Frenectomy and Frenotomy

8/10/2019 Frenectomy and Frenotomy

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FRENECTOMY

AND

FRENOTOMY


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Techniques

Conventional (Classical) frenectomy

Miller's technique

V-Y Plasty

Z Plasty

Frenectomy which was done by using

electrocautery


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Conventional technique

Introduced by Archer (1961) and Kruger (1964).

Indications

Midline diastema cases with an aberrant

frenum

Removal of the muscle fibres which were

supposedly connecting the orbicularis oris with

the palatine


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Millers technique

Miller PD in 1985. This

Indications

Post-orthodontic diastema cases.

The ideal time for performing this surgery is

after the orthodontic movement is complete

and about 6 weeks before the appliances are

removed.


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Z plasty

Introduced by Schuchardt

Indications

Hypertrophy of the frenum with a low

insertion, which is associated with an inter-

incisor diastema,

lateral incisors have appeared without

causing the diastema to disappear and also incases of a short vestibule


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V-Y Plasty

Introduced by Dieffenbach

Indications

Maxillary midline frenum

Lengthening the localized area

Broad frenum in the premolar-molar area


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Electrosurgery

Electrosurgery is recommended in cases of

patients with bleeding disorders, where the

conventional scalpel technique carries a

higher risk which is associated with problemsin achieving a haemostasis

non-compliant patients.

Armamentarium: An electrocautery unit withthe loop electrode and a haemostat


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Healing

unilateral pedicle flap shows complete healing

with zone of attached gingiva

no scar and colour of gingival tissue was

comparable to the adjacent tissue

(Hungund et al., Dentistry 2013, 4:1)


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The classical technique leaves a longitudinalsurgical incision and scarring, which may lead toperiodontal problems and an anaestheticappearance.

simple excision and a modification of V-rhomboplasty fail to provide satisfactory

aesthetic results in triangular pedicle of attachedgingiva with its free end as the apex and itsbase continuous with the alveolar mucosa.

(Kambalyal P, Kambalyal P(2013,4:1)


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Z plasty

inability to achieve a primary closure at the

centre, consequently leading to a secondary

intention healing at the wide exposed wound. It achieved both the removal of the fibrous band

and the vertical lengthening of the vestibule.

(Archer WH (1975) Oral surgery- a step by step atlas of operativetechniques. (3rdedn)


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The Millers technique offers the following advantages:

1. Post-operatively, on healing, there is a continuous

collagenous band of gingiva across the midline, that

gives a bracing effect than the scar tissue, thus

preventing an orthodontic relapse.

2. The transseptal fibres are not disrupted surgically and

so, there is no loss of the interdental papilla.

3. Obtaining an orthodontic stability without an aesthetic

sacrifice.

( Miller PD. Frenectomy, combined with a laterally positioned pedicle-


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Thus, the Millers technique results in no loss of

the interdental papilla and no scar tissue.

Thereby, it is best suited to prevent an

orthodontic relapse.

Documents

Frenectomy and Frenotomy