labial Frenectomy Medical Assignment Help

labial Frenectomy

Labial frenal attachments consi t of thin bands of fibrou tissue covered with mucosa, extending from the lip and cheek to the alveolar periosteum. The level of frenal attachments may vary. from the height of the vestibule to
the crest of the alveolar ridge and evert to the Incisal papilla area in the anterior maxilla. With the exception of the midline labial frenumr association with a diastemat

frenal attachments generally do not present problems when the dentition is intact. However, the construction of a denture may be complicated .when it is necessary to accommodate a frenal attachment. Movement of the soft
tissue adjacent to the frenum may create discomfort and ulceration and may interfere with the peripheral seal and dislodge the denture. ‘ Three surgical techniques are effective in removal of frenal attachments: (1) the simple excision technique, (2) the Z-plasty technique, and (3) a localized vestibulepIa sty with secondary epithelialization, The first two tech-,
niques (simple excision and Z-plasty) are effective when the mucosal and fibrous tissue band is relatively narrow; the third {a localized  estibuloplasty with secondary epithelialization) is often preferred when the frenal attachment bas a wide base. ‘ Local anesthetic infiltration is sufficient for surgical treatment of frenal attachments, Care must be taken to avoid excessive anesthetic infiltration directly in the frenum area, because it may obscure the anatomy that must be visualized at the time of excision. In all cases it is helpful to have the surgical assistant elevate and evert the
iii) during this procedure, For the simple excision technique ‘a narrow elliptic incision around the fren’eI:area down to the periosteum is completed (Fig. l’:+”~5}Thefibrous frenum is then sharply dissected from the edger.

FIG. 13.25-cont'd E and F, Placement of suture through mucosal margins and periosteum, which closes mucosal margin and sutures mucosa to periosteum at depth of vestibule. G and H, Wound dosure. Removal of tissue in areas adjacent to attache

FIG. 13.25-cont’d E and F, Placement of suture through mucosal margins and periosteum, which
closes mucosal margin and sutures mucosa to periosteum at depth of vestibule. G and H, Wound dosure.
Removal of tissue in areas adjacent to attache

lying periosteum and soft tissue, and the margins of the wound are gently undermined and reapproximated. Placement of the first uture should be at the maximal depth of the vestibule and should include both edges of
mucosa and underlying’periosteum at the height of the vestibule beneath the anterior nasal spine (see Fig. 13-25). This will reduce hematoma formation and allow for adaptation of the tissue to the maximal height of the
vestibule. The remaindef of the incision should then be closed with interrupted sutures. Occasionally, it is not possible to approximate the portion ofthe excision closest to the alveolar ridge crest; this wili~ndetgo secondary epithelialization without difficulty. In the Z-plasty technique an excision of  the fibrousconnective tissue is done, similar to that in the simple excision procedure just described, After excision of the fibrous tissue, two oblLque incisions are made in a Z fashion, one at each end of the previous area of excision (Fig, 13-26), The two pointed naps are then gently undermined and rotated to close the initial vertical incision “horizontally. The two small oblique extensions also require closure, This technique may d~crease the amount ‘of vestibular ablation sometimes seen after linear exctsron of a frenum.A third technique.for removal of the frenum involves
a localized vestibuloplasty with secondary epit)lelializal

 

 

 

 

 

 

 

 

 

 

 

 

 

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