Z-plasty surgery combined with orthodontic-prosthodontic approach in the rehabilitation of aberrant frenum with congenitally multiple agenesis: A case report

• Published in: International journal of surgery case reports 2024-08, Vol.121, p.109986, Article 109986
• Main Authors: Hermanegara, Nabila Amalia, Chairunnisa, Afina Zahra, Suparwitri, Sri, Alhasyimi, Ananto Ali, Aditama, Pramudya, Farmasyanti, Cendrawasih Andusyana
• Format: Article
• Language: English
• Subjects: Aberrant frenum; Diastemata; Interdisciplinary; Multiple agenesis; Z-plasty surgery
• ISSN: 2210-2612; 2210-2612
• DOI: 10.1016/j.ijscr.2024.109986

Orthodontists often encounter a clinical challenge while dealing with a big space of anterior teeth. Aberrant frenum with congenitally multiple agenesis is a complex case that requires an interdisciplinary approach. The purpose of this paper is to describe the well-synchronized periodontal surgery, orthodontic, and prosthodontic treatment of an aberrant frenum cases with congenitally multiple agenesis. A female patient, aged 20, presented with complaints of misaligned, spaced teeth, and several missing teeth. A Class III malocclusion type 1 with a high and hypertrophied maxillary labial frenum was found and diagnosed. A positive blanch test, diastemata, as well as persistent teeth 53, 71, and 81, were detected. Panoramic radiographs confirmed the teeth's agenesis. Orthodontic treatment was performed using the straightwire technique to close the spaces. The frenulum was corrected by a frenectomy utilizing the Z-plasty surgical procedure. Subsequently, prosthodontic treatment involved the fabrication of lucitone dentures to close the remaining space. This case alerted periodontists, orthodontists, and prosthodontists that collaboration is essential to intervene in such specific congenital anomalies. An interdisciplinary effort should focus on eliminating the etiology of malocclusion, considering periodontal factors, maintaining dental arch integrity, addressing biomechanical elements, designing appropriate prostheses, ensuring better retention of tooth position, and achieving aesthetic appearance. The Z-plasty frenectomy surgery treatment resulted in successful and rapid healing after the operation, with no occurrence of hypertrophic scar formation. The final outcome of orthodontic-prosthodontic treatment was also pleasing for both the patient's aesthetic and functional requirements and the operator's satisfaction. •Managing a case of aberrant frenum with congenitally multiple agenesis is a clinical challenge.•The Z-Plasty frenectomy surgery treatment led to a successful and speedy recovery, with no hypertrophic scar development.•Excellent treatment planning contributed to an acceptable, aesthetically pleasing, structural, and functional outcome.