Definition:
A frenum or frenulum is a mucous tissue connecting the cheeks, tongue, or lips to the gum area (oral vestibule).
Classification:
The classification of frenal attachments is based on the extent of attachment of fibers (Placek et al 1974):
-Mucosal attachment: The frenal attachment is positioned at the mucogingival junction.
-Gingival attachment: The frenal attachment is inserted within the attached gingiva.
-Papillary attachment: The frenal attachment extends up to the interdental papilla.
-Papilla penetrating attachment: The frenal attachment
crosses the alveolar process and extends up to the palatine papilla.
Frenectomy indications:
1. Periodontal
-The frenum pulls at the marginal gingiva
-The frenum hinders the hygiene
-The frenum is hypertrophic, unesthetic
-The frenum is associated with a periodontal pathology such as a recession, persistent inflammation, periodontal pocket
2. Biomechanical
-The frenum is hypertrophic and associated with a diastema, requiring orthodontic treatment to close it
-The lingual frenum is short, limiting the mobility of the tongue
-The frenum prevents the creation of a stable removable prosthesis
Frenectomy indications in children:
A frenectomy is only indicated:
-After the eruption of the six anterior teeth
-After the age of 8 years old
-After verifying that the vertical facial bone development is normal
NB: As the age progresses, the frenum tends to migrate apically.
A frenum is not responsible for a periodontal pathology or diastema but may be an anatomical predisposing factor.
Diagnosing an abnormal frenum attachment:
-During the traction we have:
*Blanching around the alveolar attachment of the frenum due to ischemia or movement of the papillary tip
*Opening of the gingival sulcus
*Instability of a removable prosthesis
*Apical traction of tissue bordering a recession
-Frenum is associated with a lack of keratinous tissue
-Accumulation of plaque because brushing is difficult
-Papillary attachment associated with a diastema
Surgical techniques
-Frenectomy is the complete removal of the frenum, including its attachment to the underlying bone.
-Frenotomy is the incision and the relocation of the frenal attachment.
