Labial Frenectomy Alone or in Combination with a Free Gingival Autograft
Frena, which are triangle-shaped folds found in the maxillary and mandibular alveolar mucosa, are located between the central incisors and canine premolar area. Frena may be long and thin, or short and broad. Labial frenum attachments have been described as mucosal, gingival, papillary, and papilla penetrating (Placek et al. 1974a & b).
Insertion points of the frena may become a problem when the gingival margin is involved (Corn 1964). This may be the result of an unusually high insertion of the frenum or marginal recession of the gingiva. High frenal insertion can distend and pull the marginal gingiva or papilla away from the tooth when the lip is stretched. This condition may be conducive to plaque accumulation and inhibit proper oral hygiene.
Aberrant frena can be treated by frenectomy or frenotomy procedures. The terms frenectomy and frenotomy signify operations that differ in degree of surgical approach. Frenectomy is a complete removal of the frenum, including its attachment to the underlying bone, and may be required for correction of abnormal diastema between maxillary central incisors (Friedman 1957). Frenotomy is the incision and relocation of the frenal attachment.
Abnormal frenal attachments occur most often on the facial surface between the maxillary and mandibular central incisors and in the canine and premolar areas (Whinston 1956). High frenal attachments on the lingual surface are less common. Orthodontic closure of diastema without excision of the associated frena are clinically associated with relapse separation of the teeth (Edwards 1977).
A frenectomy is a simple surgical procedure that can be performed separately (that is, for orthodontic reasons) or in conjunction with a free gingival graft (that is, to treat a gingival recession, increase the amount of attached gingival, or deepen the vestibule).
- Eliminate tension on the gingival margin (frenum-pull concomitant with or without gingival recession)
- Facilitate orthodontic treatment
- Facilitate home care