Management of Bifid Maxillary Labial Frenum Using a Vertical–Horizontal Incision Technique: A Case Report

Prabakaran Ajay; Balaji V.R.; Manikandan D.

doi:10.37841/jidam.2026.v13.i1.002

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📝Abstract

📥 Received: 4 Jan 2026 ✅ Accepted: 11 Feb 2026 📤 Published: 30 Mar 2026

Background: Aberrant maxillary labial frena are known contributors to midline diastema and may hinder orthodontic space closure. While several anatomical variations have been described, bifid frenum is rare and poorly documented in current literature. This case report presents a novel, modified scalpel frenectomy approach tailored for a bifid frenum to support successful orthodontic treatment.

Methods: A modified scalpel frenectomy was performed. A limiting suture provided traction, followed by a vertical incision to separate the bifid frenum and horizontal incisions to release remaining fibers. Complete excision was achieved, and the site was closed with 3-0 silk interrupted sutures and protected with periodontal dressing.

Conclusion: Healing was uneventful, with VAS pain score of 1 immediately postoperatively and 0 at 14 days. Soft tissue healing was excellent, with no residual tension or scarring. The patient was cleared to resume orthodontic space closure without obstruction. More documented cases and long-term follow-up are needed to establish standardized protocols for rare frenum variants.

Keywords: Frenectomy Aesthetics Gingivoplasty Bifid Frenum Vertical-Horizontal Incision

📋How to Cite

Prabakaran A, Balaji VR, Manikandan D. Management of bifid maxillary labial frenum using a vertical–horizontal incision technique: A case report. J Indian Dent Assoc Madras. 2026;13(1):9–13. DOI: 10.37841/jidam.2026.v13.i1.002

Prabakaran, A., Balaji, V. R., & Manikandan, D. (2026). Management of bifid maxillary labial frenum using a vertical–horizontal incision technique: A case report. Journal of Indian Dental Association Madras, 13(1), 9–13. https://doi.org/10.37841/jidam.2026.v13.i1.002

Prabakaran Ajay, Balaji V.R., and Manikandan D. "Management of Bifid Maxillary Labial Frenum Using a Vertical–Horizontal Incision Technique: A Case Report." Journal of Indian Dental Association Madras, vol. 13, no. 1, 2026, pp. 9–13. DOI: 10.37841/jidam.2026.v13.i1.002.

Prabakaran A, Balaji VR, Manikandan D. Management of bifid maxillary labial frenum using a vertical–horizontal incision technique: A case report. J Indian Dent Assoc Madras. 2026;13(1):9–13. doi:10.37841/jidam.2026.v13.i1.002

Prabakaran Ajay, Balaji V.R., and Manikandan D. "Management of Bifid Maxillary Labial Frenum Using a Vertical–Horizontal Incision Technique: A Case Report." Journal of Indian Dental Association Madras 13, no. 1 (2026): 9–13. https://doi.org/10.37841/jidam.2026.v13.i1.002.

📚References

1
Punse SD, Dhadse PV, Salian SS, Patil RT. Conventional scalpel technique for frenectomy during orthodontic treatment. Cureus. 2024;16(5):e60252.
2
Placek M, Skrivanek J, Mrklas L. Significance of the labial frenum attachment in periodontal disease. Oral Surg Oral Med Oral Pathol. 1974;38:627–633.
3
Alfakih AA, El Battawy W, Shemais N. Prevalence of variations in attachment and morphology of maxillary labial frenum in adults. Egypt Dent J. 2025;71:1417-1431.
4
Damasceno EL, Silva MS, Dias KS. Z-plasty aesthetic approach to frenectomy. Int J Dev Res. 2020;10:38053-6.
5
Daruka M, Rana N, Kaushik M, Singh P. Conventional frenectomy – case reports. Int J Multidiscip Res. 2023;5:1-5.
6
Mishra S, Chopra A. Evaluation of aesthetics, pain scores, and prognosis of modified paralleling technique for high frenal attachment: A case series. J Indian Soc Periodontol. 2025;29:102-106.
7
Kinney R, Burris RC, Moffat R, Almpani K. Assessment and management of maxillary labial frenum: a scoping review. Diagnostics. 2024;14:1710.
8
Baxter R, Merkel-Walsh R, Lahey L, Knutsen C, Zaghi S. Buccal frenum: diagnosis and indications for treatment among healthcare professionals. J Oral Rehabil. 2024;51:369-379.
9
Maansingh JC, Balaji VR, Manikandan D. Periodontal aesthetic surgery for irregular gingival contour post-orthodontics: A case report on frenectomy and gingivoplasty. Thai Moogambigai J Periodontics Dent Sci. 2025;6(2):10-13.
10
Tastan Eroglu Z, Babayigit O, Ucan Yarkac F, Yildiz K, Ozkan Sen D. Evaluating diode laser and conventional scalpel techniques in maxillary labial frenectomy for patient perception, tissue healing, and clinical efficacy: six-month results of a randomized controlled study. Med Oral Patol Oral Cir Bucal. 2025;30(2):e256-e264.

[1] 1
Punse SD, Dhadse PV, Salian SS, Patil RT. Conventional scalpel technique for frenectomy during orthodontic treatment. Cureus. 2024;16(5):e60252.

[2] 2
Placek M, Skrivanek J, Mrklas L. Significance of the labial frenum attachment in periodontal disease. Oral Surg Oral Med Oral Pathol. 1974;38:627–633.

[3] 3
Alfakih AA, El Battawy W, Shemais N. Prevalence of variations in attachment and morphology of maxillary labial frenum in adults. Egypt Dent J. 2025;71:1417-1431.

[4] 4
Damasceno EL, Silva MS, Dias KS. Z-plasty aesthetic approach to frenectomy. Int J Dev Res. 2020;10:38053-6.

[5] 5
Daruka M, Rana N, Kaushik M, Singh P. Conventional frenectomy – case reports. Int J Multidiscip Res. 2023;5:1-5.

[6] 6
Mishra S, Chopra A. Evaluation of aesthetics, pain scores, and prognosis of modified paralleling technique for high frenal attachment: A case series. J Indian Soc Periodontol. 2025;29:102-106.

[7] 7
Kinney R, Burris RC, Moffat R, Almpani K. Assessment and management of maxillary labial frenum: a scoping review. Diagnostics. 2024;14:1710.

[8] 8
Baxter R, Merkel-Walsh R, Lahey L, Knutsen C, Zaghi S. Buccal frenum: diagnosis and indications for treatment among healthcare professionals. J Oral Rehabil. 2024;51:369-379.

[9] 9
Maansingh JC, Balaji VR, Manikandan D. Periodontal aesthetic surgery for irregular gingival contour post-orthodontics: A case report on frenectomy and gingivoplasty. Thai Moogambigai J Periodontics Dent Sci. 2025;6(2):10-13.

[10] 10
Tastan Eroglu Z, Babayigit O, Ucan Yarkac F, Yildiz K, Ozkan Sen D. Evaluating diode laser and conventional scalpel techniques in maxillary labial frenectomy for patient perception, tissue healing, and clinical efficacy: six-month results of a randomized controlled study. Med Oral Patol Oral Cir Bucal. 2025;30(2):e256-e264.