Superior labial frenectomy by double clamping techniche: clinical case report

The lip brake is a fold in the oral mucosa, originating in the upper lip and insertion in the alveolar mucosa. At birth, the labial frenum may be inserted in the palatal papilla. As the individual grows, he can migrate to a more upper region, featuring a normal lip curl. However, when it remains inserted in the papilla, it is a case of hypertrophic lip curl. When pathological, this structure can promote the formation of interincisal diastema, periodontal pocket, gingival retraction, aesthetic problems, difficulties in phonation and brushing. The objective of this article is to report a clinical case of upper lip frenectomy using the double clamping technique or Archer technique, performed at the Oral Minor Surgery clinic of the Dentistry School of the Federal Fluminense University, in a male patient, leucoderma, 23 years old, indicated by his orthodontist after recurrence of interincisal diastema. From the procedure performed, it can be concluded that the surgical intervention and the applied technique were effective in solving the reported clinical case.

Manejo interdisciplinario para una óptima rehabilitación oral / Interdisciplinary management for optimal oral rehabilitation

Las estrategias para el éxito en la rehabilitación bucal requieren de la interrelación de varias disciplinas que en conjunto logren resultados predecibles y duraderos. La visión individualizada de cada área de especialidad puede conllevar a no ofrecer la mejor alternativa de tratamiento, es por ello que la valoración, el diagnóstico y la planificación del caso clínico debe ser realizada por un equipo interdisciplinario para evitar esta situación y crear una sinergia en donde el «todo sea mayor que la suma de sus partes¼. El objetivo de este trabajo es presentar un caso clínico en el cual intervinieron varias áreas de especialidad: periodoncia, prostodoncia, cirugía oral y patología bucal, logrando devolver la función y la estética a través del manejo interdisciplinario (AU)

The strategies for success in oral rehabilitation require the interrelation of several disciplines, which together, achieve predictable and lasting results. The individualized view of each specialty area may lead to not offering the best treatment alternative, which is why the assessment, diagnosis, and planning of the clinical case must be carried out by an interdisciplinary team to avoid this situation and create a synergy in where the «whole is greater than the sum of its parts¼. The objective of this work is to present a clinical case where several areas of specialty intervened: periodontics, prosthodontics, oral surgery, and oral pathology, thus achieving the return of function and aesthetics through interdisciplinary management (AU)

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.

Utilización de láser diodo en tejidos blandos: reporte de 3 casos / Use of diode laser in soft tissue: report of 3 cases

Existen diversas condiciones anatómicas o alteraciones mucogingivales que pueden afectar tanto el normal funcionamiento como la estética gingival de piezas dentarias e implantes dentales. Si bien los tratamientos de estas condiciones se han realizado tradicionalmente con bisturí, el desarrollo tecnológico ha permitido que actualmente se pueden realizar con láser. Existen diferentes tipos de láser, siendo el diodo uno de los más utilizados debido a su menor tamaño, portabilidad, fácil configuración y menor costo. El láser ha adquirido mayor popularidad en cirugías de tejido blando dado sus múltiples beneficios: menor tiempo operatorio, control del sangrado y de la hemostasia, reducción de la cantidad de anestesia, posibilidad de no requerir suturas y minimización del dolor e inflamación postquirúrgica. El propósito de este trabajo es presentar la resolución de tres casos clínicos a los cuales se les realizaron los procedimientos de frenectomía labial, remoción de melanosis gingival y resección de fibroma irritativo mediante el uso de láser diodo. Para desarrollar todos los procedimientos se utilizó un equipo de láser diodo de 940 nm (Biolase®, USA) con una potencia que varió entre 2 y 2.5 W en modo continuo utilizando una pieza quirúrgica con una punta de 300 µm (E 3-4), la que fue activada antes de empezar. Posterior a la cirugía se bioestimuló para disminuir el dolor y edema postoperatorio utilizando la punta de dolor a 4 W por 30 segundos a una distancia de 1 cm directo en la zona intervenida a todos los casos. La conclusión arroja que en todos los casos, el láser de diodo permitió un resultado exitoso. El procedimiento fue seguro, la técnica fue sencilla y de tiempo clínico reducido. El postoperatorio ocurrió con ausencia de dolor o molestias, generando una mayor satisfacción del paciente. Cabe señalar que la técnica depende de la habilidad del profesional que la realiza.

There are various anatomical conditions or mucogingival alterations that can affect the normal functioning and the gingival aesthetics of teeth and dental implants. Although the treatments of these conditions have been traditionally performed with a scalpel, technological development has allowed that they can be now performed with lasers. There are different types of lasers, being the diode one of the most used due to its smaller size, portability, easy configuration, and lower cost. The laser has become more popular in soft tissue surgeries due to its multiple benefits: shorter operating time, control of bleeding and hemostasis, reduction in the amount of anesthesia, possibility of not requiring sutures, and minimization of post-surgical pain and inflammation. The purpose of this work is to present the resolution of three clinical cases which underwent labial frenectomy procedures, removal of gingival melanosis and resection of irritative fibroma using diode laser. To develop all the procedures, a 940 nm diode laser equipment (Biolase®, USA) was used with a power that varied between 2 and 2.5 W in continuous mode, using a 300 µm tip (E 3-4), which was activated before starting. After surgery, biostimulation was carried out to reduce postoperative pain and edema using the pain tip at 4 W for 30 seconds at a distance of 1 cm directly in the operated area in all cases. In all cases, the diode laser allowed a successful result. The procedure was safe, the technique was simple, and the clinical time was short. The postoperative period occurred with the absence of pain or discomfort, generating greater patient satisfaction. It should be noted that the technique depends on the skill of the professional who performs it.

Patologías del área oral en los recién nacidos e infantes: frenillos y las aportaciones de los sistemas láser / Pathologies of the oral area in newborns and infants: frenula and contributions of laser systems

El propósito de este artículo es mejorar nuestro conocimiento sobre las estructuras y función de los diferentes elementos presentes en la boca del recién nacido, ya que en ocasiones los odontólogos no recuerdan la importancia de la boca en el desarrollo general del lactante y la necesidad de una intervención temprana con láseres para ayudarles a obtener un buen estado de su sistema oral. Realizamos una exploración clínica integral del paciente con el fin de realizar un diagnóstico más preciso. Cuando la cirugía sea necesaria, recomendamos utilizar láseres de Erbio siempre que sea posible (láser de 2780nm Er, Cr: YSGG o un Er: YAG de 2940nm), ya que es una opción rápida y eficaz para tratar estas lesiones orales, especialmente los frenillos labiales o linguales que pueden poner en riesgo el acto de amamantar; Asimismo podemos utilizar láseres de diodo (810nm, 940nm, 980 nm o un láser Nd: YAG de 1064nm o de CO2 10.600- 9600 nm) con sus gafas de seguridad específicas. Estos sistemas láser utilizados por un profesional certificado, en colaboración con un personal debidamente entrenado, son un factor muy importante durante la cirugía. Al tener un conocimiento adecuado de las estructuras orales y sus patologías, podemos diagnosticar si esos trastornos deben tratarse quirúrgicamente y, de ser así, cómo proceder con los sistemas láser, ya que son procedimientos mínimamente invasivos; o si debiésemos recomendar a los padres que visiten a un terapeuta miofuncional para ayudar a recuperar la función normal. La comprensión de las estructuras orales de los recién nacidos es muy importante para promover el desarrollo del crecimiento craneofacial y para brindar un servicio importante a las madres, dándoles a sus bebés un buen comienzo en la vida desde una etapa muy temprana. Necesitamos mejorar la colaboración entre profesionales de diferentes disciplinas con el fin de mejorar nuestro conocimiento.

The purpose of this article is to improve our knowledge about the structures and function of the different elements present in the mouth of newborns since dentists sometimes do not remember the importance of the mouth in the general development of infants and the need for an early intervention with lasers to help them obtain a good state of their Oral System. We performed a comprehensive clinical exploration of the patient in order to make a more accurate diagnosis. When surgery is necessary, we recommend to use erbium lasers when possible (2780nm Er, Cr: YSGG laser or a 2940nm Er: YAG), as they are a quick and effective option to treat these oral lesions, especially lip or tongue ties which can risk the act of breastfeeding; moreover, we can also use diode lasers (810nm, 940nm, 980nm or a 1064nm Nd:YAG laser or CO2 10.600-9600 nm.) al lof them with their specifical safety goggles. These laser systems used by a certified professional, in collaboration with a properly trained staff, are a very important factor during the surgery.By having proper knowledge of the oral structures and their pathologies, we are able to diagnose whether those disorders should be surgically treated and if so, how to proceed with laser systems as they are minimally invasive procedures; or if we should recommend parents to visit a myofunctional therapist in order to help recover the normal function.The understanding of oral structures of newborns is very important in order to improve the development of craniofacial growth and provide an important service to mothers by giving their babies a right start in life from a very early stage. We need to improve collaboration between professionals from different disciplines in order to enhance our knowledge.

Surgical treatment of ankyloglossia using an ophthalmic topical anesthetic and a tentacannula for tongue elevation: a case report

Ankyloglossia is characterized by the presence of a short lingual frenum that can be inserted from the alveolar ridge to the lingual apex and, until promoting a true fusion of the tongue to the floor. A short lingual frenum can generate several problems such as phonetic disorders. Objective: To describe a surgical technique for the treatment of ankyloglossia using a topical ophthalmic anesthetic and a tentacannula for tongue elevation. Case report: A 15-year-old female was referred for lingual frenulum surgery due to speech impairment. Clinical examination revealed the presence of ankyloglossia which was both hindering the pronunciation of T, D, L phonemes and reducing tongue mobility. The surgical technique chosen was a lingual frenectomy. An ophthalmic topical anesthetic was initially applied to the lateral borders of the frenum with the patient in an upright position and in the presence of adequate aspiration. With the aid of a tentacannula the tongue was raised and the frenulum gradually released with a Goldman-Fox serrated scissor. The topical anesthetic was continuously trickled onto the surgical site during surgery. Results: No postoperative pain was reported by the patient, healing occurred normally and there was no recurrence of abnormal frenulum insertion. Conclusion: The advantages of this technique in comparison to conventional methods which use infiltrative anesthesia include less trauma and a more precise evaluation of tongue movements during surgery, because there will be better control of mobility for the patient when compared to infiltrative techniques.

Introdução: A anquiloglossia caracteriza-se pela presença de um freio lingual curto que pode inserir-se desde o rebordo alveolar até o ápice lingual e, até promover uma verdadeira fusão da língua ao assoalho. Um freio lingual curto poderá gerar vários problemas como distúrbios fonéticos. Objetivo: descrever uma técnica cirúrgica para tratamento da anquiloglossia utilizando um anestésico tópico oftálmico e uma tentacânula para elevação da língua. Relato do caso: Uma paciente com 15 anos de idade foi encaminhada para cirurgia do frênulo lingual devido ao comprometimento da fala. O exame clínico revelou a presença de anquiloglossia, dificultando a pronúncia dos fonemas T, D, L e, reduzindo a mobilidade da língua. A técnica cirúrgica escolhida foi a frenectomia lingual. Um anestésico tópico oftálmico foi aplicado inicialmente nas bordas laterais do freio com o paciente na posição vertical e na presença de aspiração adequada. Com o auxílio de uma tentacânula, a língua foi elevada e o frênulo foi gradualmente liberado com uma tesoura serrilhada Goldman-Fox. O anestésico tópico foi continuamente gotejado para o local cirúrgico durante a cirurgia. Resultados: Nenhuma dor pós-operatória foi relatada pelo paciente, a cicatrização ocorreu normalmente e não houve recorrência da inserção anormal do frênulo. Conclusão: As vantagens dessa técnica em comparação aos métodos convencionais que utilizam anestesia infiltrativa, incluem menor trauma e uma avaliação mais precisa dos movimentos da língua durante a cirurgia, pois haverá um melhor controle da mobilidade do paciente quando comparado às técnicas infiltrativas.

Resultados clínicos del tratamiento de frenillos labiales; frenectomía y frenotomía / Clinical results of the treatment of labial frenulums; frenectomy and frenotomy

OBJETIVO: El propósito de esta revisión fue evaluar sistemáticamente la literatura científica sobre los resultados clínicos que se obtienen al remover los frenillos aberrantes al utilizar los procedimientos quirúrgicos convencionales y el láser. MATERIALES Y MÉTODOS: Búsqueda detallada en las bases de datos PubMed, ScienceDirect, Cochrane y SciELO para obtener la información más actualizada los resultados clínicos (dolor posoperatorio, dolor al hablar, dolor al masticar y complicaciones posquirúrgicas) entre las técnicas convencionales (uso del escalpelo) y las técnicas de remoción con el láser (búsqueda de ensayos clínicos). RESULTADOS: De los 501 archivos identificados inicialmente, se excluyeron reportes clínicos, revisiones, estudios observacionales, comentarios, estudios con pacientes pediátricos, etc. Se incluyeron cuatro ensayos clínicos que contrastaron las variables entre la técnica convencional y las técnicas con el láser Nd: YAG y láser CO2 CONCLUSIÓN: La percepción del dolor posoperatorio, el dolor al hablar y el disconfort al masticar luego de la frenectomía es menor en las técnicas que utilizan el láser de Nd: YAG y CO2 frente a las técnicas que utilizan el escalpelo. El tiempo quirúrgico con el uso del láser es significativamente menor que al utilizar el escalpelo. La heterogeneidad de los estudios limita la realización de un metanálisis con respecto a los resultados.

OBJECTIVE: The purpose of this review was to evaluate systematically the scientific literature on the clinical results obtained by removing aberrant frenulums using conventional surgical procedures and laser. MATERIALS AND METHODS: A detailed search was performed in the PubMed, ScienceDirect, Cochrane and SciELO databases to obtain the most up-to-date clinical results (postoperative pain, pain when speaking, pain when chewing and postoperative complications) among conventional (scalpel use) and laser removal techniques (search for clinical trials). RESULTS: Of the 501 records initially identified, clinical reports, reviews, observational studies, comments, studies with pediatric patients, etc. were excluded. We included four clinical trials that contrasted the variables between the conventional technique and the techniques with the Nd: YAG laser and CO2 laser. CONCLUSION: The perception of postoperative pain, pain when speaking and chewing discomfort after frenectomy is lower in the techniques using the Nd: YAG and CO2 laser versus the techniques using the scalpel. The surgical time when using of laser is significantly lower than when using the scalpel. The heterogeneity of the studies limits the performance of a meta-analysis with respect to the results.

Surgical Management of Frenula: Laser Therapy Compared with Z-Frenuloplasty Technique

Abstract Objective: To compare intra- and post-operative consequences associated with Z-frenuloplasty and laser therapy for both upper labial and lingual frenulectomies. Material and Methods: Clinical data of 120 consecutive patients with a mean age of 11 years and 2 months (age range from 9 years and 1 month to 14 years and 3 months) with hypertrophic labial and lingual frenula were assembled. Of the 70 labial frenula, 35 were removed through Z-frenuloplasty (Group 1) and 35 with laser (Group 2); of 50 lingual frenula, instead, 25 were extracted through Z-frenuloplasty (Group 1A) and 25 with laser (Group 2A). The cutting device was Laser Diode Handy 10 in continuous mode. Finally, the time of the surgery, pain and swelling were measured 24-48 hours after the removal. VAS scale was used. Results: The time of the surgery, VAS score after the removal and the swelling were lesser in Group 2 and 2A. Conclusion: Both Z-frenuloplasty and Laser therapy are valid instruments to remove frenula. Moreover, laser offers more advantages like less use of anesthesia, no bleeding in the operating phase, no need for suturing, a faster tissue healing and minor limitations in speech and nutrition.

Perceptions of the Use of the Diode Laser in Dental Surgery: A Qualitative Study

Abstract Objective: To discover the perceptions of pediatric patients, their parents and undergraduate Dentistry students of the use of the diode laser in frenectomy surgeries. Material and Methods: A qualitative study was conducted through semi-structured interviews, recorded and transcribed with subsequent content analysis. Twelve healthy children (5-8 years old) who needed a frenectomy were selected and invited, together with their parents, to undergo laser diode surgery. In addition, 28 undergraduate dentistry students were invited to attend the procedures. One week after performing the surgical procedures, the children (Group 1), their parents (Group 2) and the students who attended the procedures (Group 3) were individually interviewed for the thematic analysis. Results: The analysis of the conversations identified three emerging contents: positive thoughts on the use of diode laser; frustrations from the use of diode laser; and aspects related to professional training. Conclusion: The results pointed to the acceptance of surgical laser use in pediatric dentistry; however, the feelings of frustration indicate that its use requires guidance from the child and his/her parents, in addition to careful handling and specific training.

Displasia ectodérmica hipohidrótica tipo 1 ligada al cromosoma X, síndrome de Christ-Siemens-Touraine: caso clínico y revisión de la literatura / Type 1 hypohidrotic ectodermal dysplasia X-linked, the Christ-Siemens-Touraine syndrome: a clinical case and review of the literature

La displasia ectodérmica hipohidrótica tipo 1 ligada al X (DEH1-X) ­síndrome de Christ-Siemens-Touraine­ es una genodermatosis que forma parte de las displasias ectodérmicas, caracterizadas por alteraciones en el desarrollo de una o más estructuras derivadas de ectodermo. Clínicamente presenta hipotricosis, hipohidrosis e hipodontia de severidad variable. Propósito: Describir las características clínicas de la DEH1-X, su manejo odontológico y diferenciarla de otras entidades patológicas. Caso clínico: Paciente masculino de 18 años de edad, con antecedente familiar de displasia ectodérmica hipohidrótica diagnosticada también en un hermano menor. Acude a consulta por prótesis anterior fracturada y mal ajustada. Se trató mediante frenilectomía anterior y rehabilitación bucal protésica. Discusión: En el diagnóstico y tratamiento de las alteraciones congénitas de desarrollo es de particular importancia la identificación temprana y el trabajo en equipo multidisciplinario. El plan de tratamiento y manejo clínico de tejidos orales blandos y duros debe ser adaptado a las necesidades particulares del padecimiento, lo que permitirá establecer un mejor pronóstico. Conclusiones: La DEH1-X es una alteración congénita del desarrollo que afecta estructuras orales, por lo que debe ser identificada por el estomatólogo para atender correctamente las alteraciones dentales y evitar complicaciones posteriores (AU)

Type 1 hypohidrotic ectodermal dysplasia X-linked (DEH1-X) -Christ-Siemens-Touraine syndrome- is a genodermatosis. Ectodermal dysplasias are characterized by development alterations on one or more ectodermal derived structures. IN DEH1-X, patients present hypotrichosis, hypohidrosis and hypodontia of variable severity. Aims: To describe anatomic and clinical characteristics of the DEH1-X, dental treatment, and to differentiate from other clinical conditions. Case report: Male teenager, 18-year-old, was referred for replacement of anterior dental prosthesis. Family history for hypohidrotic ectodermal dysplasia was positive, younger brother with the same condition. Treatment consisted of anterior labial frenectomy and dental prosthetic rehabilitation with acceptable clinical and esthetic's results. Discussion: When diagnosing and treating patients with developmental genetic conditions is particularly important the early detection and the participation of interdisciplinary team work. The clinical treatment of hard and soft tissues of the oral cavity has to be planned and personalized according to the particular needing of each case, in order to achieve better results and long term prognosis. Conclusions: DEH1-X is a congenital developmental disorder, which affects oral structures, should be identified and treated appropriately by the dentist to prevent further dental complications (AU)

Clinical and x-ray oral evaluation in patients with congenital Zika Virus

Abstract Objective: The aim of this study was to investigate possible malformations in the soft, bone and/or dental tissues in patients with congenital Zika Virus (ZIKV) by clinical and x-ray evaluation. Methodology: Thirty children born with ZIKV and 30 children born without ZIKV (control group) were included in the study. Patients were evaluated over 24 consecutive months according to the variables: sex, age, cleft palates, soft tissue lesions, alveolar ridge hyperplasia, short labial and lingual frenums, inadequate posture of the lingual and perioral muscles at rest, micrognathia, narrow palatine vaults, changes in the teeth shape and/or number, sequence eruption, spasms, seizures and eruption delay were evaluated. Chi-square test, Student's t-test and nominal logistic regression were used (p<0.05). Results: Among the 30 babies examined, the mean age of the first dental eruption was 10.8±3.8 with almost two-thirds of the children (n=18, 60%) experiencing eruptions of their first tooth after 9 months of age, nine children (30%) had inadequate lingual posture at rest, more than half of the children (n=18, 60%) had short labial or lingual frenums. ZIKV babies showed a high prevalence of clef palate (p<0.001), inadequate lingual posture at rest (p=0.004), micrognathia (p=0.002), changes in the shape and/or number of teeth (p=0.006), alteration in sequence of dental eruption (p<0.001) and muscles spasms (p=0.002). The delay eruption was associated with inadequate lingual posture at rest (p=0.047), micrognathia (p=0.002) and changes in the shape and/or number of teeth (p=0.021). The delayed eruption (p=0.006) and narrow palatine vaults (p=0.008) were independently associated with ZIKV. Moreover, female patients showed the most narrow palatine vaults (p=0.010). Conclusions: The children with ZIKV showed a greater tendency to have delayed eruption of the first deciduous tooth, inadequate lingual posture and short labial and lingual frenums.

Aplicación del Láser de Baja Potencia (LLLT) en Pacientes Pediátricos: Revisión de Literatura a Propósito de una Serie de Casos / Application of Low Power Laser (LLLT) in Pediatric Patients: Review of the Literature in a Series of Cases

RESUMEN: El uso del láser de baja potencia en odontología está siendo cada vez más frecuente y con excelentes resultados, los equipos más modernos traen pre-establecidos la dosimetría de los parámetros para las diferentes acciones clínicas. El objetivo de esta revisión fue encontrar evidencia científica que permita al clínico tener como una alternativa de tratamiento el uso del láser de baja potencia en patologías orales de tejidos blandos y duros en pacientes pediátricos. Se realizó una revisión de la literatura por medio de buscadores como PubMed, LILACS y SciELO. Después de leer a texto completo todos los trabajos es posible señalar que el láser de baja frecuencia es una buena alternativa terapéutica en la resolución de signos y síntomas en patologías orales que aquejan al paciente pediátrico, puesto que, presenta un rápido control del dolor, la inflamación, el sangrado y acelera los procesos de reparación celular.

ABSTRACT: Low Level Laser Therapy in dentistry is becoming more frequent and has had excellent results, with state of the art equipment having pre-established dosimetry parameters for the various clinical actions. The objective of this review was to find scientific evidence that allows the clinician to have the use of low power laser as treatment alternative, in oral soft tissue and hard pathologies in pediatric patients. A review of the literature was performed through search engines such as PubMed, LILACS and SciELO. After reading the texts, it was possible to point out that low frequency laser is a good therapeutic alternative in the resolution of signs and symptoms in oral pathologies of the pediatric patient. This alternative allows for rapid pain control, reduces inflammation and bleeding, and accelerates cellular repair processes.

Características morfológicas encontradas na cavidade oral de neonatos: revisão de literatura / Morphological characteristics found in the oral cavity of newborns: a literature review

Objetivo: revisar a literatura sobre as característicasmorfológicas da cavidade oral de recém-nascidos. Revisãode literatura: as profissões da área de saúde estãocada vez mais voltadas para um acompanhamentoprecoce do indivíduo, iniciando-se antes mesmo donascimento ou nos primeiros dias de vida da criança.Sendo assim, recém-nascidos apresentam na cavidadeoral características peculiares da sua fase de desenvolvimentoque podem trazer dúvidas para os pais e/ouresponsáveis. As principais variações da cavidade oralde recém-nascidos envolvem tecidos duros e tecidosmoles. Considerando o posicionamento dos maxilares,as alterações mais comuns são: mordida aberta anterior,sobremordida e mordida topo a topo. Em relação aos tecidosmoles, o contorno dos lábios dos recém-nascidosse apresenta triangular e, com a amamentação constante,forma-se um aumento de volume na linha média dolábio superior. Considerações finais: além de ser necessárioque os profissionais da área tenham conhecimentodas características morfológicas da cavidade oral dosrecém-nascidos, também é imprescindível que estessaibam diagnosticar possíveis anormalidades e, quandohouver necessidade, indicar tratamento adequado. (AU)

Objective: to review the literature on the morphological characteristics of the oral cavity of newborns. Literature review: health professions are increasingly focused on the early follow-up of individuals, starting even before birth or during the first days of life of the child. Therefore, the oral cavity of newborns presents characteristics particular to their development phase, which may cause doubts to parents and/or caregivers. The major variations of the oral cavity of newborns involve both hard and soft tissues. Considering the positioning of the jaws, the most common changes are anterior open bite, overbite, and edge-to-edge bite. Regarding the soft tissues, the contour of the lips of newborns is triangular and constant breastfeeding causes an increase of volume formed in the midline of the upper lip. Final considerations: therefore, health professionals are required not only to understand the morphological characteristics of the oral cavity of newborns, but it is also essential that they are able to diagnose potential abnormalities and to indicate appropriate treatment when necessary. (AU)

Clinical Assessment of Frenum Morphology and Attachment in Malaysian Children

Objective: To determine the prevalence of various types and attachment level of maxillary frenum in Malaysian children. Material and Methods: A cross-sectional study was conducted in a total of 200 children of age ranging from 2 to 15 years. Photographs of maxillary frenum were taken and their types and level of attachment were recorded by using Placek's classification and modified Sewerin typology. Children were divided into 3 groups based on age: between 2-5, 6-11 and 12-15 years. Descriptive analysis was carried out to determine the frequency of frenum types and level of attachment. The relationship of frenal attachment with gender, and age were studied. Data collected was analyzed using descriptive statistics (frequencies, percentages, means and standard deviation). Statistical Package for Social Sciences (SPSS) version 19.0 was used to analyze the data. Results: The most common type was mucosal type of attachment (75%) and the least common was papillary penetrating (4.5%) based on Placek's classification whereas for modified Sewerin's typology, simple frenum (73%) was the most prevalent, followed by simple with nodule frenum (11.5%). There was no significant difference in the frenum attachment between the two genders. Mucosal and gingival attachment was significantly higher in older age group whereas papillary and papillary penetrating was higher in younger age group. Conclusion: This study showed that attachment of frenum in children changes according to age and whereas gender plays no role in portraying the difference. Hence, clinicians must be able to identify the different types of MMLF during dental examination to avoid any unnecessary surgical interventions particularly during the period of development.

Upper lip tie wrapping into the hard palate and anterior premaxilla causing alveolar hypoplasia

Bony anomaly caused by lip tie is not many reported yet. There was a case of upper lip tie wrapping into the anterior premaxilla. We represent a case of severe upper lip tie of limited lip motion, upper lips curling inside, and alveolar hypoplasia. Male patient was born on June 3, 2016. He had a deep philtral sulcus, low vermilion border and deep cupid's bow of upper lip due to tension of short, stout and very tight frenulum. His upper lip motion was severely restricted in particular lip eversion. There was anterior alveolar hypoplasia with deep sulcus in anterior maxilla. Resection of frenulum cord with Z-plasty was performed at anterior premaxilla and upper lip sulcus. Frenulum was tightly attached to gingiva through gum and into hard palate. Width of frenulum cord was about 1 cm, and length was about 3 cm. He gained upper lip contour including cupid's bow and normal vermilion border after the surgery. This case is severe upper lip tie showing the premaxillary hypoplasia, abnormal lip motion and contour for child. Although there is mild limitation of feeding with upper lip tie child, early detection and treatment are needed to correct bony growth.

Frenectomia: revisão de conceitos e técnicas cirúrgicas / Frenectomy: review of concepts and surgical techniques

Introdução: frenectomia é o procedimento cirúrgico que visa a remoção do freio labial, lingual e bridas, permitindo tanto a movimentação ortodôntica para fechamento de diastemas, como a movimentação adequada da língua, necessária às atividades funcionais. Existem várias técnicas para realizar a frenectomia que se diferenciam quanto ao tempo operatório e na recuperação do pós- -operatório, apresentando vantagens e desvantagens sobre a técnica utilizada. É imprescindível que o cirurgião dentista tenha conhecimento sobre as técnicas cirúrgicas específicas para cada caso para entender qual a melhor prática a ser utilizada, aplicando-as da melhor maneira para um pronto restabelecimento do paciente. Objetivo: revisar a bibliografia sobre conceitos e técnicas cirúrgicas de frenectomia. Material e métodos: foram consultados bases de dados de artigos, dissertações e teses em língua portuguesa indexados em arquivos computadorizados como MEDLINE via PubMed, Scielo e LILACS. Resultado: as técnicas cirúrgicas de Archer, de Recebido em: 25/11/2017 Archer Modificada, de Chelotti, de Wassmund, de Mead, de Howe e a técnica com Laser estão entre as mais comumente utilizadas, sendo a técnica de Archer, também conhecida como duplo pinçamento, considerada uma técnica de fácil execução por ter as pinças hemostáticas servindo de guia no procedimento de incisão, tornando-a mais rápida e segura. Considerações finais: as técnicas cirúrgicas de frenectomia podem sofrer variações, mas se bem aplicadas, apresentam resultados de bom prognóstico, no entanto, a técnica de Archer apresenta facilidade de execução, maior segurança, rapidez e um resultado menos traumático.

Introduction: frenectomy is the surgical procedure that aims to remove the labial, lingual and flange brakes, allowing either orthodontic movement to close diastemas, as well as adequate movement of the tongue, necessary for functional activities. There are several techniques to perform the frenectomy that differ in terms of operative time and postoperative recovery, presenting advantages and disadvantages over the technique used. It is imperative that the dental surgeon has knowledge about the surgical techniques specific to each case to understand the best practice to be used, applying them in the best way for a prompt reestablishment patient. Objective: to review literature on surgical concepts and techniques of frenectomy. Material and method: the databases of articles, the dissertations and theses in Portuguese language indexed in computerized files such as MEDLINE via PubMed, Scielo and LILACS have been consulted. Results: the surgical techniques of Archer, Modified Archer, Chelotti, Wassmund, Mead, Howe and the Laser technique are among the most commonly used, as such the Archer technique, also known as double clamping being considered an ease to perform by having the hemostatic clamps serving as a guide for the incision procedure, making it quick and safe. Final considerations: frenectomy surgical techniques may vary, but if well applied present good prognosis results, however the Archer technique presents ease of execution, greater safety, speed and a less traumatic result.

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)

Relación entre frenillos labiales y periodonto en una población peruana / Relationship between labial frenulum and periodontium in a Peruvian population

RESUMEN: Los frenillos aberrantes están incluidos dentro de las deformidades mucogingivales, y estas pueden alterar la función y la estética del periodonto de protección. Este estudio tuvo como objetivo evaluar la inserción de los frenillos labiales y establecer una relación con la pérdida papilar y recesión gingival a nivel de los dientes anterosuperiores y anteroinferiores. Materiales y métodos Estudio transversal que evaluó a 97 pacientes sistémicamente sanos en los cuales se evaluó el tipo de frenillo (TF), la altura del frenillo (AF), el tipo de recesión gingival y la pérdida papilar al nivel de los sectores anteriores maxilar y mandibular. Resultados El TF más prevalente fue el mucoso, con un 54,6% y 93,8% de prevalencia a nivel maxilar y de la mandíbula respectivamente; la AF promedio fue de 8,37mm ± 2,671mm para el frenillo labial maxilar y 8,33mm ± 1,657mm para el frenillo labial mandibular. No se encontraron relaciones entre el TF, la AF con la presencia y severidad de pérdida papilar y recesión gingival al nivel de los incisivos centrales (p>0,05). Conclusión El frenillo más común de la población estudiada fue el frenillo mucoso, no existiendo una relación directa entre su clasificación e inserción con la presencia de una recesión gingival o pérdida papilar.

ABSTRACT: Aberrant frenums are included within the mucogingival deformities, which can alter the function and aesthetic periodontal protection. This study aimed to evaluate the adherence of labial frenulum and establish a relationship with papillary loss and gingival recession of the anterior teeth in maxilla and in the jaw. Materials and methods A cross-sectional study was conducted on 97 systemically healthy patients in whom the type of frenulum (TF), the height of the frenulum (AF), the type of gingival recession, and papillary loss was evaluated in the upper maxillary and mandibular sectors. Results The most prevalent frenum was the mucosal. The prevalence of TF was 54.6% and 93.8% of maxilla and mandible, respectively. The mean AF was 8.37mm ± 2.671mm for the labial frenulum in maxillary, and 8.33mm ± 1.657mm for frenulum. No relationship was found between the TF, AF with the presence and severity of papillary loss and gingival recession (P>.05). Conclusion The most common frenulum of the study population was the mucosal frenulum. There was no direct relationship between the classification and adherence of the frenulum with the presence of gingival recession or papillary loss.

Análisis morfométrico del frenillo labial superior durante el crecimiento y desarrollo del niño en edades 0 a 12 años / Análise morfométrica do freio labial superior durante o crescimento e desenvolvimento crianças em idades de 0 a 12 anos / Morphometric analysis of the upper lip frenulum during growth and development of the child aged 0 to 12 years

Objetivo: Establecer un análisis morfométrico del frenillo labial superior durante el crecimiento y desarrollo del niño en edades de 0 a 12 años en el Municipio Naguanagua periodo Marzo-Septiembre 2016. Materiales y Métodos: investigación de tipo descriptivo con un diseño de campo. Teniendo como objeto una población de 650 niños tomando como Muestra 260 sujetos, distribuidos de manera porcentual en, 31% Primera Infancia 23% Segunda Infancia y 46% Tercera Infancia. Se obtuvieron fotografías del frenillo, tomando 10 "landmark" (puntos de referencia) para la conformación de la estructura, siendo procesadas para su análisis con los Software, TpsDig2, Past, IMP7 y Morphoj. Resultados: la zona que presento mayor superposición en todos los grupos fue la de inserción gingival, mientras que la inserción labial presento mayor variación, en cuanto a 1 Residente del Postgrado de Odontopediatría, Universidad de Carabobo. 2 Odontopediatra UC. Docente del Postgrado de Odontopediatría U.C. y docente de Pregrado facultad de Odontología U.C. 3 PhD, en Entomología, Docente de la Universidad de Ikiam Ecuador. la deformación de la estructura en todas las etapas hubo desarrollo en sentido horizontal en la inserción labial. La medida promedio del frenillo labial superior se estableció entre 11 a 13mm, ±1-2mm de desviación. La inserción gingival a la papila interincisal se presentó una medida promedio 1 a 3 mm. ±1 mm. Conclusiones: el frenillo labial superior al nacer es fisiológicamente tectolabial, presentara un desarrollo de 1 a 2mm durante el 1er año de vida en su zona de inserción gingival exclusivamente, manteniéndose estable sin reposicionarse ni modificarse en longitud hasta la adolescencia, por lo que al realizar el análisis Morfométrico del frenillo labial superior en todos tipos de dentición dicha estructura presento similitudes indicándonos su estabilidad en las diferentes edades del infante.

Objetivo: Estabelecer uma análise morfométrica do freio labial superior durante o crescimento e desenvolvimento de crianças de idades 0 a 12 anos no município Naguanagua período Marzo-Septiembre 2016. Materiais e Métodos: Pesquisa de tipo descritivo com um projeto de campo. Tendo como objeto uma populaçã o de 650 crianças e tomando como amostra 260 sujeitos, distribuídos de forma percentual em, 31% Primeira Infância 23% Segunda Infância e 46% Terceira Infância. Se obtiveram as fotografias do freio, tomando 10 pontos de referência para a conformação da estrutura, as quais foram processadas para seu análise com os software, TpsDig2, Past, IMP7 e Morphoj. Resultados: a zona que preside o superposição do maior em todos os grupos foi a inserção gingival, enquanto que a inserção labial apresentou a maiori variação, forma da deformação da estrutura em todas as etapas desenvolvimento ocorreu no sentido horizontal na inserção labial. A medida médioa freio labial superior foi 11 a 13mm, ± 1-2mm de desvio. A inserção gengival à la papila interincisal se mostrou uma medida média 1 a 3 mm. ± 1 mm. Conclusões: o freio labial superior , ao nascer, é fisiologicamente teto-labial, apresenta um desenvolvimento de 1 a 2mm durante o primeiro ano de vida em sua zona de inserção gengival exclusivamente, mantendo-se estável sem reposicionar nem modificando em comprimento até a adolescência. Por isso que realizar analise morfométrica do frenillo labial superior em todos os tipos de dentição nos mostra semelhanças nos indicando sua estabilidade nas diferentes idades da criança.

Objective: To establish a morphometric analysis of the upper lip frenulum during the growth and development of the child aged 0 to 12 years in the Naguanagua Municipality period March-September 2016. Materials and Methods: A descriptive research with a field design was performed. The target population was 650 children, the sample taken was 260 subjects, distributed in 31% First Infancy 23% Second Infancy and 46% Third Infancy. Photographs of the bridle were taken, taking 10 landmarks for the structure conformation, being processed for analysis with the Software, TpsDig2, Past, IMP7 and Morphoj. Results: the area that presented greater overlap in all groups was that of gingival insertion, while the labial insertion presented greater variation, in terms of the deformation of the structure in all the stages there was development in horizontal sense in the labial insertion. The mean upper lip frenulum measurement was established between 11 to 13mm, ± 1-2mm of deviation. The gingival insertion to the interincisal papilla presented an average measure of 1 to 3 mm. ± 1 mm. Conclusions: the upper labial frenulum at birth is physiologicallyw tectolabial, presenting a development of 1 to 2 mm during the first year of life in its area of gingival insertion exclusively, remaining stable without repositioning or modification in length until adolescence, The morphometric analysis of the upper lip frenulum in all types of dentition said structure showed similarities indicating its stability in the different ages of the infant.

Combinación quirúrgica: una necesidad en odontopediatría / Combinação cirúrgica: uma necessidade em odontopediatria / Surgical combination: a necessity in Pediatric Dentistry

Introducción: El Mesiodens es un diente supernumerario que se forma en la línea media entre los incisivos centrales superiores, más frecuentemente en la dentición permanente y en pacientes de sexo masculino. Su etiología es bastante desconocida, pero la hiperactividad de la lámina dentaria es la teoría más aceptada. Se presenta asociado a otras complicaciones, como el diastema interincisivo, que puede también estar asociado a la inserción anormal del frenillo labial superior, provocando alteraciones en la estética dentaria. El objetivo de este trabajo fue comunicar sobre un caso clínico de exodoncia de un mesiodens y de la resección del frenillo labial superior en un solo procedimiento quirúrgico, con seguimiento del cierre fisiológico del diastema luego de 1 año. Reporte de caso: El presente trabajo reporta el caso de un niño, de 11 años de edad, que ingresó a la clínica-escuela de Odontopediatría de la Facultad Independiente del Nordeste acompañado por su madre, con queja estética de separación dental. Después de la anamnesis, examen clínico y radiográfico se diagnosticó la presencia de mesiodens e inserción anormal del frenillo labial superior. Se seleccionó como tratamiento una técnica quirúrgica combinada de exodoncia del mesiodens y frenectomía en una misma sesión, con seguimiento de un año y observación del cierre progresivo del diastema entre los incisivos. Conclusión: El diagnóstico correcto de dientes supernumerarios y anormalidades del frenillo es fundamental, a través de un buen examen clínico y radiográfico para la realización del tratamiento individualizado, siendo exitoso en este caso la combinación quirúrgica.

Introdução: Mesiodens é um dente supranumerário que ocorre na linha média entre os incisivos centrais superiores, com maior frequência na dentição permanente e em pacientes do sexo masculino. Sua etiologia ainda não é completamente entendida, sendo a hiperatividade da lâmina dentária a teoria mais aceita. O mesiodens traz algumas complicações, sendo uma delas o diastema interincisal, podendo este também estar associado à inserção anormal do freio labial superior, causando alterações na estética dentária entre outros. O objetivo desse trabalho é relatar um caso clínico da remoção de mesiodens e freio labial superior em mesmo tempo cirúrgico, com avaliação do fechamento gradual fisiológico do diastema após 1 ano. Relato de caso: O presente trabalho relata um caso de uma criança, 11 anos de idade, sexo masculino, que compareceu à clínica-escola de Odontopediatria da Faculdade Independente do Nordeste (FAINOR) com sua mãe, com queixa estética de afastamento dentário; após anamnese, exame clínico e radiográfico foi diagnosticada a presença de mesiodens e inserção anormal do freio labial superior. Esse relato teve por escolha o tratamento de remoção cirúrgica do mesiodens associado à frenectomia labial superior em uma mesma sessão, com proservação de 1 ano e observação do fechamento gradual do diastema interincisal. Conclusão: O diagnóstico correto de dentes supranumerários e anomalias do freio é fundamental por meio de um bom exame clínico e radiográfico. A oportunidade individual da realização do tratamento é outro fator importante.

Introduction: Mesiodens is a supernumerary tooth that occurs on the midline between the maxillary central incisors, with a higher frequency on permanent teeth and on male patients. Its etiology is not completely understood yet, with dental lamina hyperactivity being the most accepted theory. Mesiodens may bring some complications, one of them being the interincisal diastema, which can also be associated with an abnormal superior labial frenum insertion, causing alterations in the dental aesthetics among others. The aim of this study is to report a clinical case of mesiodens removal and superior labial frenum on the same surgical time, with evaluation of the diastema's physiological gradual closure after one year. Case report: This study reports the case of a child, 11 years of age, male, who attended the Odontopediatrics teaching clinic of the Facultad Independente do Nordeste (FAINOR) with his mother, with an esthetic complaint of dental gap. After anamnesis, clinical and radiographic examination, the presence of mesiodens and abnormal insertion of the superior labial frenum were diagnosed. The treatment of choice was surgical removal of the mesiodens associated with superior labial frenectomy, with a one year follow-up and observation of the interincisal diastema's gradual closure. Conclusion: The correct diagnosis of supernumerary teeth and frenum abnormalities is fundamental, through a good clinical and radiographic examination. The individual opportunity for treatment is another important factor.