Frenectomy with conventional scalpel and Nd:YAG laser technique: A comparative evaluation

Clinical evaluation of pain perception and surgical wound healing after lower labial frenectomy with diode laser technique: pilot study

The aim of this study was to evaluate the postoperative period of diode laser frenectomies of the lower labial frenulum (LLF) with anomalous insertions and the perceptions of postoperative pain and wound healing. This cross-sectional pilot study evaluated 3 patients who underwent mandibular labial frenectomy with a diode laser between April 2024 and July 2024. Individuals were divided into two groups according LLF insertion type and the parameters evaluated were gender, age, traumatic brushing, dentin hypersensitivity (DH), traumatic brushing, postoperative pain presence, healing, analgesic use and periodontal parameters, with follow-up occurring up to 90 days after frenectomy. Statistical analyses were performed by frequency of categorical variables, Fisher's exact test and G test were used for intra and intergroup comparisons and the Wilcoxon test was used to compare different postoperative times, with the level of significance set at 0.05 (p < 0.05). The mean age of the sample was 34.6 years and there was a predominance of female participants (n = 2/ 66.6%), we verified that 2 (66.6%) patients presented a bifurcated frenulum insertion and 100% presented mild to intense DH and gingival recession. In the postoperative period, 100% of individuals reported pain and visual dissatisfaction with the scar until the 4th day of follow-up and after 30 days of follow-up only 1 individual remained with pain and visual dissatisfaction with the scar and no evaluated parameter showed statistical significance. Diode laser frenectomy proved to be effective in controlling postoperative pain, improving healing and reducing bleeding.

Untying the Knot: Frenectomy of Lip and Tongue Ties Using Diode Lasers

Frenulum attachments in the oral cavity are pivotal, and any abnormality in their position leads to various issues such as displacement of teeth causing diastema, improper functioning of the tongue affecting deglutition, speech, gingival recession, esthetics, and overall growth of oral musculature and alveolar ridges. Timely diagnosis and correction of frenums is essential following a conservative approach. Diode lasers have been widely used for multiple tissue procedures in dentistry. Due to its superior properties of precise cutting with a blood-free surgical site, minimal pain and discomfort, and minimal need of local anesthesia, laser-assisted frenectomy has been proved to be an efficacious treatment modality in pediatric patients, alleviating stress and anxiety for both children and their caregivers. Thus, a case report of pediatric patients with grade II superior labial frenum (SLF) attachment and class II ankyloglossia treated with diode lasers is presented.

Diode Laser Intended Frenotomy Procedure for High Frenal Attachment Causing Gingival Recession: A Case Presentation

The alveolar mucous membrane, the gingiva, and the underlying bone are fixed to the lip and cheek by the frenum, a fold in the mucous membrane. The surgical process known as a frenectomy involves completely removing the frenum that connects it to the bone. Traditional frenectomy involves using a blade, while a more recent technique is frenectomy assisted by a laser. When the frenum has an atypical connection, a labial or lingual frenectomy is performed. In this instance, there is an abnormal frequency of attachment, which puts the patient's appearance, causing midline diastema and plaque control, at serious risk and could result in mucogingival impairment. This case study describes how diode laser therapy was used to successfully treat a female patient who was suffering from sensitivity.

Assessment and Management of Maxillary Labial Frenum-A Scoping Review

BACKGROUND

The maxillary labial frenum (MLF) is a soft tissue fold connecting the upper lip to the alveolar process. Abnormal attachment can cause periodontal, functional, and esthetic problems. Differential diagnosis is important and can prevent unnecessary interventions. This study aims to summarize the current evidence on the assessment and management of abnormal MLF.

METHODS

A thorough review of the literature was conducted. Five online databases were searched for relevant peer-reviewed human studies. Article screening and data extraction were performed independently by two reviewers using predefined inclusion/exclusion criteria. Information about article type, study design, participants' characteristics, interventions, and outcomes was extracted and synthesized.

RESULTS

52 articles met the review criteria. MLF is a dynamic structure characterized by a wide normal morphological variation. MLF assessment in infants has not been standardized. Studies in pre-adolescents reported a change in the thickness and position of the MLF observed over time, resulting in a lower prevalence of abnormal MLF morphology. Studies in adolescents and adults reported variable differential diagnosis criteria. Lasers appear as the most advantageous frenectomy modality.

CONCLUSIONS

There is a need for more objective MLF diagnostic protocols and treatment guidelines, which could prevent unnecessary surgical interventions.

Maxillary labial frenectomy: a randomized, controlled comparative study of two blue (445 nm) and infrared (980 nm) diode lasers versus surgical scalpel

BACKGROUND

This study aimed to compare the intra and postoperative complications of frenectomy procedure with a surgical scalpel versus 445 nm and 980 nm diode lasers.

METHODS

This randomized controlled clinical trial was conducted on 174 patients requiring maxillary labial frenectomy. After completion of fixed orthodontic treatment and primary closure of maxillary diastema, the patients were randomly assigned into three groups (n = 58): group 1 (frenectomy via 445 nm diode laser, continuous-wave, 1.5 W), group 2 (frenectomy via 980 nm laser, continuous-wave, 1.7 W), and control group (V-Y plasty technique via scalpel). Intra-operative bleeding, discomfort in chewing and speaking, pain, and tissue healing were compared among the groups immediately, at 7 and 30 days postoperatively using the Kruskal-Wallis, Mann-Whitney, and Chi-square tests.

RESULTS

Pain scores were significantly lower in group 1 compared to group 2 (immediately and day 7, P < 0.05). Significant faster tissue healing at days 7 and 30 were observed in group 1 compared to group 2 (P < 0.05). Group 1 was superior to the control group regarding lower intraoperative bleeding, discomfort in chewing and speaking (immediately and day 7), lower pain (immediately and day 7), and tissue healing (day 7) (P < 0.05 for all). Group 2 was significantly superior to the control group in lower intraoperative bleeding, discomfort in chewing and speaking (immediately and day 7), and better tissue healing (day 7) (P < 0.05 for all).

CONCLUSIONS

In conclusion, diode laser frenectomy resulted in significantly lower intra and postoperative complications compared to the scalpel. Moreover, 445 nm diode laser showed significantly superior effects compared to 980 nm diode laser.

TRIAL REGISTRATION

The study protocol was registered on 29.10.2022 at the Iranian Registry of Clinical Trials ( www.irct.ir ) (registration number: IRCT20220630055326N1).

Conventional Frenectomy With Topical Ozonated Oil Application

The frenum is a mucous membrane fold that connects the lip and cheek to the gingiva, periosteum, and alveolar mucosa. When the frena are linked too closely to the gingival border, there may be issues with plaque removal, and the overall gingiva may be affected. In addition, the maxillary frenum may provide aesthetic difficulties or interfere with the aesthetic outcome in cases of midline diastema, which may result in a recurrence after treatment. A labial frenectomy, a frequently performed surgical operation in the specialty of dentistry, is used to address such an abnormal frenum. This article describes a case study of a maxillary labial frenectomy using a traditional scalpel approach and topical application of ozonated olive oil.

A Comparative Study of Mucosal Wound Healing after Excision with a Scalpel, Diode Laser, or CO2 Laser

We aimed to compare the clinical and histological secondary healing effectiveness of various types of high-level laser versus scalpel excision in mucosa frenectomy.

Methods

Forty-five Sprague Dawley rats were used in this study. These rats were divided into two laser intervention groups (CO2, n = 15; diode, n = 15) and one control group with scalpel excision (n = 15). The effectiveness of therapy has been assessed based on the comparison of intraoperative, postoperative, and histological parameters on days 7, 21, and 35, and postoperative weight changes as pain indicator.

Results

Both laser groups demonstrated significantly (P < 0.05) less bleeding than did the control group during the intraoperative stage, whereas the CO2 laser showed more precise cutting compared with the diode laser (P < 0.05). The highest healing score was reported in the CO2 and scalpel groups on the first week of healing than in the diode group (P < 0.05). However, no significant difference was observed between the groups on days 21 and 35. Weight loss was significantly (P < 0.05) demonstrated in the diode group compared to the scalpel and CO2 groups till day 7. Both laser groups demonstrated delayed healing process compared with the scalpel. Nevertheless, the CO2 group followed the scalpel trends after day 7.

Conclusion

Scalpel and CO2 laser yielded a superior clinical outcome compared with the diode excision of oral mucosa, whereby the CO2 has been proposed as the most effective laser type at the end of the first postoperative month.

Labial Frenectomy using Laser: A Scoping Review

Labial frenectomy is a surgical technique, that aims to remove the frenulum with its attachment to the underlying bone. Frenectomy, is indicated if the frenulum attachment causes midline diastema, gingival recession, hindrance in maintaining oral hygiene, or if it interferes with lip movements and for prosthetic needs. A labial frenectomy can be performed either by the routine scalpel technique, electrocautery, and most recently medical lasers. The aim of this study was to evaluate, whether the laser technique is more effective than the conventional surgical technique, and whether there are differences between the different types of lasers. The scoping review was conducted and prepared on the basis of the indications of the PRISMA guidelines (PRISMA Extension for Scoping Reviews, PRISMA-ScR) of PRISMA checklist, and nine papers were considered admissible to the qualitative analysis for the following outcomes: bleeding during intervention, use of sutures, duration of the intervention, and use of analgesic drugs in the days following the intervention. This review suggests that laser-performed labial frenectomy is faster and offers better intra- and postoperative management; however, due to the limited number of available papers, the final results of the present review are not absolute.

[Lingual frenectomy with ND:YAG laser. case report]

Ankyloglossia is considered a congenital patology, whose treatment indicated is a frenectomy, this surgical technique consists in remove the tissue that joins the tongue with the floor mouth. This technique allows the patient a considerable improvement to limitations caused by this anomaly such as difficulties in suction, pronunciation, chewing and difficulty in touching the lower lip with the tip of the tongue. Currently the use of laser technology and its benefits in modern dentistry, allows the realization of surgical procedures free of bleeding, with very little pain and inflammation of the tissues and with a recovery time much lower than necessary with conventional techniques. The present clinical case, show a 12-year-old patient with severe ankyloglossia, lingual frenectomy was indicated. A contact Nd: YAG laser was used, achieving a surgical intervention with little pain, free bleeding and without suture.

Comparative frenectomy with conventional scalpel and dual-waved laser in labial frenulum

Aim

The purpose of the study is to compare the labial frenectomy between the laser surgery (erbium yttrium aluminum garnet and neodymium-doped yttrium aluminum garnet (Er:YAG and Nd:YAG)) and the scalpel method.

Methods

The trial was a randomized controlled test. Thirty four patients aged from 5 to 10 years requiring the frenectomy were included in this study. Patients were randomly divided into two groups: group A: Er:YAG and Nd:YAG laser group and group B: scalpel group. In addition, this comparison considered the following factors: surgical time and Visual Analog Scale (VAS) pain score, which includes intraoperative pain, postoperative pain and complications, such as speaking and chewing, for 1 day and 7 days following labial frenectomy. After 3 months, we recorded the healing outcome by photos.

Results

There was a statistically significant difference in mean surgical time between laser surgery (mean=224±59 s) and scalpel surgery (mean=740±168 s). According to VAS scores of the intraoperative period (3 hours after the operation and 1st postoperative day of pain), chewing and speaking were statistically higher in group B than those in group A; but in the 7th postoperative day of pain, there was no significant difference in speaking and chewing. After 1 month, all of the patient results were recorded, including the healing of wound and scar. Except for one patient in group B who had a scar, all patients achieved good results.

Conclusion

Based on the results of this study, it can be concluded that Nd:YAG laser is an efficient and more comfortable alternative to the scalpel for a frenectomy in upper lip frenulum.

Clinical Comparison of Diode Laser Assisted “v-Shape Frenectomy” and Conventional Surgical Method as Treatment of Ankyloglossia

(1) Background: Ankyloglossia, or tongue-tie is a condition, in which the tip of tongue cannot protrude beyond the lower incisor teeth because of short frenulum linguae, often containing scar tissue. Limitations of movement are the most important clinical symptoms of this condition, together with feeding, speech, and mechanical problems. (2) Methods: the present study included two groups of patients (group A and group B) including, respectively, 29 and 32 patients (61 patients total), aged from 8 to 12 and presenting ankyloglossia classified according to the Kotlow’s classification. The patients in group A underwent a common surgical procedure. For the patients of group B, a diode laser device (K2 mobile laser, Dentium, Korea) with a micro-pulsed wavelength of 980 ± 10 nm and power of 1.2 watts was used. The post-surgical discomfort of the patients (recording the pain perceived immediately after the end of the anesthesia and during the following week, using the Numeric Rating Scale (NRS) system) and healing characteristics (recorded using the Early Wound Healing Score or EHS) were evaluated. (3) Results: The results shows that the pain in the patients who underwent laser-assisted frenectomy is significantly reduced (p < 0.001) when compared to those who underwent conventional surgical frenectomy, both immediately after surgery (with a reduction in the average NRS of 80.6%) and after the first week (with a reduction in the average NRS of 86.58%). Additionally, in the same patients, an augmentation in the average value of the EHS of 45% was recorded, highlighting significantly (p < 0.001) better quality in the healing of the wound within the 24 h after surgery. Moreover, other advantages observed in the use of laser assisted-frenectomy are the absence of bleeding and, consequently, a clear operative field; no need to use sutures; no need to take painkillers or antibiotics after surgery; and having a faster recovery and less time needed to perform the operation. (4) Conclusions: within the limits of the present study, it seems possible to assert that the laser frenectomy performed using the v-shape technique presents a series of advantages if compared to the conventional surgical method.

Diode laser chairside frenectomy in orthodontics: A case series (DIODE LASER FRENECTOMY: CASE SERIES)

Offering the whole orthodontic and surgical treatment to the patient as a single package in a one office can save them considerable time and the trouble. Diode laser enables orthodontists to do so while enjoying its benefits over the scalpel.

Frenal attachment and its association with oral hygiene status among adolescents in Dakshina Kannada population: A cross-sectional study

BACKGROUND AND OBJECTIVE

Frenum is a mucous membrane fold that attaches the lip and the cheek to the alveolar mucosa, gingiva, and the underlying periosteum. The frena may jeopardize the gingival health when they are attached too closely to the gingival margin, either due to interference in the plaque control or due to muscle pull. Identifying labial frenum attachment and its association with oral hygiene helps in primary prevention of gingival health. The purpose of this study was to examine the prevalence of the various types of maxillary labial frenum attachment and its association with oral hygiene status in adolescent population.

METHODOLOGY

A total of 300 adolescents between 13 and 18 years were selected randomly. They were clinically examined for maxillary frenum attachment. Placek's classification of the labial frenum attachments was used to check the origin of frenum. Oral hygiene index (simplified) was recorded and results were subjected to statistical analysis.

RESULTS

Among 300 examined children 53% were males and 47% were females. The prevalence of the maxillary labial frenum was gingival type (39%) followed by mucosal (28.3%), papillary (23.7%), and papillary penetrating type (9.0%). The gingival type of frenal attachment was statistically significant among different age of children and also between different types of frenal attachment and oral hygiene status (p value < 0.001). There was no significance between frenum attachment and gender.

CONCLUSION

The type of frenal attachment is strongly associated with oral hygiene status. as the age progresses the frenum tends to migrate apically. However, our study did not reveal any relationship between the gender and type of frenal attachment.