Soft Tissue Lasers: Frenectomy
The frenotomy is the use of incision on the attachment of periosteal fiber and it can be sutured on frenum found on the periosteum on vestibule base. It is believed to cause less discomfort during post operation compared to frenectomy and it can suffice in most situations.
What is Frenectomy?
The frenoctomy is the use of incision on the attachment of periosteal fiber and it can be sutured on frenum found on the periosteum on vestibule base. It is believed to cause less discomfort during post-operation compared to frenectomy and it can suffice in most situations. Frenectomy works on frenum and the periosteal attachment. It is required if there is fleshy and large frena to remove.
The use of frenectomy is required in the following circumstances
- When there is higher frenum attachment which is associated to the area of the persistent gingival inflammation which had not responded to any root panning method and highly recommended oral hygiene.
- When frenum is associated with the recession place which is also progressive
- High maxillary frenum with associated midline diastma which persists after the complete eruption of permanent canines.
- The manbibular lingual frenum can inhibit a tongue so that it does not touch central incisors. This may interfere with the ability of the child to make some sounds like L, D, T. When there is high frenum which is associated with the minal or no keratinized gingiva, the frenectomy will be recommended.
The use of frenectomy
Using of frenectomy procedure is not always recommended since it will increase the attached gingiva after the procedure. Even if alveolar is being characterized by the smooth surface or red color, and it is mobile and loose while the gingiva is stippled, firm, pink, keratinized and it has no mobility.
Gingival survey is found in the soft tissue augmentation and it is needed in these conditions:
- If the marginal gingiva had inflamed
- Execudate and bleeding is found at the pocket and sulcus
- If there is obvious recession
- If pulling of the marginal tissue takes place if there is a retracting of the lip
- If using of direct measurement, sulcular depth with the millimeter has been substracted away of keratinized zone of the gingiva. There are at least 2mm for keratinized attached gingiva and it has to be present within final product.
It is possible to predict the results of the laser if the following steps had been followed.
- Creating of periosteal fenestration on the base of frenectomy in order to prevent fiber reattachment.
- Removal of the impeding fiber muscle
The laser wavelength can be used in order to perform the frenectomy in a successful manner. The technique used with the laser frenectomy is the same as the one used with blade. Topical and local anesthesia is given. A clinician performs a mental outline at frenectomy and then starts with coronal attachment and it moves laser tip in one direction by pulling at the lips to achieve tension. When correct parameters like hand speed, power and spot size have been used, just one pass, will be enough to get rid of fibers. When there is a need to use multiple passes, then it is important to make sure that there is no excessive thermal necrosis that takes place over the tissue that had been already lased. Lasing will continue in order to undermine muscle attachment up to the time periosteum will be reached.
To make sure that there is minimal regrowth or frenum relapse; periosteum has to be fenestrated using hand instrument. Any laser can be used for the frenectomy and the settings are used to conform to manufacturer’s guideline. It is important to be careful so that the tissue will not be charred or suffer thermal damage. Erbium laser does create wound which had some level of hemorrhage. This means that sealing a wound with the bandage approach is needed. There is no dressing or suturing required.
Dental lasers with pediatric dentistry
Even if any laser wavelength may be used to perform both mandibular and maxillary frenectomies, the patient who suffers bleeding problem will require to have hemostasis when performing soft tissues surgery or to use safest choice to do the surgery.
What are the symptoms of tooth eruption?
The most common symptom is biting! Babies tend to bite everything when teething to relieve the discomfort created by the erupting teeth. Another thing is that the teething pain is usually transferred to ears causing the child pull the ears.
When teeth are erupting, babies tend to produce excess saliva, which can cause facial rash. The baby will get fussy, and probably the gums will be inflamed. Gum inflammation usually happens when larger molars are erupting. Teething eruption brings sleepless nights for both the child and the parent. Nighttime wakefulness becomes the order of every night. Another thing is that the baby might change his/her eating habit. In fact, most babies lose appetite, it becomes uncomfortable for them to suck feeding bottles or have a spoon in their mouth.
It is easy to tell your baby teeth are erupting! The teething process and sequence might be different for each baby, but some are common such as;
- Loss of appetite
- Irritability, crying or fussiness
- Trouble sleeping
- Excessive drooling
- Biting
- Pulling ears
- Swollen or red gums
Having tight frenulum, it will lead to problems for adults and children. Infants will not feed well when they suffer lip or tongue lip. In children, when the frenulum is found at the upper lip, it can remove the gap found between front teeth and it has to get remove so that the orthodontic treatment can start. Someone who is wearing a denture, he can have problems since the denture will not be sitting in the proper manner and it may be lifted away of the gum while eating or talking. The tongue tie can hinder speech for the patient regardless of age and lip tie can prevent the mouth to close in the proper manner. This results in the mouth breathing.
Frenectomy types
The labial frenectomy for the upper lip: this is done on the upper lip. The labial frenectomy involves the frenum, which is attached to the upper lip and the upper jaw. This is normally with children while the gum and the teeth are still developing.
Labial frenectomy for the lower lip: The frenectomy on the lower lip is done for the same reasons as it happens with the upper lip. It is meant to stop the gum recession and periodontal problems. However, it can be done in old people who want to have dentures fixed. If the lip is moving, the frenum may make the denture lose, leading to an improper fit.
Lingual frenectomy: A lingual frenectomy is a surgical procedure to remove a small piece of tissue (the frenulum) attached to the tongue. Frenum happens with the tight cord found under the tongue, and it tetters a tongue to be in a resting position. In some cases, there is enough flexibility, and the tongue may move around, and it can perform the function of eating and speaking. However, when the tongue is tied down, it can hinder growth and speech.