Show Your Work: Mandibular Frenectomies Made Simple by Dr. Timothy Anderson

High frenum attachments are something that we see a lot of in our practice, many of which have gone untreated. A high attachment often results in a localized perio defect, patient discomfort and poor aesthetics. During my general practice residency, we were taught to release these attachments with local anesthetics, a scalpel and resorbable sutures. This technique completely changed for our practice once we began using a CO2 laser.

The Solea CO2 laser’s 9.3-micron wavelength allows me to vaporize hard, soft and osseous tissue without anesthesia and minimal bleeding. Previously, to perform a frenectomy I had to inject anesthesia, wait for profound numbness, and manage bleeding with packing or another hemostatic agent throughout the procedure. The laser makes removing soft tissue simple and virtually blood-free. Eliminating injectable anesthesia from this procedure has greatly increased the patient’s comfort level and case acceptance, especially those with significant dental anxiety. The laser’s unique cutting properties significantly simplify the tissue management, allowing for a clear and clean working field.

Before using this laser, I never would have imagined completing these types of procedures with such precision and predictability. The patients are no longer intimidated by the procedure and my team loves the laser’s ease of use. Having the right technology, which encompasses such diversity in cutting, enables me to take an often referred-out procedure and now provide a safe, simple, quality service to my patients.

Case summary
A 62-year-old patient required a mandibular frenectomy because of a localized gingival and perio defect secondary to a high, mandibular labial frenum attachment (Fig. 1). The procedure was completed with the laser for a total chair time of

15 minutes. No injectable anesthetic was used, with the patient feeling comfortable throughout the procedure. There was minimal to no bleeding, and no sutures were required.

Technique
A simple compounded topical anesthetic was used for this frenectomy. No injectable needle was necessary and there was no waiting time for analgesia to take place. The procedure was performed using the hard- and soft-tissue selection (Fig. 2). A 0.5–0.75mm spot size was selected with 10 percent mist. The laser’s cutting speed was managed between 20–40 percent using the variable speed foot pedal. The total surgical procedure time was less than 10 minutes and the immediate postop area was as clear as possible (Fig. 3).

Benefits
With traditional tools, this procedure is typically completed with a scalpel, moderate bleeding, sutures, injectable anesthetic and slower healing. The laser’s precision enabled complete control of the tissue and the results (Fig. 4). The procedure was extremely fast and there was almost no bleeding. With traditional methods (i.e., scalpel and sutures) the entire procedure would have taken significantly longer.

The four-week postop photo shows rapid healing with no scarring (Fig. 5). As indicated in the photo, the tissue healed extremely well. The patient only noted very mild sensitivity lasting for about a day. This case highlights exceptionally clean surgical cutting with predictable, rapid healing.

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