The frenectomy combined with a laterally positioned pedicle graft. Functional and esthetic considerations

In many cases it is necessary to perform a frenectomy to prevent reopening of a midline diastema following closure by orthodontic therapy. Often the loss of the interdental papilla between the maxillary incisors during the classic frenectomy creates an unacceptable esthetic result. A surgical technique combining a frenectomy with a laterally positioned pedicle graft is presented. The interdental papilla is left surgically undisturbed if it is of physiologic size. If it is enlarged, gingivoplasty is performed to reduce it to an appropriate size. Closure across the midline by laterally positioning gingiva and healing by primary intention results in attached gingiva across the midline. This attached gingiva may have a bracing effect and thus aid in preventing orthodontic relapse (reopening of the diastema). Twenty-seven cases were treated. No relapse was found in 24 cases and in 3 cases only minimal relapse was noted (less than 1 mm). The esthetic result is superior to that obtained with the classic frenectomy technique.