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VYplasty
VYplasty
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Vineet Nair
BURDWAN DENTAL COLLEGE & HOSPITAL, WEST BENGAL, INDIA
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AUTHORS’ CONTRIBUTIONS
This work was carried out in collaboration among all authors. Author VN designed the study, performed the
statistical analysis, wrote the protocol, and wrote the first draft of the manuscript. Authors NK and SC managed
the analyses of the study. Author VN managed the literature searches. All authors read and approved the final
manuscript.
ABSTRACT
Frenum is a mucous membrane fold that attaches the lip and the cheek to the alveolar mucosa, the gingiva and
the underlying periosteum. Sometimes the shape, size or attachment location of the frenum might be abnormal
and then it is called as aberrant frenum. Aberrant frena may be a risk to the gingival health when they are
attached too closely to the gingival margin, either due to an interference in the plaque control or due to a muscle
pull. Also there are aesthetic problems or recurrence problems after orthodontic treatment. The management of
such an aberrant frenum is accomplished by performing a frenectomy. This paper sheds light on the aberrant
frenum and its management, mainly by using scalpel in the VY-plasty technique.
A smile is a curved line that can make all matters Mucosal – when the frenal fibres are attached up to
straight. The patient’s dream of a beautiful smile the muco-gingival junction.
might sometimes be shattered by a constantly
increasing gap in between the front teeth (diastema) Gingival – when the fibres are inserted within the
which in turn is due to an aberrant frenum [1]. Frenal attached gingiva.
attachments are thin folds of mucous membrane with
enclosed muscle fibers that attach the lips to the Papillary – when the fibres are extending into the
alveolar mucosa and underlying periosteum. Among interdental papilla.
the frenum of importance are the maxillary labial
frenum, the mandibular labial frenum and the Papilla penetrating – when the frenal fibres cross the
lingual frenum. Aberrant frenum may be an obstacle alveolar process and extend up to the palatine papilla.
to the gingival health when they are attached too
closely to the gingival margin, either due to an Aberrant frena are clinically identified by applying
interference in the plaque control or due to a muscle tension over it to see the movement of papillary tip or
pull [2]. blanching produced due to ischemia of the region.
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The frenum is considered as pathogenic when it is effective procedure with the advantages of a shorter
unusually wide or when there is no apparent zone of duration of the surgery, simplicity of the procedure,
the attached gingiva along the midline or the the absence of post-operative infections, lesser pain,
interdental papilla shifts when the frenum is extended. swelling and the presence of a small or no scar [9].
Clinically, papillary and papilla penetrating frena are The disadvantages as compared to the scalpel
considered as pathological and have been found to be technique include a delayed healing, a reduced
associated with loss of papilla, recession, diastema, surgical precision resulting in an inadvertent laser-
difficulty in brushing, malalignment of teeth and it induced thermal necrosis and/or a photo acoustic
may also hinder the denture fit or retention leading to injury [10].
psychological disturbances to the individual [4].
The present article is a case report of aberrant frenum
The treatment modality for such an aberrant frenum is which was treated by the VY-plasty technique (Fig.
frenotomy or frenectomy [5]. Frenectomy is the 1). All the patients chosen for the study (10 in
complete removal of the frenum, including its number) were in the age group of 12-35 years, were
attachment to the underlying bone, while frenotomy is clinically exhibiting papillary or papilla penetrating
the incision and the relocation of the frenal attachment frena as these two are considered as pathological.
[6]. Frenectomy can be accomplished either by the
routine scalpel technique, electrosurgery or by using 2. CASE REPORT
lasers. The scalpel technique can be performed by
three ways- the simple excision technique, the Z- A 25 year old female patient presented with midline
plasty technique, the VY-plasty technique or by a diastema (Fig. 2). The armamentarium included
localized vestibuloplasty with secondary haemostat, scalpel blade no.15, gauze sponges, 4-0
epithelialisation [7]. black silk sutures, suture pliers, scissors and a
periodontal dressing. After the area was anaesthetized
The use of electro surgery and lasers has also been with a local infiltration by using 2 % lignocaine with
proposed for frenectomy [8-10] The advantage of 1:80000 adrenaline, the frenum was held with the
electrocautery probe is its efficacy, safety, mild haemostat and an incision was made in the form of V
bleeding and few or absence of postoperative on the undersurface of the frenal attachment (Fig. 3).
complications. The complications include burns, the The frenum was relocated at an apical position (Fig.
risk of an explosion if combustible gases are used, 4) and the V shaped incision was converted into a Y,
interference with pacemakers and the production of by suturing it with 4-0 silk sutures (Fig. 5). A
surgical smoke. However these complications have periodontal dressing was placed. The periodontal
not been reported with the advancement in electro dressing and the sutures were removed at one week of
surgical techniques like the Argon Beam Coagulation follow-up (Fig. 6). At one month of follow-up, the
(ABC) [11]. Recently, the use of a CO2 laser in frenal attachment was found to be relocated at an
lingual frenectomies has been reported as a safe and apical position with an uneventful healing.
9
Kundu et al.; JOCRIMS, 7(1): 8-12, 2021
10
Kundu et al.; JOCRIMS, 7(1): 8-12, 2021
11
Kundu et al.; JOCRIMS, 7(1): 8-12, 2021
12