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 Table of Contents  
CASE REPORTS
Year : 2019  |  Volume : 13  |  Issue : 1  |  Page : 19-22

Diode laser frenectomy: A case report with review of literature


1 Department of Oral Medicine and Radiology, Dayananda Sagar College of Dental Sciences, Bengaluru, Karnataka, India
2 Orthodontics and Dentofacial Orthopedics, Dayananda Sagar College of Dental Sciences, Bengaluru, Karnataka, India
3 Periodontics, Dayananda Sagar College of Dental Sciences, Bengaluru, Karnataka, India

Date of Web Publication24-Jul-2019

Correspondence Address:
Dr. Preeti Patil
Department of Oral Medicine and Radiology, Dayananda Sagar College of Dental Sciences, Bengaluru, Karnataka
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/jdl.jdl_1_19

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  Abstract 

Abnormal/aberrant frenum is very common and causes various problems in function and aesthetics. It is managed by procedures such as frenotomy and frenectomy. Lasers are currently becoming popular in various fields of dentistry and provide alternative to conventional scalpel procedures. In recent years, lasers such as CO2, Neodymium-doped yttrium aluminum garnet, Erbium-doped yttrium aluminium garnet, and diode have been used for frenectomy. In this paper, we present a case of diode laser frenectomy and review various studies and reports conducted on diode laser frenectomy.

Keywords: Diode laser, frenectomy, midline diastema


How to cite this article:
Patil P, Kabbur KJ, Madaiah H, Satyanarayana S. Diode laser frenectomy: A case report with review of literature. J Dent Lasers 2019;13:19-22

How to cite this URL:
Patil P, Kabbur KJ, Madaiah H, Satyanarayana S. Diode laser frenectomy: A case report with review of literature. J Dent Lasers [serial online] 2019 [cited 2019 Aug 19];13:19-22. Available from: http://www.jdentlasers.org/text.asp?2019/13/1/19/263341




  Introduction Top


Frenum is a fold of mucous membrane, usually with enclosed muscle fibers that attaches the lips and cheeks to the alveolar mucosa and/or gingiva and underlying periosteum.[1] Placek et al.[2] have classified frenum depending on the extension of attachment of fibers, (1) Mucosal: when the frenal fibers are attached up to mucogingival junction, (2) Gingival: when fibers are inserted within attached gingiva, (3) Papillary: when fibers are extending into interdental papilla, and (4) Papilla penetrating: when the frenal fibers cross the alveolar process and extend up to palatine papilla.

According to Miller,[3] the frenum should be characterized as pathogenic when it is unusually wide or there is no apparent zone of attached gingiva along the midline or the interdental papilla shifts when the frenum is extended. These pathogenic frenums can lead to midline diastema, gingival recession, interference with retention of denture, and compromised gingival health because of poor plaque control. The management of such abnormal frenum includes frenectomy or frenotomy. In this paper, we present a case of diode laser frenectomy and review various studies and reports conducted on diode laser frenectomy.


  Case Report Top


A 20-year-old female patient undergoing orthodontic treatment for spacing in the maxillary anterior teeth was referred for the evaluation of maxillary labial frenum. On intraoral examination, midline diastema and high frenal attachment were observed. Also the labial frenum was thick and wide [Figure 1]. The patient was advised frenectomy. After detailed explanation of procedure, written consent was obtained from the patient.
Figure 1: Thick and wide labial frenum with high frenal attachment and midline diastema

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Procedure and laser parameters: Frenectomy was performed using diode laser of 980nm. The labial frenum was sprayed with topical spray and infiltration anesthesia was given to the frenum. The laser was activated before performing the procedure. Surgical tip at 400 µm was used with a power of 1.37 W and was applied in contact mode. The incision was started with the frenum from the attached gingiva and interdental papilla on the labial surface between the central incisors extending upward from inner side of upper lip to the depth of vestibule ending in a rhomboidal area causing separation of the fibers. Hemostasis was optimal and no sutures were given [Figure 2]. Safety measures were taken for the dentist, assistance, and the patient by wearing the protective goggles.
Figure 2: Immediate postoperative picture showing rhomboidal shaped laser cut with adequate hemostasis

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The patient was given verbal instructions to avoid taking hot and spicy food for a few days and to maintain meticulous oral hygiene. Postoperative analgesics were given to the patient. After 2 weeks of follow-up, significant healing was noted and after 1 month, complete healing of the surgical site with normal mucosal type of frenal attachment was reported [Figure 3].
Figure 3: One-month postoperative picture showing complete healing and normal frenal attachment

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  Discussion Top


Lasers are becoming increasingly popular in the field of dentistry providing alternative to conventional scalpel procedures. In recent years, lasers such as Nd:Yag, Er, diode, and diode in conjunction with Er:Yag have been used for frenectomy.

The diode laser was introduced in the mid-90s.[4] The diode laser contains a solid active medium and is composed of semiconductor crystals of aluminum or iridium, gallium, and arsenic.[5] Wavelengths of diode laser range from 810 to 1064nm. They are used in soft tissue surgeries as their wavelength approximates the absorption coefficient of pigmented tissue containing hemoglobin, collagen, melanin, and chromophores.

Diode lasers are becoming popular over conventional techniques because they are less invasive, which result in reduced postoperative edema. The sealing of nerve endings result in reduced inflammatory response and the formation of a protein layer over the surgical wound protects the wound from external irritation, causing less post operative pain and avoiding the use of analgesic drugs.[6] Photothermal interaction with tissue is the basic concept of surgical laser. In this process, radiant light is absorbed by the tissue and transformed to heat energy changing tissue structure. Laser light within was converted to thermal energy on contact with the tissue, causing laser tissue interaction, which when appropriately applied can produce reactions ranging from the incision, vaporization, to coagulation.[7]

For routine clinical dental treatments, pain control is quite important for patient’s physical and mental well-being as well as for the effectiveness of therapy.[8]

The laser has a coagulation effect on small vessels, which provides hemostasis and seals the sensory nerve endings, providing reduced need for anesthesia.[9]

In this case, we reported 980-nm wavelength diode laser frenectomy with no complications and excellent patient satisfaction. We used infiltration anesthesia and local anesthesia spray for the procedure. Most of the studies conducted on laser frenectomy have been performed using topical spray with or without infiltration anesthesia. However, in the study conducted by Aldelaimi and Mahmood,[10] the frenectomy was performed under sedative analgesia using midazolam and topical spray.

In the present case, the patient had no intraoperative complication such as pain, swelling, or bleeding, which is in accordance to many studies and reports.[10],[11],[12],[13] Aldelaimi and Mahmood[10] reported that of 25 patients only two experienced mild pain during first 3 days postoperatively and were given analgesics. Awooda et al.[11] in their study reported that among eight patients, one patient experienced pain and another patient had pain and swelling after the first day. However, after 1-week follow-up, good healing was reported.[14]

Patel et al.,[12] in their study, reported that the subjects treated with the diode laser had significantly less postoperative pain both on day 1 and day 7 as compared to scalpel surgery, as well as the number of analgesics used was lower in the laser group. Though the healing of laser wounds after the 7th day and 1 month was found to be delayed as compared to scalpel wound, after 3 months, no significant difference was found in healing between scalpel and laser group.[15]

In this study, near-complete healing was seen in 2 weeks and complete healing with no scar was seen after 1-month follow-up. The review of various studies conducted on diode laser frenectomy is summarized in [Table 1].
Table 1: Summary of literature on diode laser frenectomy

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  Conclusion Top


The rapid developments in laser technology and better understanding of bio-interactions of different laser systems have expanded the use of laser in dentistry. They provide an excellent alternative to conventional scalpel surgery because of patient comfort, bloodless field, and reduced pain and healing time. Owing to the small size, low cost, fiber optic delivery, and ease of use for minor surgery of oral soft tissue, diode laser has become an excellent choice for frenectomy.[21]

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Newman M, Takei H, Klokkevold P, Carranza F. Periodontal plastic and esthetic surgery. In: Carranza FA, editor. Carranza’s Clinical Periodontology. 10th ed. MO: Saunders: St. Louis, Missouri: An Imprint of Elsevier Science; 2006. p. 1023-4.  Back to cited text no. 1
    
2.
Placek M, Miroslav S, Mrklas L. Significance of the labial frenal attachment in periodontal disease in man. Part 1; Classification and epidemiology of the labial frenum attachment. J Periodontol 1974;45:891-4.  Back to cited text no. 2
    
3.
Miller PD Jr. The frenectomy combined with a laterally positioned pedicle graft. Functional and esthetic considerations. J Periodontol 1985;56:102-6.  Back to cited text no. 3
    
4.
Coluzzi DJ. Fundamentals of dental lasers: Science and instruments. Dent Clin North Am 2004;48:751-70.  Back to cited text no. 4
    
5.
Akbulut N, Kursun ES, Tumer MK, Kamburoglu K, Gulsen U. Is the 810-nm diode laser the best choice in oral soft tissue therapy? Eur J Dent 2013;7:207-11.  Back to cited text no. 5
  [Full text]  
6.
Pié-Sánchez J, España-Tost AJ, Arnabat-Domínguez J, Gay-Escoda C. Comparative study of upper lip frenectomy with the CO2 laser versus the Er, Cr:YSGG laser. Med Oral Patol Oral Cir Bucal 2012;17:e228-32.  Back to cited text no. 6
    
7.
Catone GA, Alling C. Laser Application in Oral and Maxillofacial Surgery. 1st ed. Philadelphia, PA: W.B. Saunders; 1997. p. 30-40, 115-46, 181-93.  Back to cited text no. 7
    
8.
Hsu YP, Chiang ML, Hsu MH. Maxillary frenectomy using diode laser in infants. Taiwan J Oral Maxillofac Surg 2013;24:126-33.  Back to cited text no. 8
    
9.
Strauss RA. Lasers in oral and maxillofacial surgery. Dent Clin North Am 2000;44:851-73.  Back to cited text no. 9
    
10.
Aldelaimi TN, Mahmood AS. Laser-assisted frenectomy using 980nm diode laser. J Dent Oral Disord Ther 2014;2:1-6.  Back to cited text no. 10
    
11.
Awooda EM, Osman B, Yahia NA. Use of diode laser (810) nm in frenectomy. Sudan J Med Studies 2007;2:45-7.  Back to cited text no. 11
    
12.
Patel RM, Varma S, Suragimath G, Zope SA, Kale V. Comparison of labial frenectomy procedure with conventional surgical technique and diode laser. 2015;9:94-9.  Back to cited text no. 12
    
13.
Singh P, Gulati RK, Agarwal RR, Khan F Laser assisted frenectomy—A case report. Ann Dent Specialty 2016;4: 18-9.  Back to cited text no. 13
    
14.
Khan MA, Farooqui M, Saimbi CS, Yadav SK, Saxena A. Untangle the lingual aberrant frenum by diode laser: A case report with review of literature. J Dent Laser 2016;10:34-6.  Back to cited text no. 14
    
15.
Kafas P, Stavrianos C, Jerjes W, Upile T, Vourvachis M, Theodoridis M, et al. Upper-lip laser frenectomy without infiltrated anaesthesia in a paediatric patient: A case report. Cases J 2009;2:7138.  Back to cited text no. 15
    
16.
Gargari M, Autili N, Petrone A, Prete V. Using the diode laser in the lower labial frenum removal. Oral Implantol (Rome) 2012;5:54-7.  Back to cited text no. 16
    
17.
Khan NS, Abdul N, Iqbal S. Maxillary labial frenectomy using diode laser. Report of two cases. Int J Oral Care Res 2015;2:93-6.  Back to cited text no. 17
    
18.
Ize-Iyamu IN, Saheeb BD, Edetanlen BE. Comparing the 810nm diode laser with conventional surgery in orthodontic soft tissue procedures. Ghana Med J 2013;47:107-11.  Back to cited text no. 18
    
19.
Mangalekar SB, Kaushal L, Johnson L, Soni A, Thakur P. Maxillary labial frenectomy using diode laser and classical technique: A case report. Int J Oral Health Med Res 2015;2:48-50.  Back to cited text no. 19
    
20.
Suresh S, Kumar JR. Lingual frenectomy by diode laser. Indian J Appl Res 2013;5:508-9.  Back to cited text no. 20
    
21.
Furtado GS, Ferreira WDR, Pinheiro AFdeS, Lago ADN. Lingual frenectomy with diode high-power laser in an adult patient: A case report. J Dermat Cosmetol 2018;2:56-8.  Back to cited text no. 21
    


    Figures

  [Figure 1], [Figure 2], [Figure 3]
 
 
    Tables

  [Table 1]



 

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