Refining the Frenum: A Multi-Technique Case Series on Management of Aberrant Labial Frena

Abstract

Introduction: An aberrant labial frenum, when attached close to the gingival margin or papilla, can lead to midline diastema, gingival recession, and impaired oral hygiene. Several surgical techniques have been proposed to manage such attachments, aiming to improve function and esthetics with minimal morbidity. Presentation of Case: Four patients with maxillary aberrant frena were treated using different techniques—conventional scalpel, Z-plasty, V-Y plasty, and diode laser frenectomy. All presented with papillary attachments affecting esthetics and posing relapse risks in orthodontic cases. Procedures were done under local anesthesia with uneventful healing. Discussion: The laser technique demonstrated superior intraoperative hemostasis and greater patient comfort. In contrast, Z-plasty and V-Y plasty were more effective in enhancing vestibular depth and achieved optimal tissue repositioning with minimal scar formation. Although the conventional scalpel technique was clinically effective, it was associated with comparatively increased bleeding and a longer healing period. Overall, technique selection should be individualized according to the type of frenal attachment, the need for tissue repositioning, and esthetic demands. Flap-based procedures such as Z-plasty and V-Y plasty are particularly advantageous in papillary and papilla-penetrating frena, as they redistribute tension and help preserve papillary integrity. Diode laser frenectomy, on the other hand, represents a minimally invasive alternative, offering rapid healing, excellent hemostasis, and superior patient comfort. Conclusion: Overall, all methods were successful, with diode laser and flap-based approaches yielding the most favorable esthetic and functional outcomes through individualized, predictable treatment.