|Year : 2012 | Volume
| Issue : 1 | Page : 30-32
Laser-assisted diastema closure
Department of Conservative Dentistry and Endodontics, M.A. Rangoonwala College of Dental Sciences, Pune, India
|Date of Web Publication||15-Sep-2012|
Department of Conservative Dentistry and Endodontics, M.A. Rangoonwala College of Dental Sciences, Pune
Source of Support: None, Conflict of Interest: None
Frenectomy is a common soft tissue procedure in the field of aesthetic dentistry. It prerequisites for many corrective and aesthetic treatments. Lasers have proved as a Midas touch for soft tissue procedures. Use of lasers is advantageous as there is no bleeding and pain during the procedure. Patients are comfortable during and post treatment. Here is a case of 36-year-old male with high labial frenal attachment between maxillary incisors who needed frenectomy followed by diastema closure.
Keywords: Diastema, frenectomy, laser
|How to cite this article:|
Sathe S. Laser-assisted diastema closure. J Dent Lasers 2012;6:30-2
| Introduction|| |
Soft tissue management is an integral part of dental treatment. For aesthetic treatment, it is utmost important to understand and manage gingival and mucosal tissue to achieve desirable results. Aesthetic treatments like composite restorations of anterior teeth or direct or indirect veneers or diastema closure or designing a smile of the patient demand soft tissue managements.
Diastema is one of the challenging situations in our clinical practice. Diastema is the space between two teeth. The most common condition that we come across is the diastema present between maxillary central incisors, where aesthetics is demanding. In addition to aesthetics, phonetics is also affected. Treatment of diastema has multifold objectives, such as to improve aesthetics and phonetics of the patient, which helps to uplift the confidence and improves personality. 
Before deciding the treatment plan of the patient, it is utmost important to know the cause of diastema. (r) Causes of diastema include congenitally missing teeth, undersized or malformed teeth, habits such as tongue thrusting or thumb sucking or periodontal diseases. One of the most common reasons is a prominent labial frenum that extends interproximally between the central incisors. Labial frenum is the normal anatomic landmark. Frenum is a thin band of fibrous tissue. , When this frenal attachment is thick, and is attached at a higher level at the crest of the alveolar ridge, it may cause space between the two central incisors. It is very essential to take care of the causes and then correct diastema.
Frenectomy is the procedure to cut the labial frenal attachment by cutting the muscle fibers so that the attachment is rep ositioned near the vestibule.  Frenectomy is done conventionally surgically with the help of blade. As it is a surgical procedure, it is associated with bleeding, which is, at times, uncomfortable and unacceptable to the patient. It can also be associated with swelling and is prone for infection. (r) But, with the invention of lasers, it is now possible to perform soft tissue surgery with great precision without much complication. There is no bleeding and pain and, therefore, the patient is very comfortable. We can expect sterilization of the surgical site due to laser energy and heat energy. Surgical dressing is not required. We can use different lasers for frenectomy, such as Nd-YAG, Er-YAG, Diode, CO2. 
| Case Report|| |
Here is the classic case of diastema between maxillary central incisors caused due to high labial frenum. As seen in the photograph, there is diastema of about 5-6 mm. The patient is a 36-year-old male who reported to the dental clinic with the complaint of space between two front teeth, and desired aesthetic treatment [Figure 1].
A thorough case history was taken and aetiology was confirmed. He had discoloration of upper right central incisor and history of trauma few years back. After confirming on radiograph, it was decided to perform root canal treatment of the affected central incisor, followed by frenectomy.
Local anesthesia was administered. The upper lip was reflected and stretched. It was decided to use a diode laser of 980 nm wavelength to perform the labial frenectomy. The procedure was explained to the patient and informed consent was recorded.
A 400 micron fiber of diode laser (980 nm) was used. Parameters were 2.5 W at continuous mode.  The frenal attachment was relieved by cutting the muscle fibers. There was no bleeding [Figure 2]. No sutures were required. The patient was also very comfortable.
After 1 week, healing was observed at the surgical site. There was no infection. Make covers as covered. 
After 3 weeks, we completed the treatment by giving zirconia crowns on central and lateral incisors [Figure 3]. Because the diastema was moderately large, composite build up of the mesial surface of the left central incisor was also performed to achieve desirable results [Figure 4].
| Conclusion|| |
Frenectomy can be performed with lasers most effectively with very good results. Patient acceptance is high. Because there is no bleeding and pain, patients are comfortable.
| References|| |
|1.||Roberson TM, Herald O Heymann, Edward J Swift. Sturdevant's Art and Science of Operative Dentistry, 4 th ed. |
|2.||Hupp JR. Wound repair. In: Peterson LJ, Ellis E, Hupp JR, Tucker MR, editors. Contemporary oral and maxillofacialSurgery. 3 rd ed. St Louis: Mosby; 1998. pp.231-7. |
|3.||Rose LF, Mealey BL. Genco RJ, Cohen DW. Periodontics: medicine, surgery, and implants. Ed. Elsevier Mosby 2004, St Louis, Missouri.Pg-726. |
|4.||Malik N. Text Book of Oral and Maxillofacial Surgery. New Delhi, India: JP Brother Medical Publishers; 2008. pg 427-8. |
|5.||Lasers in clinical Dentistry, October 2004, D.C.N.A |
|6.||Desiate A, Cantore S, Tullo D, Profeta G, Grassi FR, Ballini A. 980 nm diode laser in oral and facial practice: current state of the science and art. Int I Med Sci 2009;6:358-64. |
|7.||A. Moritz, F. Beer, K. Goharkhay, U. Schoop, M. Strassl, P. Verheyen, L. Walsh, J. Wernisch, E. Wintner (ed.): "Oral Laser Application"; Quintessenz Verlags-GmbH, Berlin, 2006, ISBN: 1-85097-150-1; p 271. |
[Figure 1], [Figure 2], [Figure 3], [Figure 4]