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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
straight. The patient’s dream of a beautiful smile
might sometimes be shattered by a constantly
increasing gap in between the front teeth (diastema)
which in turn is due to an aberrant frenum [1]. Frenal
attachments are thin folds of mucous membrane with
enclosed muscle fibers that attach the lips to the
alveolar mucosa and underlying periosteum. Among
the frenum of importance are the maxillary labial
frenum, the mandibular labial frenum and the
lingual frenum. Aberrant frenum may be an obstacle
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 [2].
_____________________________________________________________________________________________________
Mucosal – when the frenal fibres are attached up to
the muco-gingival junction.
Gingival – when the fibres are inserted within the
attached gingiva.
Papillary – when the fibres are extending into the
interdental papilla.
Papilla penetrating – when the frenal fibres cross the
alveolar process and extend up to the palatine papilla.
Aberrant frena are clinically identified by applying
tension over it to see the movement of papillary tip or
blanching produced due to ischemia of the region.

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


The frenum is considered as pathogenic when it is
unusually wide or when there is no apparent zone of
the attached gingiva along the midline or the
interdental papilla shifts when the frenum is extended.
Clinically, papillary and papilla penetrating frena are
considered as pathological and have been found to be
associated with loss of papilla, recession, diastema,
difficulty in brushing, malalignment of teeth and it
may also hinder the denture fit or retention leading to
psychological disturbances to the individual [4].
The treatment modality for such an aberrant frenum is
frenotomy or frenectomy [5]. Frenectomy is the
complete removal of the frenum, including its
attachment to the underlying bone, while frenotomy is
the incision and the relocation of the frenal attachment
[6]. Frenectomy can be accomplished either by the
routine scalpel technique, electrosurgery or by using
lasers. The scalpel technique can be performed by
three ways- the simple excision technique, the Z-
plasty technique, the VY-plasty technique or by a
localized vestibuloplasty with secondary
epithelialisation [7].
The use of electro surgery and lasers has also been
proposed for frenectomy [8-10] The advantage of
electrocautery probe is its efficacy, safety, mild
bleeding and few or absence of postoperative
complications. The complications include burns, the
risk of an explosion if combustible gases are used,
interference with pacemakers and the production of
surgical smoke. However these complications have
not been reported with the advancement in electro
surgical techniques like the Argon Beam Coagulation
(ABC) [11]. Recently, the use of a CO2 laser in
lingual frenectomies has been reported as a safe and
Fig. 1. VY- plasty technique
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Kundu et al.; JOCRIMS, 7(1): 8-12, 2021
effective procedure with the advantages of a shorter
duration of the surgery, simplicity of the procedure,
the absence of post-operative infections, lesser pain,
swelling and the presence of a small or no scar [9].
The disadvantages as compared to the scalpel
technique include a delayed healing, a reduced
surgical precision resulting in an inadvertent laser-
induced thermal necrosis and/or a photo acoustic
injury [10].
The present article is a case report of aberrant frenum
which was treated by the VY-plasty technique (Fig.
1). All the patients chosen for the study (10 in
number) were in the age group of 12-35 years, were
clinically exhibiting papillary or papilla penetrating
frena as these two are considered as pathological.
2. CASE REPORT
A 25 year old female patient presented with midline
diastema (Fig. 2). The armamentarium included
haemostat, scalpel blade no.15, gauze sponges, 4-0
black silk sutures, suture pliers, scissors and a
periodontal dressing. After the area was anaesthetized
with a local infiltration by using 2 % lignocaine with
1:80000 adrenaline, the frenum was held with the
haemostat and an incision was made in the form of V
on the undersurface of the frenal attachment (Fig. 3).
The frenum was relocated at an apical position (Fig.
4) and the V shaped incision was converted into a Y,
by suturing it with 4-0 silk sutures (Fig. 5). A
periodontal dressing was placed. The periodontal
dressing and the sutures were removed at one week of
follow-up (Fig. 6). At one month of follow-up, the
frenal attachment was found to be relocated at an
apical position with an uneventful healing.
 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

10

Fig. 5. Placement of sutures in the form of ‘Y’
Fig. 6. Follow up after one week
3. DISCUSSION
A diastema is a space or “gap”, most often seen
between two upper front teeth. Diastema can affect
the speech besides producing a lack of confidence and
psychological problem [12]. Treatment of diastema
varies and it requires correct diagnosis of its etiology.
Commonly, the aberrant frenum is the reason and the
common treatment modality is the classical technique
of frenectomy put forth by Archer (1961) and
Kruger [13]. However in this article, we have
focussed on a modification- the VY plasty. Here the
frenum is relocated apically rather than remove it in
totality.
The healing takes place by primary intention which
leads to minimal scar formation. There is initial
haemorrhage followed by approximation of cut
wound ends due to epithelial cell migration and
proliferation. There is no granulation tissue formation.
11
Kundu et al.; JOCRIMS, 7(1): 8-12, 2021
The advantage of the classical technique is that it is
easy to perform but on the down side it leaves a
longitudinal surgical incision and scarring, which may
lead to periodontal problems and an un-aesthetic
appearance. There is also scar formation which
prevents the closure of midline diastema during
orthodontic treatment [14]. Hence, the scar formation
contraindicates the conventional frenectomy
procedure prior to orthodontic treatment [15]. The
VY-plasty technique can always be employed in such
circumstances.
4. CONCLUSION
Despite the various modifications in frenectomy, the
widely followed procedure still remains the classical
technique. While an aberrant frenum can be removed
by any of the techniques, a functional and an aesthetic
outcome can be achieved by a proper technique
selection.
 Kundu et al.; JOCRIMS, 7(1): 8-12, 2021

CONSENT Surgery. Germany: Blackwell Munksgaard;

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AL, Haddad AE. The application of diode and
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