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Diode laser frenectomy: A case report with review of literature

Article  in  Journal of Dental Lasers · January 2019

DOI: 10.4103/jdl.jdl_1_19

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Case Report

Diode Laser Frenectomy: A Case Report with Review of Literature

Preeti Patil, Karthik J Kabbur1, Hemanth Madaiah1, Sunil Satyanarayana2

Department of Oral Abnormal/aberrant frenum is very common and causes various problems in

Abstract
Medicine and Radiology, function and aesthetics. It is managed by procedures such as frenotomy and
1
Orthodontics and frenectomy. Lasers are currently becoming popular in various fields of dentistry
Dentofacial Orthopedics,
and provide alternative to conventional scalpel procedures. In recent years, lasers
and 2Periodontics,
Dayananda Sagar College such as CO2, Neodymium-doped yttrium aluminum garnet, Erbium-doped
of Dental Sciences, yttrium aluminium garnet, and diode have been used for frenectomy. In this
Bengaluru, Karnataka, paper, we present a case of diode laser frenectomy and review various studies
India and reports conducted on diode laser frenectomy.
Keywords: Diode laser, frenectomy, midline diastema

Introduction On intraoral examination, midline diastema and high

F renum is a fold of mucous membrane, usually
with enclosed muscle fibers that attaches the lips
and cheeks to the alveolar mucosa and/or gingiva and
underlying periosteum.[1] Placek et al.[2] have classified
frenum depending on the extension of attachment of
fibers, (1) Mucosal: when the frenal fibers are attached
up to mucogingival junction, (2) Gingival: when fibers
are inserted within attached gingiva, (3) Papillary:
when fibers are extending into interdental papilla, and
(4) Papilla penetrating: when the frenal fibers cross the
alveolar process and extend up to palatine papilla.
According to Miller,[3] the frenum should be
characterized as pathogenic when it is unusually wide
or there is no apparent zone of attached gingiva along
the midline or the interdental papilla shifts when the
frenum is extended. These pathogenic frenums can lead
to midline diastema, gingival recession, interference
with retention of denture, and compromised gingival
health because of poor plaque control. The management
of such abnormal frenum includes frenectomy or
frenotomy. In this paper, we present a case of diode
laser frenectomy and review various studies and reports
conducted on diode laser frenectomy.
frenal attachment were observed. Also the labial frenum
was thick and wide [Figure 1]. The patient was advised
frenectomy. After detailed explanation of procedure,
written consent was obtained from the patient.
Procedure and laser parameters: Frenectomy was
performed using diode laser of 980 nm. The labial frenum
was sprayed with topical spray and infiltration anesthesia
was given to the frenum. The laser was activated before
performing the procedure. Surgical tip at 400 µm was used
with a power of 1.37 W and was applied in contact mode.
The incision was started with the frenum from the attached
gingiva and interdental papilla on the labial surface between
the central incisors extending upward from inner side of
upper lip to the depth of vestibule ending in a rhomboidal
area causing separation of the fibers. Hemostasis was
optimal and no sutures were given [Figure  2]. Safety
measures were taken for the dentist, assistance, and the
patient by wearing the protective goggles.
The patient was given verbal instructions to avoid taking
hot and spicy food for a few days and to maintain
meticulous oral hygiene. Postoperative analgesics were
given to the patient. After 2 weeks of follow-up, significant
healing was noted and after 1 month, complete healing

Case Report Address for correspondence: Dr. Preeti Patil,

A 20-year-old female patient undergoing orthodontic Department of Oral Medicine and Radiology,
treatment for spacing in the maxillary anterior teeth was Dayananda Sagar College of Dental Sciences,
Bengaluru, Karnataka, India.
referred for the evaluation of maxillary labial frenum. E-mail: pritipatil.4@gmail.com

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How to cite this article: Patil P, Kabbur KJ, Madaiah H, Satyanarayana

DOI: 10.4103/jdl.jdl_1_19
S. Diode laser frenectomy: A case report with review of literature. J Dent
Lasers 2019;13:19-22.

© 2019 Journal of Dental Lasers  |  Published by Wolters Kluwer - Medknow 19

 Patil, et al.: Diode laser frenectomy
Figure 1: Thick and wide labial frenum with high frenal attachment
and midline diastema
Figure 2: Immediate postoperative picture showing rhomboidal
shaped laser cut with adequate hemostasis
of the surgical site with normal mucosal type of frenal
attachment was reported [Figure 3].
Discussion
Lasers are becoming increasingly popular in the field of
dentistry providing alternative to conventional scalpel
procedures. In recent years, lasers such as Nd:Yag, Er,
diode, and diode in conjunction with Er:Yag have been
used for frenectomy.
The diode laser was introduced in the mid-90s.[4] The
diode laser contains a solid active medium and is
composed of semiconductor crystals of aluminum or
iridium, gallium, and arsenic.[5] Wavelengths of diode
laser range from 810 to 1064 nm. They are used in soft
tissue surgeries as their wavelength approximates the
absorption coefficient of pigmented tissue containing
hemoglobin, collagen, melanin, and chromophores.
Diode lasers are becoming popular over conventional
techniques because they are less invasive, which result
20 Journal of Dental Lasers  ¦  Volume 13  ¦  Issue 1  ¦  January - June 2019
Figure 3: One-month postoperative picture showing complete
healing and normal frenal attachment
in reduced postoperative edema. The sealing of nerve
endings result in reduced inflammatory response and
the formation of a protein layer over the surgical
wound protects the wound from external irritation,
causing less post operative pain and avoiding the use of
analgesic drugs.[6] Photothermal interaction with tissue
is the basic concept of surgical laser. In this process,
radiant light is absorbed by the tissue and transformed
to heat energy changing tissue structure. Laser light
within was converted to thermal energy on contact with
the tissue, causing laser tissue interaction, which when
appropriately applied can produce reactions ranging
from the incision, vaporization, to coagulation.[7]
For routine clinical dental treatments, pain control is
quite important for patient’s physical and mental well-
being as well as for the effectiveness of therapy.[8]
The laser has a coagulation effect on small vessels,
which provides hemostasis and seals the sensory nerve
endings, providing reduced need for anesthesia.[9]
In this case, we reported 980-nm wavelength diode
laser frenectomy with no complications and excellent
patient satisfaction. We used infiltration anesthesia
and local anesthesia spray for the procedure. Most
of the studies conducted on laser frenectomy have
been performed using topical spray with or without
infiltration anesthesia. However, in the study conducted
by Aldelaimi and Mahmood,[10] the frenectomy was
performed under sedative analgesia using midazolam
and topical spray.
In the present case, the patient had no intraoperative
complication such as pain, swelling, or bleeding, which
is in accordance to many studies and reports.[10-13]
Aldelaimi and Mahmood[10] reported that of 25 patients
only two experienced mild pain during first 3  days
postoperatively and were given analgesics. Awooda
 Patil, et al.: Diode laser frenectomy

Table 1: Summary of literature on diode laser frenectomy

Author Laser equipment Analgesia Demographic details Postoperative follow up
details
Aldelaimi and The Chirolas 20 W, Sedative analgesia using 25 patients, 16, males Marked excellent satisfaction in
Mahmood[10] 980 nm diode laser injectable midazolam (M), 9, females (F); all 25 patients throughout 1, 2,
with a power density (5 mg/mL) IV along with age, 3 months to and 4 weeks, postoperatively
of 7961.78 W/cm2 xylocaine spray 10% 18 years
Khan et al.[14] Diode laser (980 nm) Topical anesthesia 7 year/M Patient was able to protrude his
tongue up to 17 mm
Gargari et al.[16] Diode laser (940 nm) 10% lidocaine spray 32 years Good healing without scar
Khan et al.[17] Photon plus diode Topical lidocaine spray 20 year, 16 year No pain intra-operatively/
laser, Zolar Tech postoperatively. New insertion
Technology, 980 nm of labial frenum with diastema
wavelength at 3 W closure
power continuous
mode
Awooda et al.[11] Ora Laser jet 20 Spray or topical anesthesia 8 patients (14– Good wound healing with
(Germany). Ga Al As 75 years old) faster epithelialization rate. No
diode laser emitting visible scar
810 nm. Max power
output 20 W
Patel et al.[12] Diode laser (Photon 2% lignocaine with 1:80,000 Total 20 patients, At the end of 3 months, healing
Plus; Zolar Tech adrenaline age, 16–40 years; was same for both techniques.
Technology and MFG, Laser group = 10; Diode lasers provide better
Canada, wavelength, Conventional scalpel patient perception in terms of
980 nm) at power group = 10 reduced operative time, pain,
setting of 10 W and bleeding than encountered
by the scalpel
Singh et al.[13] 980 nm diode laser Local infiltration anesthesia 38 years Mucosal type of frenal
attachment was seen
Kafas et al.[15] 1400 mW at 808 nm Topical lidocaine stray 9-year-old Caucasian Healing was uneventful
with continuous boy
output, optical fiber of
300 mm diameter
Ize-Iyamu et al.[18] Soft tissue diode laser Laser frenectomy: 10 23 patients, 17, F, 6, Postoperative pain was
810 nm patients, topical anesthesia, M; age, 10–30 years; significantly reduced in all
2 patients, infiltration conventional surgery: cases treated with the diode
anesthesia; conventional 11 patients; laser laser. Significant difference in
frenectomy: 10 patients, frenectomy: 12 postoperative bleeding in all
infiltration anesthesia patients cases treated with the diode
laser
Mangalekar et al.[19] Diode laser (810 nm, Topical xylocaine 20 year/F Healing was significantly
Picasso; AMD) at 0.8 satisfactory than that
W, continuous contact compared to classical technique
mode using light-brush after 10 days. Laser showed less
stroke motion discomfort and postoperative
pain
Suresh and Kumar[20] Diode laser (830 nm) Topical anesthesia, few 15 year/M Satisfactory healing and
with fiber-optic tip of drops of lignocaine was increased tongue mobility after
300 µm and average injected in the frenum 1 month
power of 1.37 W in a
pulsed mode.
Furtado et al.[21] Diode high power Local infiltration 20 year/F Complete healing in 2 weeks
laser (Thera Lase
Surgery, DMC, São
Carlos, SP, Brazil).
2 W, wavelength of
300 μm optical fiber

Journal of Dental Lasers  ¦  Volume 13  ¦  Issue 1  ¦  January - June 2019 21

 Patil, et al.: Diode laser frenectomy
et al.[11] in their study reported that among eight patients,
one patient experienced pain and another patient had
pain and swelling after the first day. However, after
1-week follow-up, good healing was reported.[14]
Patel et al.,[12] in their study, reported that the subjects
treated with the diode laser had significantly less
postoperative pain both on day 1 and day 7 as compared
to scalpel surgery, as well as the number of analgesics
used was lower in the laser group. Though the healing
of laser wounds after the 7th day and 1  month was
found to be delayed as compared to scalpel wound,
after 3 months, no significant difference was found in
healing between scalpel and laser group.[15]
In this study, near-complete healing was seen in 2
weeks and complete healing with no scar was seen
after 1-month follow-up. The review of various studies
conducted on diode laser frenectomy is summarized in
Table 1.
Conclusion
The rapid developments in laser technology and better
understanding of bio-interactions of different laser
systems have expanded the use of laser in dentistry.
They provide an excellent alternative to conventional
scalpel surgery because of patient comfort, bloodless
field, and reduced pain and healing time. Owing to the
small size, low cost, fiber optic delivery, and ease of use
for minor surgery of oral soft tissue, diode laser has
become an excellent choice for frenectomy.
Declaration of patient consent
The authors certify that they have obtained all
appropriate patient consent forms. In the form the
patient(s) has/have given his/her/their consent for his/
her/their images and other clinical information to be
reported in the journal. The patients understand that
their names and initials will not be published and
due efforts will be made to conceal their identity, but
anonymity cannot be guaranteed.
Financial support and sponsorship
Nil.
Conflicts of interest
There are no conflicts of interest.
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22 Journal of Dental Lasers  ¦  Volume 13  ¦  Issue 1  ¦  January - June 2019
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