# Clinical Evaluation of Keratinized Tissue Gain Using a Free Gingival Graft Combined With Frenotomy in Patients With Aberrant Mandibular Frenal Attachment: A Three-Month Follow-Up Case Series

## TL;DR

This study shows that combining a free gingival graft with frenotomy improves keratinized tissue width and healing in patients with abnormal lower lip frenum attachments.

## Contribution

The novel contribution is demonstrating the effectiveness of combining frenotomy with free gingival grafts for treating aberrant mandibular frenum attachments.

## Key findings

- Keratinized tissue width increased significantly from 2.08 mm to 8.83 mm after three months.
- Postoperative pain scores decreased significantly from day 1 to day 7.
- Mucosal healing was successful in 83.3% of cases based on the inflammatory proliferative remodelling index.

## Abstract

Introduction: The aim of the present study was to evaluate the treatment of aberrant frenum attachment using frenotomy combined with free gingival grafts (FGGs) with respect to the gain in the width of keratinized gingiva, relapse, mucosal healing, and postoperative pain, as well as scar formation.

Methodology: Twelve adult patients (three males and nine females) with aberrant mandibular frenum attachment underwent frenotomy combined with free gingival grafting at the Faculty of Dentistry, Cairo University, and October University for Modern Sciences and Arts. Frenotomy was performed using split-thickness incisions on both sides of the frenum, followed by apical relocation of the muscle through blunt dissection. A palatal FGG was then harvested and secured to the recipient site with resorbable sutures.

Results: Keratinized tissue increased significantly from 2.08 ± 0.34 mm to 8.83 ± 0.53 mm at three months (p < 0.001). The postoperative pain scores dropped significantly from 5.83 ± 0.35 on day 1 to 0.33 ± 0.14 on day 7 (p < 0.001). The "inflammatory proliferative remodelling" index showed successful healing with scores of 5.33 ± 0.26 (inflammatory), 4.00 ± 0.21 (proliferative), and 2.17 ± 0.11 (remodelling), with a total of 11.5 ± 0.45, indicating excellent healing in 83.3% of cases (p = 0.021). At three months, the frenum was located at a more apical level than baseline by 4.3 ± 0.43 mm, with a significant difference between its baseline and three-month location (p < 0.001). The mean scar index at three months was 4.17 ± 0.94, reflecting mild to moderate scarring.

Conclusion: This combined approach is an effective, safe, and predictable modality for treating aberrant labial mandibular frenum attachments in adults, particularly where periodontal health and soft tissue augmentation are the primary goals.