Apport de la technique combinée gingivectomie-frénectomie dans la prise en charge d'un accroissement gingival associé à un frein pathologique: à propos d'un cas / contribution of the combined gingivectomy-frenectomy technique in the management of gingival growth associated with a pathological frenulum: about a case

Introduction : La prise en charge de l'accroissement gingival repose sur un entretien médical bien mené, un examen clinique rigoureux, un diagnostic bien posé et une exérèse chirurgicale. Cependant, une récidive de la lésion peut être observée avec un rendu gingival souvent inesthétique. L'objectif de ce travail était d'illustrer, à travers un cas clinique, l'apport de la gingivectomie et de la frénectomie dans la prise en charge d'un accroissement gingival associé à un frein pathologique. Observation : Il s'agissait d'un patient âgé de 27 ans, venu consulter pour un problème esthétique lié à une excroissance gingivale. L'examen exo-buccal a mis en évidence, une asymétrie faciale dans le sens horizontal. La lésion gingivale était visible au sourire et évoluant depuis plus de 5 ans. L'examen endo-buccal a relevé la présence d'une gingivite induite par le biofilm, d'un frein de type 4 de Placek associés à un accroissement gingival pédonculé saignant au contact et siégeant entre la 11 et la 21. Après la thérapeutique initiale et une réévaluation, une gingivectomie à biseau interne (GBI) associée à une frénectomie ont été réalisées. L'examen anatomo-pathologique a mis en évidence un épulis fibreux ou fibrome périphérique avec absence de signes histologiques de malignité. L'évolution après 6 mois est marquée par une muqueuse gingivale cliniquement saine avec absence de récidive. Conclusion : L'apport de la gingivectomie et de la frénectomie est un atout important en termes de résultat clinique et de limitation de récidives dans l'exérèse des excès gingivaux combinés à un frein labial pathologique.

Introduction: Gingival growth is a change in the size and/or multiplication of cells, the gingival vascular system and the extracellular matrix. Management is based on a wellconducted medical interview, a rigorous clinical examination, a well-made diagnosis and surgical excision. However, a recurrence of the lesion can be observed with an often unsightly gingival rendering. The objective of this work was to illustrate, through a clinical case, the contribution of gingivectomy and frenectomy in the management of gingival growth associated with a pathological frenulum. Observation: It was a patient aged 27 who came to consult for an aesthetic problem related to a gingival growth. The exo-oral examination highlighted, a facial asymmetry in the horizontal direction. The gum lesion was visible on the smile and had been evolving for more than 5 years. The endooral examination noted the presence of biofilm-induced gingivitis, a type 4 Placek frenulum associated with pedunculate gingival growth bleeding on contact and sitting between 11 and 21. After initial therapy and reassessment, an internal bevel gingivectomy (IGG) combined with frenectomy was performed. The anatomo-pathological examination revealed fibrous epulis or peripheral fibroid with absence of histological signs of malignancy. The evolution after 6 months is marked by a clinically healthy gingival mucosa with no recurrence. Conclusion: The contribution of gingivectomy and frenectomy is an important asset in terms of clinical outcome and limitation of recurrence in the excision of excess gingival combined with a pathological labial frenulum.

Management of a patient with angle class I Malocclusion with Anterior Crossbite and Maxillary Central Diastema caused by high attachment of the Maxillary Labial Frenulum

@#Maxillary Central diastema is common and normal for the growth and development of the anterior segment. If the central diastema persists after the eruption of the permanent cuspids, the orthodontist should clarify the etiology and establish a treatment plan. This case report discusses a 22-year-old woman with anterior crossbite and central diastema due to a high maxillary labial frenulum attachment. Treatment was performed using a fixed orthodontic appliance with a posterior bite raiser. Frenectomy was performed at the end of the orthodontic treatment.

Diagnóstico e tratamento cirúrgico do freio labial com inserção marginal: relato de caso / Diagnosis and surgical treatment of labial frenulum with marginal insertion: a case report

O freio labial é uma estrutura presente em todos os indivíduos que em alguns casos pode apresentar-se mal posicionado, gerando efeitos adversos importantes, como formação de diastemas, mal adaptação de prótese, inibição dos movimentos dos lábios e língua, inflamação gengival, retração gengival e perda óssea. O presente estudo foi realizado com objetivo de relatar o diagnóstico e tratamento de um caso clínico de freio labial inferior com inserção marginal, causando retração gengival. Paciente de 39 anos de idade, gênero feminino, apresentou-se com acúmulo de biofilme e retração gengival entre os incisivos centrais inferiores. Após o exame clínico e a constatação da presença de freio labial inferior com inserção na gengiva marginal e ausência de gengiva queratinizada, optou-se pelo tratamento cirúrgico por meio da frenectomia labial inferior. Após o período de 45 dias do procedimento cirúrgico, o processo de reparo estava adequado, a paciente não relatou sintomatologia dolorosa, não havia sinais de infecção e houve uma melhora na qualidade de gengiva inserida. Pode-se concluir que, desde que bem indicada, através de um diagnóstico correto, a frenectomia labial pode resultar em um bom prognóstico e melhora da qualidade da gengiva inserida. (AU)

The labial frenulumis a structure present in all individuals that in some cases may be poorly positioned, generating important adverse effects such as diastema formation, maladaptation of prosthesis, inhibition of lip and tongue movements, gingival inflammation, gingival retraction and bone loss. The present study was carried out with the objective of reporting the diagnosis and treatment of a clinical case of lower labial brake with abnormal insertion, causing gingival retraction. A 39-year-old female patient presented with biofilm accumulation and gingival retraction between the lower central incisors. After the clinical examination and observation of the presence of a lower labial frenulum with marginal gingival insertion and absence of keratinized gingiva, surgical treatment was chosen by means of the inferior labial frenectomy. After the 45-day period of the surgical procedure, the repair process was adequate, the patient did not report painful symptoms, there were no signs of infection and there was an improvement in the quality of attached gingiva. It can be concluded that, since well indicated through a correct diagnosis, the lip frenectomy can result in a good prognosis and improvement of the quality of the attached gingiva. (AU)

Description of the Upper Labial Frenulum Characteristics in Preschool Children of Passo Fundo, Brazil

Objective: To describe the morphological and insertion characteristics of the Upper Labial Frenulum in preschool children of Passo Fundo, Brazil. Material and Methods: This cross-sectional study performed clinical tests in 304 children aged 0-6 years enrolled in Early Childhood Education Schools of Passo Fundo. The five investigators were previously trained and calibrated. Children were examined in the classroom with natural light. The clinical examination consisted of upper lip distension for viewing and classification according to morphologic criteria and upper labial frenulum insertion. Demographic (ethnicity, age and gender) and clinical variables (morphologic aspects and the upper labial frenulum insertion) were collected. Data were processed and descriptive statistical analysis was performed. Results: Most of the evaluated preschoolers were white (71%) and aged 37-60 months (50%). The most prevalent labial frenulum type was simple, found in 77.3% of children, followed by simple with appendix (8.6%), and persistent tectolabial frenulum (8.6%). The most prevalent insertion type was attached gingiva in 51% of cases. Conclusion: This study found that in the study sample, considering simple, simple with nodule and single with appendix, they are the majority. In most cases, labial frenulum insertion is found in the attached gingiva. Only a small proportion shows penetrating insertion. Thus, the prevalence of normal labial frenulum is high, suggesting the follow-up of the labial frenulum characteristics in preschool children.

Tratamento cirúrgico de freio labial anormal / Surgical removal of abnormal labial frenulum

O freio labial torna-se um problema se sua inserção está próxima à gengiva marginal, ou quando mantém sua inserção na papila palatina, transformando-se em uma grossa faixa de tecido denominado freio labial anormal. Esta é uma das causas do diastema interincisal. Para solucionar este problema existem cirurgias periodontais como a frenectomia e a frenotomia. O objetivo deste trabalho foi mostrar a remoção cirúrgica de um freio com inserção anormal superior, utilizando a associação das técnicas de frenectomia e de frenotomia labial. Paciente com 21 anos de idade, do sexo masculino, procurou atendimento odontológico com queixa estética, relatando constrangimento ao sorrir por seus dentes anteriores superiores apresentarem diastema. Durante exame clínico foi observado freio labial proeminente inserido na gengiva papilar dos incisivos centrais superiores, que ao ser tracionado, causava isquemia papilar. O exame radiográfico mostrou ausência de lesões patológicas. Considerando a localização da inserção do freio labial, o tratamento eleito foi a frenotomia labial superior associada à frenectomia palatina. No pós-operatório de sete dias não houve relato de dor, o edema era mínimo, não havia sinais de infecção e o tecido apresentava-se com boa condição de reparo tecidual. Após seis meses, houve completa cicatrização tecidual, ausência de inflamação ou sintomatologia dolorosa e condição clínica adequada para a realização do tratamento ortodôntico. Concluiu-se que a cirurgia com associação das técnicas de frenectomia e frenotomia do freio labial pode ser considerada opção de tratamento cirúrgico seguro, com prognóstico favorável em longo prazo.

Labial frenulum becomes a problem if their insertion is near the marginal gingiva, or when you keep their insertion in the palatine papilla, turning into a coarse band of tissue, called abnormal labial frenulum. This is one of the causes of interincisal diastema. To solve this problem there are periodontal surgery as frenectomy and frenotomy. The objective of this study was to demonstrate the surgical removal of a brake with upper abnormal insertion, using the association of frenectomy and frenotomy labial techniques. Patient 21 years of age, male, came for dental care esthetic complaint, reporting constraint to smile for your upper front teeth present diastema. During clinical exam was observed prominent labial frenulum inserted in the papillary gingiva of the maxillary central incisors, that to the being tractioned, was causing papillary ischemia. Radiographic exam present with the absence of pathologic lesions. Considering the location of the insertion of the labial frenulum, treatment was elected the upper labial frenotomy associated with palatine frenectomy. Postoperatively 7 days there was no report of pain, the edema it was minimal, there were no signs of infection and the tissue presented with good condition of tissue repair. After 6 months, there was complete tissue healing, absence of inflammation or painful symptomatology and adequate clinical condition for the completion of orthodontic treatment. It is concluded that surgery with a combination of techniques of frenectomy and frenotomy the labial frenulum can be considered safe surgical treatment option with a favorable prognosis in the long term.

Aesthetic improvements in free gingival graft due to its association with frenectomy

Introduction: The insufficient amount of attached gingiva and the abnormal insertion of the labial frenulum may be related. When this occurs, it is common to associate frenectomy techniques with free gingival graft (FGG). Objective: To evaluate the clinical and histological staining difference and blood flow when the FGG is or is not associated with frenectomy. Material and methods: Ten patients were selected in the Dentistry Clinics of the Positivo University and divided into two groups (n = 5): group GF (graft/frenectomy), with association of FGG and frenectomy in the V sextant, and group G (graft), in which only the FGG was performed in the V sextant. Clinical examination, initial standardized photographs and post-surgery following-up for seven, 14 and 21 days were executed. For histological analysis the excesses of the graft tissues of a patient from each group were removed. Results: Clinically, it was observed in both groups after seven and 14 post-operative days, superficial necrosis of the tissue and color similar to the surrounding soft tissue. At 21 days, there is the total reduction of the necrosed tissue, and it was not seen the color difference between groups. Histologically, the difference between groups is related to the epithelial tissue, which was thicker in group G. Conclusion: Clinical (color) and histological (vascularization) significant differences were not observed between groups GF and G.

Descrição da morfologia dos frênulos labiais superiores em escolares de Teresina / Description of the Morphology of Upper Labial Frenulum in Students from Teresina

O objetivo desta pesquisa foi o de fazer um levantamento da prevalência dos diferentes tipos de frênulos labiais superiores, além de suas inserções em escolares de Teresina - PI. Para tanto, foram realizados exames clínicos em 300 escolares com idades entre 7 e 10 anos. As crianças foram escolhidas ao acaso, e o exame consistiu na distensão do lábio superior com o auxílio dos dedos de um único examinador, envoltos por gaze,sendo os achados anotados em ficha padronizada. Foi utilizada a classificação dos frênulos labiais superiores proposta por Sewerin (1971) e das inserções proposta por Placek et al. (1974). Os dados foram processados através do programa de computação SPSS, sendo a análise estatística do tipo descritiva. O frênulo labial de maior prevalência foi o simples, seguido do teto-labial persistente, simples com nódulo, coincidência de duasou mais variações ou anormalidades, simples com apêndice, com recesso, bífido e duplo. O tipo de inserção mais prevalente foi a inserção na mucosa alveolar, seguida da gengiva inserida, papila interdental e penetrantena papila

The objective of this paper was to estimate the prevalence and attachment of different kinds of upper lip frenulum in students from Teresina - PI. A sample of 300 students aged 7 to 10 years were clinicallyexamined. The children were chosen at random and the examiner distended their upper lip just using his fingers wrapped up in gauze. The findings were recorded on a standard chart. The classification for upperlabial frenulum proposed by Sewerin (1971) and that of the attachments proposed by Placek et al. (1974) were used The data were processed using the computation program SPSS and descriptive statistical analysis. The simple upper labial frenulum showed the largest prevalence, followed by the persistent tectolabial, simple with nodule, coincidence of two or more variations or abnormalities, simple with appendix, with recess, bifid and double. The attachment to alveolar mucous was the most prevalent, followed by inserted gum, interdental papilla and penetrating in the papilla attachments.