusing the beam and lasering the bed.