Soft Tissue Lasers: Frenectomy

The frenotomy is the use of incision on the attachment of periosteal fiber and it can be sutured on frenum found on the periosteum on vestibule base. It is believed to cause less discomfort during post operation compared to frenectomy and it can suffice in most situations.

Dental lasers can be used to treat frenectomies, gingivoplasty, gingivectomy, and many other dental situations

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What it is frenectomy?

The frenoctomy is the use of incision on the attachment of periosteal fiber and it can be sutured on frenum found on the periosteum on vestibule base. It is believed to cause less discomfort during post operation compared to frenectomy and it can suffice in most situations. Frenectomy works on frenum and the periosteal attachment. It is required if there is fleshy and large frena to remove.

The use of frenectomy is required in the following circumstances

  • When there is higher frenum attachment which is associated to the area of the persistent gingival inflammation which had not responded to any root panning method and the best oral hygiene.
  • When frenum is associated with the recession place which is also progressive
  • High maxillary frenum with associated midline diastma which persists after the complete eruption of permanent canines.
  • The manbibular lingual frenum can inhibit a tongue so that it does not touch central incisors. This may interfere with the ability of the child to make some sounds like L, D, T. When there is high frenum which is associated with the minal or no keratinized gingiva, the frenectomy will be recommended.

The use of frenectomy

Using of frenectomy procedure is not always recommended since it will increase the attached gingivae after the procedure. Even if alveolar is being characterized by the smooth surface or red color, and it is mobile and loose while the gingiva is stippled, firm, pink, keratinized and it has no mobility.

Gingival survey is found in the soft tissue augmentation and it is needed in these conditions:

  • If the marginal gingiva had inflamed
  • Execudate and bleeding is found at the pocket and sulcus
  • If there is obvious recession
  • If pulling of the marginal tissue takes place if there is a retracting of the lip
  • If using of direct measurement, sulcular depth with the millimeter has been substracted away of keratinized zone of the gingiva. There are at least 2mm for keratinized attached gingiva and it has to be present within final product.

It is possible to predict the results of the laser if the following steps had been followed.

  • Creating of periosteal fenestration on the base of frenectomy in order to prevent fiber reattachment.
  • Removal of the impeding fiber muscle

The laser wavelength can be used in order to perform the frenectomy in a successful manner. The technique used with the laser frenectomy is the same as the one used with blade. Topical and local anesthesia is given. A clinician performs a mental outline at frenectomy and then starts with coronal attachment and it moves laser tip in one direction by pulling at the lips to achieve tension. When correct parameters like hand speed, power and spot size have been used, just one pass, will be enough to get rid of fibers.  When there is a need to use multiple passes, then it is important to make sure that there is no excessive thermal necrosis that takes place over the tissue that had been already lased.  Lasing will continue in order to undermine muscle attachment up to the time periosteum will be reached.

To make sure that there is minimal regrowth or frenum relapse; periosteum has to be fenestrated using hand instrument. Any laser can be used for the frenectomy and the settings are used to conform to manufacturer’s guideline. It is important to be careful so that the tissue will not be charred or suffer thermal damage. Erbium laser does create wound which had some level of hemorrhage. This means that sealing a wound with the bandage approach is needed. There is no dressing or suturing required.

Dental lasers with pediatric dentistry

Even if any laser wavelength may be used to perform both mandibular and maxillary frenectomies, the patient who suffers bleeding problem will require to have hemostasis when performing soft tissues surgery or to use safest choice to do the surgery.

The laser frenectomy offers the following benefits

  • It is not invasive and there is no suture or cutting involved
  • It does not lead to too much pain or too much swelling
  • The lasers may remove the bacteria better compared to other available options
  • It leads to faster healing because of laser bio stimulation for the cells
  • It offers faster recovery compared to the conventional methods.

Having tight frenulum, it will lead to problems for adults and children. Infants will not feed well when they suffer lip or tongue lip.  In children, when the frenulum is found at the upper lip, it can remove the gap found between front teeth and it has to get remove   so that the orthodontic treatment can start. Someone who is wearing a denture, he can have problems since the denture will not be sitting in the proper manner and it may be lifted away of the gum while eating or talking. The tongue tie can hinder speech for the patient regardless of the age and lip tie can prevent the mouth to close in the proper manner. This results in the mouth breathing.

Frenectomy types

The labial frenectomy for upper lip: this is done on the upper lip. The labial frenectomy does involve frenum which is attaching at upper lip and at the upper jaw. This is normally with children while the gum and the teeth are still developing.

Lingual frenectomy: lingual frenum happens with the tight cord found under the tongue and it tetters a tongue to be in resting position. In some cases, there is enough flexibility and the tongue may move around and it can perform the function of eating and speaking.  However, when the tongue had been tied down it can hinder the growth and the speech.

Labial frenectomy for the lower lip: The frenectomy on the lower lip is done for the same reasons as it happens with upper lip. It is meant to stop the gum recession and periodontal problems. However, it can be done in old people who want to have denture fixed. If the lip is moving, frenum may make the denture loose which may lead to the improper fit.

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