Effects of topically administered 0.6% hyaluronic acid on the healing of labial frenectomy in conventional and 940-nm indium gallium arsenide phosphide (InGaAsP) diode laser techniques in pediatric patients: a randomized, placebo-controlled clinical study

This study aimed to investigate the effects of 0.6% hyaluronic acid (HA) gel on the healing process and postoperative pain levels after diode laser-assisted labial frenectomy in pediatric patients. Ninety-six pediatric patients (females, 50 and males, 46) aged 8-14 years were randomly divided into four groups as follows: (1) conventional frenectomy with 0.6% topically administered HA (CFH, n = 24); (2) conventional frenectomy with placebo gel (CFP, n = 24); (3) frenectomy performed by diode laser with 0.6% topically administered HA (DLH, n = 24); and (4) frenectomy performed by diode laser with placebo gel (DLP, n = 24). HA application was continued for 1 week thrice daily after the frenectomy. Visual analog scale forms were collected from patients 1 week after the operation. In addition, the plaque index, gingival index, periodontal probing depth, and keratinized tissue width and thickness were recorded. This process was repeated 1 and 3 months after the first visit. The DLH group revealed significant differences in the probing depth, bleeding on probing, keratinized gingiva width, and attached gingiva width according to dual comparisons of the initial, first, and third-month values (p = 0.010, p = 0.007, p<0.001, and p = 0.001, respectively). Significant differences were observed between the CFP and CFH groups according to the initial and initial third-month values with regard to the bleeding on probing (p=0.019 and p = 0.019, respectively). The attached gingival thickness revealed significant differences between the CFP and CFH groups for the initial and initial-third-month comparisons (p = 0.005 and p = 0.007, respectively). The mean values of the initial and initial-third-month differences were significantly higher in the CFH group than those in the CFP group. HA- and laser-assisted labial frenectomies revealed better outcomes in terms of the probing depth, attached gingiva width, keratinized gingiva width, healing process, and postoperative comfort.

Blanket or tailored prescription of retainers in orthodontics: a questionnaire-based study

OBJECTIVE

To explore retainer protocols and how they are influenced by orthodontic presentation and the nature of occlusal correction.

MATERIALS AND METHODS

A prepiloted 45-item online questionnaire targeting orthodontists was developed. The questionnaire covered clinical preferences in terms of retainer type, fabrication, and follow-up during retention; the clinical indications for adjunctive surgical procedures; and the use of active designs to mitigate relapse in specific malocclusions.

RESULTS

A total of 206 responses were obtained. The majority of the respondents prescribed maxillary removable and mandibular fixed retainers, with almost half (49.1%) reviewing patients for more than 1 year primarily in person (95.1%). The majority prescribed vacuum-formed (69.6%) 1-mm-thick (44.3%) retainers. Only 37.3% were aware of the type of material used, with polyethylene terephthalate glycol copolymer, followed by polypropylene, being the most common. Hawley retainers were preferred following nonsurgical maxillary expansion and with suboptimal interdigitation. A preference for clear retainers and/or fixed retainers was found in open-bite cases and deep-bite cases. Supracrestal fiberotomy was prescribed commonly (61.1%) for rotations greater than 90°. No retainer was rarely prescribed except after the correction of an anterior crossbite.

CONCLUSIONS

Blanket prescription of orthodontic retention is common, with limited awareness of clear plastic retainer materials. Future trials evaluating the effectiveness of approaches for retainer prescription based on the presenting malocclusion would be timely.

Evaluation of parental perceptions of lingual and labial frenectomy on their child: a comparison of CO2 laser and conventional scalpel

To evaluate parental reports of postoperative pain, improvement and satisfaction following frenectomy with scalpel versus carbon dioxide (CO2) laser treatment. Forty-nine patients aged 2-6 years with a short labial or lingual frenulum who required frenectomy were randomly assigned to undergo CO2 laser or scalpel treatment. They were divided into a labial and a lingual frenulum group based on the severity of attachment. Frenectomy was performed using a scalpel or Pixel CO2 10,600 nm laser (Alma Lasers Company, Caesarea, Israel). Postoperative follow-up was conducted via a mobile application where pain was evaluated daily using the visual analog scale (VAS) in the first 72 hours, and painkiller use was recorded. Improvement and satisfaction were evaluated at 1-month post-surgery and compared among the groups. Our results showed significant differences between the degree of clinical attachment of the frenulum, one-month postoperative improvement and satisfaction based on VAS scores (p < 0.001). Although the use of scalpel was associated with lower postoperative pain scores than the CO2 groups, VAS scores of improvement and satisfaction after 1 month were higher in the CO2 groups (p < 0.05). This study showed that although laser was associated with more postoperative pain, it showed greater improvement and higher satisfaction among patients' parents at 1 month post-surgery compared with scalpel.

Tongue-tie and breastfeeding

OBJECTIVE

To evaluate the efficiency of maternal breastfeeding and maternal pain pre- and post-lingual frenulum release procedures in infants with ankyloglossia.

METHODS

Infants under 4 months of age with tongue-tie who were actively breastfeeding, and their mothers (mother-infant dyads) were recruited. Infants' ankyloglossia severity was evaluated using the Coryllos® ankyloglossia tongue-tie grading scale. Each mother completed a pre-procedure questionnaire where breastfeeding efficiency was evaluated using the LATCH® criteria. Each mother also reported a numeric score of pain with feeding, breastfeeding time, and a perceived feeding efficiency score. After the tongue-tie release procedure, each mother completed a post-procedure questionnaire within a 1-week to 1-month window to assess the change in breastfeeding efficiency using the LATCH® criteria, breastfeeding pain, breastfeeding time, and perceived breastfeeding efficiency.

RESULTS

41 mother-infant dyads participated in the study. No surgical complications occurred during or post-procedure. All dyads reported improved (40) or equal (1) LATCH® scores: with a mean improved LATCH® score of 3.2 points (p < 4^10^-15, 95% CI 2.6, 3.7.). The mean improved maternal perception of feeding was 3.3 points (p < 6^10^-10,95% CI 2.6, 4.0.), the mean decreased maternal pain was 4.0 points (p < 1^10^-14, 95% CI 3.3, 4.8), and the mean decreased maternal feeding time was 0.80 points (p = 0.002, 95% CI 0.5, 1.1.).

CONCLUSION

Lingual frenulum release procedures appear to consistently improve breastfeeding efficiency and decrease maternal pain.

Labial frenectomy

OBJECTIVES

To obtain views of orthodontists in the United Kingdom on frenectomy in terms of its indications and timing and a recommended retention regimen after correction of median diastema.

MATERIALS AND METHODS

A 14-item online questionnaire was sent to orthodontic specialists for completion. The questionnaire covered demographics and orthodontists' experience and views on frenectomy.

RESULTS

Three hundred and fifty-three orthodontists with various background and experience responded to the survey. Three-quarters of respondents routinely performed a blanche test to aid diagnosis of the abnormal frenum; however, only 15% carried out radiographic investigation. Three-quarters of the orthodontists would consider frenectomy as a part of orthodontic treatment, and variation existed among the clinicians in terms of its timing. Frenectomy without orthodontic treatment was not preferred. There was much variation in the retention regimen after diastema closure regardless of frenectomy.

CONCLUSIONS

Complete consensus among the orthodontists was not obtained; however, some agreement was found regarding the development of a logical diagnosis and treatment approach. High-quality studies are required to produce national protocols or UK guidelines.

Association between superior labial frenum and maxillary midline diastema - a systematic review

BACKGROUND

Pediatric otolaryngologists have seen an increased focus on upper lip frenum as a possible culprit for feeding difficulties and the development of maxillary midline diastema (MMD). This increase may be encouraged by parents' exposure to medical advice over the internet about breastfeeding and potential long-term aesthetic concerns for their children. Subsequently, there has been increased pressure on pediatric otolaryngologists to perform superior labial frenectomies. There has been a reported 10-fold increase in frenectomies since the year 2000. However, there is no consensus within the literature regarding the benefit of superior labial frenectomy in preventing midline diastema.

OBJECTIVE

To provide physicians and parents with the most updated information by systematically reviewing the available literature for the association between superior labial frenum and midline diastema.

METHODS

A literature search was performed in MEDLINE (PubMed), EMBASE, Web of Science, the Cochrane Library and Dental and Oral Sciences Source (DOSS). Using the Covidence platform, a systematic review was conducted. The initial 314 articles identified underwent systematic review and 11 studies were included in the final review.

RESULTS/DISCUSSION

Available data, primarily from the dental literature, showed that two subtypes of frenum: papillary and papillary penetrating frenum, are associated with maxillary midline diastema. Superior labial frenectomy should be delayed until permanent lateral incisors have erupted, as this can spontaneously close the physiological MMD. Current literature recommends against frenectomy before addressing the diastema with orthodontics, which helps to prevent diastema relapse. It is also imperative to rule out other odontogenic and oral cavity causes of diastema, such as thumb sucking, dental agenesis, and other causes. Online information may not always be fully representative and should be interpreted in the full context of the patient's medical history before referral for surgical intervention.

Trends in outpatient intervention for pediatric ankyloglossia

OBJECTIVES

Anecdotally, there has been an increase in ankyloglossia referrals and frenotomy procedures performed in recent years. Many studies have characterized frenotomy indications and outcomes, but none have quantified how the frequency of referrals and interventions have changed over time in the outpatient setting. This study analyzes temporal trends in the diagnosis and intervention of ankyloglossia in a pediatric otolaryngology practice to further clarify how patterns of management of this condition have changed over time.

METHODS

This study was a retrospective chart review of patients evaluated for ankyloglossia in an outpatient pediatric otolaryngology clinic between 2008 and 2018. The chi-square test for trend was used to assess yearly changes in the referral numbers, surgical interventions, and procedure indication prevalence proportions of interest.

RESULTS

Referral numbers and frenotomy procedures increased as a percentage of total office visits from 2008 to 2018 (P = 0.0026, P < 0.0001). The trend in frenotomies was especially pronounced in the 0 to 2-month age group (P < 0.0001) but was not observed in the 2 months to 1-year (P = 0.30) or 1- to 4-year (P = 0.40) age groups. Frenotomy performed for concerns of feeding (P < 0.0001) increased over the study period, but there was no significant increase in procedures performed for speech concerns (P = 0.13).

CONCLUSION

Significant increases in referrals for frenotomy and number of frenotomy procedures performed are demonstrated, especially in young infants for feeding concerns. It is unlikely representative of a true increase in the incidence of ankyloglossia, but rather the result of cultural and clinical factors driving referrals and intervention.

Reduced Need of Infiltration Anesthesia Accompanied With Other Positive Outcomes in Diode Laser Application for Frenectomy in Children

Introduction: The abnormal maxillary labial frenum is common in children during the primary or mixed dentition stage. A conventional surgery for this abnormality usually requires infiltration anesthesia which leads to fear in children and consequent noncooperation during the surgery. The aim of present study was to evaluate the reduction in the need of infiltration anesthesia, intraoperative bleeding control and postoperative pain and wound healing in children when using the diode laser for abnormal labial frenum in the maxilla. Methods: The present study was carried out among 30 children attending the Hanoi Medical University, Vietnam. A Diode Laser with 810 nm wavelength and power of 0.8 W was used for frenectomy. Results: The proportion of procedures without any need of infiltration anesthesia was 70%, while 93.34% of children demonstrated positive and very positive behavior. Proportion of indolence on the first day after surgery was 83.3%. While 83.3% of children did not take any analgesics, not a single child complained of any pain 3 days after surgery. Conclusion: Our results indicated that the use of diode laser showed several benefits in maxillary labial frenectomy in children. These included reducing the need of infiltration anesthesia, increasing the children's cooperation as well as decreasing the postoperative pain.

The Esthetic Crown Lengthening by Er;Cr:YSGG laser: A Case Series

Introduction: Laser technology as a new modality in dentistry has gained special attention. Among different types of lasers, erbium lasers have gained special attention for management of oral soft and hard tissue simultaneously. This study presents series of cases of crown lengthening (CL) and restorations accomplished by erbium, chromium: yttrium-scandium-gallium-garnet (Er,Cr:YSGG). Case Reports: Seven patients were selected for this study. After complete oral examination and diagnosis, the treatment plan of each patient was designed. All cases needed esthetic CL. In some cases, frenum revision and class V cavity preparation was done by Er;Cr:YSGG laser. All patients treated with Er;Cr:YSGG laser producing a wavelength of 2780 nm (Biolase, Irvine, California, USA); Tip T4, 400 µm Diameter for soft tissue management and Tip G6, 6 mm long, 600 µm diameter for hard tissue management. Results: All patients reflected acceptable results based on clinical evaluation and patients' declaration of post-surgical status. Conclusion: Using Er;Cr:YSGG laser in class v cavity preparation and flapless CL seemed to be effective and beneficial.

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

Background:

Frenectomy is complete excision of the frenum attachment to the underlying bone. Conventional frenectomy with blade has been widely used; however, laser-assisted frenectomy is the most recent alternative.

Aim:

The present study aims to compare two methods of frenectomy for the pain experienced, intraoperative bleeding, healing outcome, and need for analgesics.

Materials and Methods:

Twenty patients with high labial frenum attachment requiring frenectomy were included in this study. Patients were randomly divided into Group A: scalpel group and Group B: neodymium-doped yttrium aluminum garnet (Nd:YAG) laser group. Visual Analog pain score, intraoperative bleeding, number of analgesics used, and healing outcome 3 months postoperatively were recorded.

Results:

Group B patients experienced less pain (P = 0.016), less bleeding (P = 0.016), and required fewer number of analgesics (P = 0.008). Healing outcome at 3 months showed no significant difference between the two groups (P = 0.095).

Conclusion:

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

What does the world think of ankyloglossia?

AIM

The diagnosis of tongue-tie (or ankyloglossia) has increased more than 10-fold in some countries. Whether this is a global phenomenon or related to cultural and professional differences is uncertain.

METHODS

An online survey in English, Japanese, Chinese and Spanish was disseminated between May and November 2016 via 27 international professional bodies to >30 clinical professions chosen a priori to represent occupations involved in the management of neonatal ankyloglossia.

RESULTS

A total of 1721 responses came from nursing (51%), medical (40%), dental (6%) and allied health (4%) clinicians. Nurses (40%) and allied health (34%) professionals were more likely than doctors (8%) to consider ankyloglossia as important for lactation problems, as were western (83%) compared to Asian (52%) clinicians. Referrals to clinicians for ankyloglossia management originated mainly from parents (38%). Interprofessional referrals were not clearly defined. Frenectomies were most likely to be performed by surgeons (65%) and dentists (35%), who were also less likely to be involved in lactation support. Clinicians performing frenectomies were more likely to consider analgesia as important compared to those not performing frenectomies.

CONCLUSION

The diagnosis and treatment of ankyloglossia vary considerably around the world and between professions. Efforts to standardise management are required.

Patient perceptions and clinical efficacy of labial frenectomies using diode laser versus conventional techniques

INTRODUCTION

The aim of present study was to compare the keratinized gingival tissue measurements, degree of subjective complaints and functional complications of using an 980nm diode laser versus a scalpel for labial frenectomies.

MATERIAL AND METHODS

Thirty-six patients requiring labial frenectomies, between 14 and 51 years old, were randomly assigned to either scalpel or diode laser treatments. The soft tissue measurements, including the keratinized gingiva width (KGW), attached gingiva width (AGW) and attached gingiva thickness (AGT), were recorded before surgery, immediately after, one week later and one, three and six months after surgery. In addition, the functional complications and the morbidity (level of pain, swelling and redness) were evaluated during the first postoperative week using a visual analog scale (VAS).

RESULTS

We determined statistically significant gains in the KGW, AGW and AGT after surgery in both groups; however, there was no significant difference between the study groups. The VAS scores indicated that the patients treated with a diode laser had less discomfort and functional complications compare with scalpel surgery.

DISCUSSION

The results described above show that diode laser surgery offers a safe, impressive alternative for labial frenectomies that are comfortable for the patients.

Lingual Frenectomy in Joubert Syndrome

AIM

Our aim is to present a case of a rare disorder, such as Joubert syndrome (JS) which required oral surgical intervention under general anesthesia at a very young age to help in achieving normal developmental milestones.

BACKGROUND

Ciliopathies are an emerging class of diseases of which JS is a significant member. There have been very few cases of JS with its distinguishing features which have been reported in recent literature.

CASE REPORT

We herewith present a case of JS who reported to our unit with a complaint of speech abnormality. Intraoral examination revealed a tongue-tie which was planned for surgical release. As any drugs that interfere with respiratory depression have to be used with utmost care, adequate precautions were taken in this case and the patient was treated under general anesthesia. The tongue-tie was released and associated ham-artomatous outgrowths from the floor of the mouth were also excised. Appropriate postoperative care was taken and the patient was discharged.

CONCLUSION

The patient treated by us did not reveal any significant intraoperative or postoperative complications. Treatment of cases of JS required a team effort of multiple dental and medical specialists. Long-term follow-up of such patients is required so that they achieve normal chronological development.

CLINICAL SIGNIFICANCE

Joubert syndrome being a rare disorder requires special anesthetic care during any surgical procedure, especially that involving the oral cavity. The need and timing of surgical intervention in such cases should be carefully assessed and appropriate precautions should be taken.

Soft Tissue Applications of Er,Cr:YSGG Laser in Pediatric Dentistry

Soft tissue laser, such as diode and Nd:YAG lasers were initially used in soft tissue lesions because of its increased success rate. It was because of the fact that these lasers were well-absorbed by chromophores, such as hemoglobin and melanin which are found abundant in the oral mucosa. The introduction of erbium family in 1990 comprising the Er:YAG and Er,Cr:YSGG lasers made the hard tissue laser a boon for dentistry. Erbium, chromium-doped yttrium, scandium, gallium and garnet (Er,Cr:YSGG) was introduced in 1997 for the surgical needs of clinical dentistry in general practice. The erbium belongs to the rare earth which is embedded in a host crystal. The actual lasing process takes place in the Er ion Er³⁺. Two host crystals consisting of yttrium, aluminum, and garnet (Y₃A₅O₁₂) and yttrium, scandium, gallium, and garnet (Y₃Sc₂Ga₃O₁₂) are added to the erbium. The interest to use these hard tissue laser in the treatment of soft tissue lesion was because of the properties of these lasers which are well-absorbed by chromophore water apart from hydroxy appetite crystals. Erbium laser energy is absorbed by collagen, hydroxyapatite, and water components. It allows the laser to cut soft tissue, tooth structure, and bone. In the noncontact mode, the incision is scalpel-like, with very little hemostasis. In contact mode, it performs soft tissue sculpting with adequate hemostasis. The Er,Cr:YSGG is the world’s most advanced dental laser, which is ideal all-tissue laser because all dental tissues contain water, for the multidisciplinary dentist who performs a broad spectrum of procedures. It delivers the highest level of clinician control, operating efficiency, flexibility in tip, and accessory selection. For optimal clinical results and patient comfort in hard and soft tissue procedures, the erbium lasers have set a new standard of clinical performance. The present case series aims to highlight the various soft tissue applications of Er,Cr:YSGG (Waterlase Biolase®, Biolase, Inc, San Clemente, California, USA) in pediatric patients.

Postoperative discomfort after Nd:YAG laser and conventional frenectomy: comparison of both genders

BACKGROUND

Evidence has suggested that males and females experience and report feeling pain differently. The aim of this study was to determine the postoperative perception levels of both females and males after neodymium-doped yttrium aluminum garnet (Nd:YAG) laser frenectomy and conventional frenectomy, and to compare the perceptions between genders.

METHODS

Eighty-nine patients requiring frenectomy were randomly assigned to have treatment with either the conventional frenectomy or with the Nd:YAG laser. Postoperative discomfort (pain, chewing, talking) was recorded using a visual analog scale (VAS) on the operation day and postoperative days 1, 3, 7 and 10.

RESULTS

According to the female VAS scores of the pain, chewing and speaking discomfort were statistically higher in the conventional group than those of the laser group on the operation day, and on the first and third postoperative days. Pain discomfort in males was statistically higher in the conventional group than those of the laser group on the operation day. Speaking discomfort in males was statistically higher in the conventional group than those of the laser group on the operation day and the first postoperative day.

CONCLUSIONS

The present study indicated that Nd:YAG laser treatment used for frenectomies provides better postoperative comfort for each gender, especially in females in terms of pain, chewing and speaking than the conventional procedure up to the seventh postoperative day. According to our results, Nd:YAG laser may provide a safe, bloodless, painless surgery and an impressive alternative for frenectomy operations.

Vestibular Extension along with Frenectomy in Management of Localized Gingival Recession in Pediatric Patient: A New Innovative Surgical Approach

This paper reports case of pediatric localized gingival recession (LGR) in mandibular anterior region which was treated by using new innovative surgical approach, i.e. combination of frenectomy and vestibular extension. These interceptive surgeries not only gained sufficient width of attached gingival but also lower the attachment of labial frenum. How to cite this article: Jingarwar M, Pathak A, Bajwa NK, Kalaskar R. Vestibular Extension along with Frenectomy in Management of Localized Gingival Recession in Pediatric Patient: A New Innovative Surgical Approach. Int J Clin Pediatr Dent 2015;8(3):224-226.

[Diagnosis and management of ankyloglossia in young children]

Ankyloglossia is a common condition. Its prevalence is between 3.2% and 4.8% depending on the series and is largely underestimated given the fact of non-diagnosis when the symptoms are limited. It is defined as a short lingual frenulum resulting in a limitation of the lingual mobility. It is due to a defect in cellular apoptosis embryogenesis between the floor of the mouth and tongue. The result is a fibrous and short lingual frenulum. Several classifications were used to make the diagnosis. However, these are the clinical implications, particularly on food and primarily breastfeeding in the baby and phonation in older children that will motivate the management. This is surgical and different techniques are available: infants before the age of 6 months and when the lingual frenulum is still a fine cellular membrane, frenotomy is recommended. Frenectomy with or without frenoplasty is indicated for the older child. The surgery is simple, the results are good and rapidly improving grievances. Complications are rare. Finally, speech therapy is important when there are implications for phonation.

Frenectomy: a review with the reports of surgical techniques

The frenum is a mucous membrane fold that attaches the lip and the cheek to the alveolar mucosa, the 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 an interference in the plaque control or due to a muscle pull. In addition to this, the maxillary frenum may present aesthetic problems or compromise the orthodontic result in the midline diastema cases, thus causing a recurrence after the treatment. The management of such an aberrant frenum is accomplished by performing a frenectomy.The present article is a compilation of a brief overview about the frenum, with a focus on the indications, contraindications, advantages and the disadvantages of various frenectomy techniques, like Miller's technique, V-Y plasty, Z-plasty and frenectomy by using electrocautery. A series of clinical cases of frenectomy which were approached by various techniques have also been reported.

Frenectomy for improvement of a problematic conventional maxillary complete denture in an elderly patient: a case report

Maxillary labial and buccal frena are considered as normal anatomic structures in the oral cavity. However, they may exist intraorally as a thick broad fibrous attachment and/or become located near the crest of the residual ridge, thus interfering with proper denture border extension resulting in inferior denture stability, retention and overall patient satisfaction. This case report highlights the importance of clinical examination and treatment planning which may mandate preprosthetic surgery prior to fabrication of a new conventional complete denture. Adequate patient satisfaction with conventional complete dentures can be significantly increased after frenectomy.

Lingual frenectomy using multiple series Z-plasty

The tongue is an important structure for speech, mastication and deglutition. Avulsion of a portion of tongue can significantly limit the range of motion thereby impairing its functions. This is the case report of a traumatically amputated tongue which was reconstructed to fulfill its function effectively. Z-plasty is one of the most commonly used soft tissue corrective procedures in plastic surgery. Here we describe the use of a modification of the Z-plasty-multiple series Z-plasty for a tongue frenectomy.