A labial fraenectomy is indicated in various clinical situations and is performed to facilitate orthodontic closure of a maxillary midline diastema. In these clinical situations, timing of surgery during the phase of orthodontic treatment is important. Labial fraenectomy can be performed before, during or after the orthodontic closure of the maxillary midline diastema, depending on the individual case. It is important to understand how to perform the procedure efficiently and effectively. Success relies as much on accurate diagnosis of the fleshy, prominent or persistent fraenum as it does on meticulous technique to ensure its complete elimination. This article presents the indications for labial fraenectomy. The appropriate timing of the labial fraenectomy procedure to facilitate orthodontic treatment is discussed.
Clinical Relevance: A surgical technique to perform maxillary labial fraenectomy procedure in an effective and efficient manner is a useful addition to the clinician's armamentarium.
Article
The maxillary labial fraenum is a fold of tissue, usually triangular in shape, extending from the maxillary midline area of the gingiva into the vestibule and mid-portion of the upper lip. It originates as a post-eruptive remnant of the tectolabial bands, which are embryonic structures appearing at approximately three months in utero and connecting the tubercle of the upper lip to the palatine papilla.1
Relocation of this soft tissue attachment, in an apical direction, usually occurs during the normal vertical growth of the alveolar process. Failure of the attached fraenal fibres to migrate apically results in a residual band of tissue which sometimes extends between the maxillary central incisors (Figure 1). This has been implicated in the literature as a causative factor of persistent midline diastemas. The residual fraenal fibres which persist between the maxillary central incisors may also attach to the periosteum and the internal connective tissue of the V-shaped intermaxillary suture (Figure 2). In addition to the persistent fraenum sometimes preventing complete and permanent space closure between the maxillary central incisors, the fraenum has also been implicated in gingival inflammation associated with poor oral hygiene owing to the difficulty in carrying out effective toothbrushing leading to a resultant inflammatory periodontal destruction2 (Figure 3).
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