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8/10/2019 Frenectomy and Frenotomy
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FRENECTOMY
AND
FRENOTOMY
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Techniques
Conventional (Classical) frenectomy
Miller's technique
V-Y Plasty
Z Plasty
Frenectomy which was done by using
electrocautery
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Conventional technique
Introduced by Archer (1961) and Kruger (1964).
Indications
Midline diastema cases with an aberrant
frenum
Removal of the muscle fibres which were
supposedly connecting the orbicularis oris with
the palatine
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Millers technique
Miller PD in 1985. This
Indications
Post-orthodontic diastema cases.
The ideal time for performing this surgery is
after the orthodontic movement is complete
and about 6 weeks before the appliances are
removed.
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Z plasty
Introduced by Schuchardt
Indications
Hypertrophy of the frenum with a low
insertion, which is associated with an inter-
incisor diastema,
lateral incisors have appeared without
causing the diastema to disappear and also incases of a short vestibule
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V-Y Plasty
Introduced by Dieffenbach
Indications
Maxillary midline frenum
Lengthening the localized area
Broad frenum in the premolar-molar area
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Electrosurgery
Electrosurgery is recommended in cases of
patients with bleeding disorders, where the
conventional scalpel technique carries a
higher risk which is associated with problemsin achieving a haemostasis
non-compliant patients.
Armamentarium: An electrocautery unit withthe loop electrode and a haemostat
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Healing
unilateral pedicle flap shows complete healing
with zone of attached gingiva
no scar and colour of gingival tissue was
comparable to the adjacent tissue
(Hungund et al., Dentistry 2013, 4:1)
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The classical technique leaves a longitudinalsurgical incision and scarring, which may lead toperiodontal problems and an anaestheticappearance.
simple excision and a modification of V-rhomboplasty fail to provide satisfactory
aesthetic results in triangular pedicle of attachedgingiva with its free end as the apex and itsbase continuous with the alveolar mucosa.
(Kambalyal P, Kambalyal P(2013,4:1)
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Z plasty
inability to achieve a primary closure at the
centre, consequently leading to a secondary
intention healing at the wide exposed wound. It achieved both the removal of the fibrous band
and the vertical lengthening of the vestibule.
(Archer WH (1975) Oral surgery- a step by step atlas of operativetechniques. (3rdedn)
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The Millers technique offers the following advantages:
1. Post-operatively, on healing, there is a continuous
collagenous band of gingiva across the midline, that
gives a bracing effect than the scar tissue, thus
preventing an orthodontic relapse.
2. The transseptal fibres are not disrupted surgically and
so, there is no loss of the interdental papilla.
3. Obtaining an orthodontic stability without an aesthetic
sacrifice.
( Miller PD. Frenectomy, combined with a laterally positioned pedicle-
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Thus, the Millers technique results in no loss of
the interdental papilla and no scar tissue.
Thereby, it is best suited to prevent an
orthodontic relapse.