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ePaper created 2017-10-26, 15:28:59 | version 1.38.0
After local anaesthesia with xylocaine, the frenum was infiltrated, incised from the attachment of the tissue and lip-side of tissue first, rather than incising in the centre of the frenum or separating and detach- ing the tissue from the side attached to the alveolus. Using the diode laser, the tissue was incised, keeping the field of vision intact and accessible. Continuing movement of the laser tip toward the alveolar-covered tissue allows the trough to be made wider until the de- sired length is acquired. All of this is accomplished painlessly, without a pool of blood blocking the view. This laser automatically enhances a clot, allowing not only a view but also a comfortable working envi- ronment for the operator as well as a painless one for the patient. The assistant retracts the lip, with the laser allowing complete vision and aiding in curtailing the bleeding. After the tissue is dissected to the desired level, the remaining loose tissue of the frenum is removed using the diode laser, as well. These results leave a slight charring when we wish to control bleed- ing (Figs. 4 & 5). Postsurgery Healing proceeds uneventfully until it is completed and is maintainable (Fig. 6). Once the frenum is re- moved and healed, the patient is no longer uncom- fortable when eating nor is her lip restricted when she desires to smile. The healed area allows the patient to keep the area clean. She is able to reach and floss the mesial aspects, which she couldn’t do previously. After completion, she is reminded of the need to cor- rect the restorations of her maxillary anterior teeth and get rid of the obvious overhanging margins. Conclusion This particular patient desired a little correction at a time, but, in the meantime, the positive results of the laser treatment made her positive about correcting and improving the aesthetics of her anterior maxillary teeth Kurz & bündig Fig. 4 Fig. 5 Fig. 6 in the near future. With the use of this diode laser, we are able to remove the frenum attachment from the lip side initially, allowing a predictable approach that helps avoid exposing a large hole in the very front and centre of her smile. This laser treatment and its positive results for her, allowed her to consider future restorative cor- rections with a positive attitude. In this case, use of the diode laser allowed her smile to be corrected, and changed her discomfort into a comfortable glow._ Editorial Note: This article was first published in Dental Tribune U.S. Edition, Vol. 7, No. 8, August 2012. contact Dr David L. Hoexter DMD, FICD, FACD Private Practice 654 Madison Ave New York City, USA drdavidlh@gmail.com www.drhoexter.com Author details Der Artikel beschreibt den Fall einer jungen Patientin, die zur Behandlung eines Frenums im Oberkieferfrontzahnbereich vorstellig wurde. Wenige Jahre zuvor wurde sie bereits wegen eines Diastema zwischen ihren Oberkieferfrontzähnen behan- delt. Der damalige Zahnarzt schloss den diastemischen Spalt zwischen den Kronen durch Bonding, wobei er überhängende Ränder im mesialen Bereich beider Zähne zurückließ. Obwohl das Areal klinisch geschlossen erschien, beeinträchtigte die konstante Reizung und Blutung in diesem Bereich die Patientin sehr. Zur Beseitigung des Frenums wurde statt einer Stan- dard-Frenektomie mit scharfen Edelstahlinstrumenten, die möglicherweise weitere Komplikationen zur Folge gehabt hätte, eine Frenektomie mittels Laser durchgeführt. Hierbei fiel die Wahl auf den Diodenlaser, der sich besonders für die Weichge- webebehandlung eignet. Die Behandlung mit dem Diodenlaser erfolgte schmerzfrei und ohne große Mengen an Blut, die das Sichtfeld des Behandlers blockiert hätten. Das Frenum konnte vollständig entfernt werden und der Heilungsprozess verlief problemlos. Die unkomplizierte Laserbehandlung und das damit verbundene positive Ergebnis ermöglichen der Patientin, auch in Zukunft restaurative Korrekturen in Betracht zu ziehen – mit einer positiven Erwartungshaltung. case report | Fig. 4: Initial use of diode laser for releasing the frenum attachment from the lip mucosal side. Fig. 5: Completed extension using the laser and removal of the rest of the frenum. Fig. 6: Final completion of healed area, labial view. Notice the healed labial area, minus the large frenum, yet, avoiding the exposure of the large void between the incisors, as seen in the X-ray (Fig. 2) initially. laser 3 2017 13