Laser ulectomy and lip frenulum removal of the upper arch: a clinical case

Introduction: The maxillary labial frenulum is an anatomical structure formed by thin folds of mucous membrane and connective tissue. In its constitution, we can find muscle fibers that limit the movement of the upper lip. [1 Wheeler B, Carrico CK, Shroff B, et al. Management of the Maxillary Diastema by Various Dental Specialties. J Oral Maxillofac Surg. 2018;76(4):709–715.[Crossref], [PubMed], [Web of Science ®] , [Google Scholar]] Throughout the mixed dentition, the lip and the lingual frenulum may assume an inadequate shape and position, causing aesthetic and functional limitations. In the deciduous and mixed dentition, the presence of an inter-incisive diastema is common, but this tends to close with the eruption of the permanent teeth, lateral incisors and superior canines. [2 Kumar G, Rehman F, Chaturvedy V. Soft Tissue Applications of Er,Cr:YSGG Laser in Pediatric Dentistry. Int J Clin Pediatr Dent. 2017;10(2):188–192.[Crossref], [PubMed] , [Google Scholar]]. In the current literature, it is still not clear which is the best age to perform the upper frenum surgery. This procedure can be performed with scalpel (conventional technique), electric scalpel or laser. It has been described that the use of intraoral laser in these surgical procedures improves the prognosis [3 Medeiros Júnior R, Gueiros LA, Silva IH, et al. Labial frenectomy with Nd:YAG laser and conventional surgery: a comparative study. Lasers Med Sci. 2015;30(2):851–856. doi:10.1007/s10103-013-1461-8[Crossref], [PubMed], [Web of Science ®] , [Google Scholar],4 Guideline on Pediatric Oral Surgery. American Academy of Pediatric Dentistry. Reference Manual. Vol 36, No 6. Adopted 2005. Revised 2010, 2014. [Google Scholar]]. Therefore, this study aims to present a clinical case of ulectomy and frenectomy of the upper lip with laser, in a child with mixed dentition and absence of eruption of the upper central incisors.Materials and methods: A 9-year-old female was referred to paediatric dentistry clinic, the chief complaint “the non-eruption of the upper incisors” SIC mother. After obtaining informed consent, a clinical analysis was performed, confirming the absence of premanent central incisors and the presence of a fibrous upper frenum.Results: With the ulectomy and removal of the upper frenulum with a one-year follow-up, it was possible to observe the spontaneous eruption of teeth 11 and 21.Discussion and conclusions: In the presence of a broad fibrous upper lip frenulum, even without the eruption of the superior canines in which the child has a mixed dentition, frenectomy is indicated. It is known that laser surgery presents a better postoperative because it allows a precision in the excision of the tissue, in the adjacent tissues causes less damages, has a hemostatic effect, it is not necessary to use suture and consequently reduces the pain and postoperative edema that is quite beneficial to the patient. [4 Guideline on Pediatric Oral Surgery. American Academy of Pediatric Dentistry. Reference Manual. Vol 36, No 6. Adopted 2005. Revised 2010, 2014. [Google Scholar]] The ulectomies performed with laser provide better postoperative comfort for the patient, so it was used in this case, and the eruption of teeth 11 and 21 was verified over a year.