Frenectomy frenotomy vestibular deepening gingival graft
Introduction:
Definitions : Periodontal surgery includes surgical treatments performed on periodontal soft tissues and on alveolar bone.
Mucogingival surgery is an extension of periodontal surgery which aims to recreate or maintain a volume of attached gum in relation to the dental organ.
Mucogingival surgery maneuvers – also called periodontal plastic surgery – aim to correct or prevent the appearance of recessions.
In 1992, the American Academy of Periodontology defined mucogingival surgery as “the set of plastic surgery techniques devoted to the correction of defects in morphology, position and/or quantity of gingiva around the underlying teeth.
The development of implant therapies involves the use of these techniques to manage peri-implant tissues. This definition can therefore be extended to the tissue management of dental implants.
Definition of the frenulum : the frenulum is a fold of stretched mucosa between two anatomical structures.
Definition of frenectomy : This is the term used in periodontal plastic surgery to designate the total surgical removal of a frenulum.
Frenotomy: consists of the partial removal of a frenulum.
The objectives of frenectomy: The correction or elimination of an anatomical abnormality of the gingiva and/or the alveolar mucosa.
This surgery concerns
- The maxillary vestibular median frenulum
- The mandibular vestibular median frenulum
- The medial lingual frenulum
- Lateral vestibular brakes
Brake classification according to Placek et al.1974:
Class 1: Mucosal attachment: the insertion of the maxillary labial frenum belongs to the alveolar mucosa and is located at the limit of the mucogingival line.
Class 2: Gingival attachment: the lower insertions of the maxillary labial frenum are embedded in the attached gingiva.
Class 3: Papillary attachment: the maxillary labial frenum is inserted into the papillary gingiva. In this case, lip traction causes a displacement of the marginal gingiva of the central incisors.
Class 4: Interdental attachment: the maxillary labial frenum joins the top of the gingival septum and merges with the bunoid papilla. This anatomical situation is generally related to the persistence of the interincisor diastema.
Frenectomy frenotomy vestibular deepening gingival graft
Indications for frenectomy:
Periodontal indications:
-Brake exerting traction on the marginal gingiva (opening of the gingivodental groove) and/or hindering hygiene
-disharmonious brake for the aesthetics of the gummy smile
-brake associated with periodontal pathology
Biomechanical indications:
-hypertrophic median frenulum and anterosuperior diastema
-short lingual frenulum
Indications for lingual frenectomy:
-Abnormally short lingual frenulum
– discomfort of the tongue in the range of lingual movements (inability to propel the tongue beyond the mandibular incisal edges).
-excessive tissue traction of the mandibular retro-incisal marginal tissues
-the association with an evolving retro-incisive recession
– plaque buildup due to inability to clean.
Surgical techniques:
Vestibular frenectomy :
-vestibular para-apical anesthesia (palatal if necessary)
-the brake is highlighted by a strong grip of the lip and immobilized by self-locking tweezers
– the incisions in the attached gum 1 mm on either side of the attachment of the frenum on the gum delimit the two sides of a triangle whose gingival apex may possibly be in the interdental space or on the palatal surface, then a second triangle with an opposite apex is dissected on the internal surface of the lip, in the labial mucosa, using a gum chisel or blade. The common base of the two triangles corresponds to the mucogingival line of the adjacent teeth.
-all of the rhomboid tissue is resected.
-the brake attachment is detached, a diamond-shaped wound is obtained.
-the edges of the diamond are brought together by a series of discontinuous bridges or a running suture starting from the lip towards the gum. The triangular area of excision of the frenulum in its gingival part is protected by a cross suture.
In the presence of a palatal inserted frenulum, it is advisable to disinsert the fibers located in the intermaxillary suture using a periodontal curette.
When the frenulum is associated with a diastema, it was previously recommended to section the papilla and the interdental tissue which could have been responsible for the recurrence of the diastema.
Currently, especially when we know the difficulties of periodontal plastic surgery applied to the restoration of the papillae, it is advisable to respect the papilla.
Lingual frenectomy:
-retro-incisive lingual para-apical anesthesia, and anesthesia of the base of the tongue.
-a horizontal incision at the base of the frenulum is sufficient if it is thin.
-the tongue is stretched upwards and backwards by the surgical aid or with the aid of a grooved probe or by a suture which pierces the tip of the tongue.
-when the frenulum is thick, make a diamond-shaped incision associated or not with horizontal incisions at the base of the tongue.
-The edges of the wound are brought together and sutured with a running stitch or simple, separate stitches.
If speech disorders are associated, it may be necessary to prescribe speech therapy of the tongue.
Benefits:
-fast and effective action
-less painful after-effects
Disadvantages:
-operative difficulty for the lingual frenulum
-risk of unsightly scarring and discomfort (rare)
Vestibuloplasty (vestibular extension procedure):
The procedures used to modify the shape of the vestibule are grouped under the term vestibuloplasty.
Goals:
-increase the vestibular depth in order to provide adequate space to increase the attached gingival area.
-increased depth can also facilitate improved oral hygiene and gum health.
Vestibular extension using a partial thickness (mucosal) flap (mucosal dissection or stripping):
-place a blade against the gum, directing the tip in an apical direction, and insert it inside the muco-gingival junction at one end of the operating field.
-it is moved along the mucogingival junction to separate a flap made up of epithelium and a thin layer of underlying connective tissue, which allows the vestibule to be deepened at the same time.
-When the desired depth is reached (approximately twice the desired attached gingival surface), the flap is pushed in an apical direction until its edge reaches the newly established vestibular depth.
-clean the wound
-the edge of the flap can be attached to the periosteum by a suture made at the base of the surgical field. Bleeding is controlled by compression of the area.
-a dressing is put in place.
Frenectomy frenotomy vestibular deepening gingival graft
Wisdom teeth may need to be extracted if they are too small.
Sealing the grooves protects children’s molars from cavities.
Bad breath can be linked to dental or gum problems.
Bad breath can be linked to dental or gum problems.
Dental veneers improve the appearance of stained or damaged teeth.
Regular scaling prevents the build-up of plaque.
Sensitive teeth can be treated with specific toothpastes.
Early consultation helps detect dental problems in time.