Parallelling Technique for Frenectomy to Prevent Black Triangle in Pre-Orthodontic Patients: A Case Report


Background: Gingival recession can cause esthetic problems, especially if it occurs in the maxillary anterior region. Gingival recession accompanied by endodontic complications requires a multidisciplinary approach to achieve successful therapy.

Objective: To report the treatment of Miller’s class-III gingival recession using laterally stretched flap + connective tissue graft with frenotomy and apicoectomy in one visit.

Case Report: A healthy 24-year-old man presented with chief complaints of open and painful gums on his left upper front tooth. After objective and radiographic examinations, the diagnosis of tooth 21 was Miller’s class-III gingival recession, that is, plaque and calculus with endo–perio lesions and grade 1 luxation. The treatment given included scaling, root planning, curettage, retreatment of root canal and root coverage therapy with frenotomy and apicoectomy.

Results: The results obtained were partial root coverage of 71.4% and an increase in the thickness of keratinized tissue.

Conclusion: Healing of periodontal tissue damage accompanied by endodontic lesions showed success and obtained stable treatment results with a multidisciplinary approach.

Keywords: Miller’s class-III gingival recession, endodontic lesion, laterally stretched flap, apicoectomy

[1] Nowzari H, Rich SK, Moslemi N, Johari M, Farahani R. Smile enhancement through periodontal surgery. Thrita. 2015;4(2); e26549.

[2] Placek M, Skach M, Mrklas L. Problems of the labial frenum attachment in periodontics. II. Attempt to determine the resistance of periodontium to the influence of individual types of the labial frenum attachment. Ceskoslovenska Stomatologie. 1974;74(6):401–406.

[3] Delli K, Livas C, Sculean A, Katsaros C, Bornstein MM. Facts and myths regarding the maxillary midline frenum and its treatment: A systematic review of the literature. Quintessence International. 2013;44(2):177–187.

[4] Sharma P, Salaria SK, Gowda RKN, Ahuja S, Joshi S, Bansal DK. Frenectomy - A brief review. Int J Cont Med Res. 2014;1(1):37–52.

[5] Dibart S, Karima M. Dibart S, editors. Practical periodontal plastic surgery. Boston, John Wiley & Sons, Inc.; 2017. Labial frenectomy alone or in combination with a free gingival autograft; p. 73–75.

[6] Chaubey KK, Thakur R, Arora V, Narula I. Perio-esthetic surgery: Using LPF with frenectomy for prevention of scar Journal of Indian Society of Periodontology. 2011;15(3):265.

[7] Abullais S, Dani N, Ningappa P et al. Paralleling technique for frenectomy and oral hygiene evaluation after frenectomy. Journal of Indian Society of Periodontology. 2016;20(1):28-31.

[8] Haytac MC, Ozcelik O. Evaluation of patient perceptions after frenectomy operations: A comparison of carbon dioxide laser and scalpel techniques. Journal of Periodontology. 2006;7(11):1815–1819.

[9] Thahir H, Djais AI, Wendy S, Achmad MH, Akbar FH. Management of maxillary labial frenum with comparison of conventional and incision below the clamp techniques: A case report. Journal of Dentomaxillofacial Science. 2018;3(1):61-66.

[10] Dhalkari C, Indurkar M, Patil S. Paralleling technique for frenectomy - A case report. International Journal of Advanced Research. 2017;5(9):1219–1224.