AN AESTHETIC CORRECTION OF POST ORTHODONTIC TREATMENT: THE

COMBINATION OF FRENECTOMY AND CROWN LENGTHENING

(Case Report)

Surijana Mappangara*; Sri Oktawati*; Dian Setiawati**;Febri E.N.Tetelepta**;Maisaroh

Dinyati**;Nurfaisah**
*
Staff of Departement Of Periodonsia, Faculty of Dentistry, Hasanuddin University.
**
Resident of Post Graduated, Program In Periodonsia, Faculty of Dentistry, Hasanuddin
University. Makassar, Indonesia

Introduction
The use of fixed orthodontic appliance aimed to align teeth position to allow maximum
aesthetic result. However, the relapse of central diastema and tooth crown asymmetric often
occur after orthodontic treatment completed. Relapse may occurs due to high attachment of
superior labial frenulum and extends up to the incisive papillae. The abnormality existences lead
to the extreme separation between central incisors, which requires a frenectomy. Gummy smile
and shorten of tooth appearance after orthodontic treatment will affect to tooth harmony
visualization. This problem can be solved by crown lengthening, is a gingival removal
procedures with or without alveolar bone removal to lengthen clinical tooth crown.
Objective
The aim of this case report is to elucidate the combination of frenectomy and crown
lengthening procedures on relapse and aesthetic correction after orthodontic treatment.
Case Report
A 19-years old female patient visited the Hasanuddin University Dental Hospital, Makassar,
Indonesia. The patient complained a space between her front teeth and the crowns were visually
shorten after orthodontic appliance had been removed. On the clinical examination a diastema
was covered owing to the high attachment of labial frenulum which extended up to the
interdental papillae. On the anterior teeth crowns, the cervico-gingival distance was shorter than
the gingival vertical dimension which lead to anaesthetic smile appearance.
Case Management
1. Desinfeksi ekstra oral dan intra oral dengan larutan iodium. Dilanjutkan dengan anestesi
lokal infiltrasi di sekitar frenulum labialis superior dan mukosa labial yang akan di eksisi.

2. dilakukan bone sounding dengan cara probe periodontal dimasukkan ke dalam sulkus
sampai kontak dengan puncak alveolar. Beri tanda titik perdarahan
3. crown lengthening dengan menggunakan kauter

4. frenektomi menggunakan scalpel dan 2 klem dengan teknik incision below the clamp

5. Tahap akhir, setelah di irigasi dengan larutan salin dilakukan penjahitan pada dasar
vestibulum dan daerah mukosa bibir dengan silk 5-0 dan dilanjutkan pemasangan
periodontal pack.

6. Instruksi post operasi dan pasien diminta datang kembali 1 minggu kemudian untuk
kontrol

7. Kontrol 9 bulan
CASE MANAGEMENT
1. Extra oral and intra oral disinfection with iodine solution. Proceed with local anesthesia
infiltration around the superior labial frenulum and labial mucosa to be in excision.
2. bone soundings conducted by means of a periodontal probe inserted into the groove until the
contact with the alveolar crest.
3. crown lengthening by using cauter
4. frenectomies using a scalpel and 2 clamp technique incision below the clamp
5. The final stage, after irrigation with saline solution infibulation is performed immediately on
the basis of the vestibule and lip mucosa area with 5-0 silk and continued installation of
periodontal pack.
6. Postoperative instructions and patients are requested to come back 1 week later for control

PEMBAHASAN
Terjadinya diastem sentralis rahang atas kemungkinan disebabkan oleh penyisipan frenulum
labialis ke dalam tonjolan tulang alveolar sehingga terdapat jaringan ikat diantara gigi insisivus
sentralis, menyebabkan kedua gigi tersebut terpisah Pada remaja dan usia muda terjadinya
Altered, active dan arrested, passive eruption dapat menjadi penyebab adanya gingiva yang
berlebihan pada pasien yang melakukan perawatan orthodontik. Pada pasien orthodontik aktif
altered passive eruption dapat terjadi bersamaan dengan pembesaran gingiva dan diperparah
oleh kebersihan mulut yang buruk.

Discussion
The occurrence diastem maxillary central likely to be caused by the insertion of the frenulum
labialis into the protrusion of the alveolar bone so that there is the connective tissue between the
central incisors, causing both the tooth separately. Altered, active and Arrested, passive eruption
can be the cause of excessive gingival in patients who do Orthodontics treatment. In active
orthodontic patients Altered passive eruption can occur simultaneously with gingival
enlargement and exacerbated by poor oral hygiene

Conclusion
The combination of frenectomy and crown lengthening procedure improved orthodontic
treatment and provided maximum aesthetic result.