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Journal of Case Reports in Medical Science FRENECTOMY USING SCALPEL IN


THE VY-PLASTY TECHNIQUE-A CASE REPORT

Article · June 2021

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Journal of Case Reports in Medical Science

7(1): 8-12, 2021


ISSN: 2456-9143

FRENECTOMY USING SCALPEL IN THE VY- PLASTY


TECHNIQUE- A CASE REPORT

NITESH KUNDU1, VINEET NAIR2* AND SAYAN CHATTOPADHYAY1


1
Burdwan Dental College & Hospital, Burdwan, India.
2
Department of Periodontia, Burdwan Dental College & Hospital, Burdwan, India.

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.

Received: 10 April 2021


Accepted: 17 June 2021
Published: 22 June 2021 Case Study
__________________________________________________________________________________

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.

Keywords: Aesthetics; diastema; frenum; surgery.

1. INTRODUCTION Placek et al. (1974) classified frenum as-[3]

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.
_____________________________________________________________________________________________________

*Corresponding author: Email: drvineet_nair@yahoo.co.in;


Kundu et al.; JOCRIMS, 7(1): 8-12, 2021

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.

Fig. 1. VY- plasty technique

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Kundu et al.; JOCRIMS, 7(1): 8-12, 2021

Fig. 2. Midline diastema

Fig. 3. Placement of ‘V’ shaped incision

Fig. 4. Relocation of the frenum apically

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Kundu et al.; JOCRIMS, 7(1): 8-12, 2021

Fig. 5. Placement of sutures in the form of ‘Y’

Fig. 6. Follow up after one week

3. DISCUSSION The advantage of the classical technique is that it is


easy to perform but on the down side it leaves a
A diastema is a space or “gap”, most often seen longitudinal surgical incision and scarring, which may
between two upper front teeth. Diastema can affect lead to periodontal problems and an un-aesthetic
the speech besides producing a lack of confidence and appearance. There is also scar formation which
psychological problem [12]. Treatment of diastema prevents the closure of midline diastema during
varies and it requires correct diagnosis of its etiology. orthodontic treatment [14]. Hence, the scar formation
Commonly, the aberrant frenum is the reason and the contraindicates the conventional frenectomy
common treatment modality is the classical technique procedure prior to orthodontic treatment [15]. The
of frenectomy put forth by Archer (1961) and VY-plasty technique can always be employed in such
Kruger [13]. However in this article, we have circumstances.
focussed on a modification- the VY plasty. Here the
frenum is relocated apically rather than remove it in 4. CONCLUSION
totality.
Despite the various modifications in frenectomy, the
The healing takes place by primary intention which widely followed procedure still remains the classical
leads to minimal scar formation. There is initial technique. While an aberrant frenum can be removed
haemorrhage followed by approximation of cut by any of the techniques, a functional and an aesthetic
wound ends due to epithelial cell migration and outcome can be achieved by a proper technique
proliferation. There is no granulation tissue formation. selection.

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Kundu et al.; JOCRIMS, 7(1): 8-12, 2021

CONSENT Surgery. Germany: Blackwell Munksgaard;


Labial frenectomy alone or in combination
Informed written consent was taken, pre-operative with a free gingival autograft; 53.
investigations done and oral prophylaxis completed 7. Kahnberg KE. Frenum surgery. I.A comparison
before the surgery. of three surgical methods. Int J Oral Surg.
1977;6:328-333.
ETHICAL APPROVAL 8. Verco PJW. A case report and a clinical
technique: argon beam electrosurgery for the
It is not applicable. tongue ties and maxillary frenectomies in
infants and children. European Archives of
Paediatric Dentistry; 2010.
COMPETING INTERESTS 9. Gontijo I, Navarro RS, Naypek P, Ciamponi
AL, Haddad AE. The application of diode and
Authors have declared that no competing interests Er:YAG lasers in labial frenectomies in infants.
exist. J Dent Child. 2005;72(1):10-15.
10. Olivi G, Chaumanet G, Genovese MD,
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