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

Introduction: 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.
Case presentation: 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.
Discussion: 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 biome
chanical elements, designing appropriate prostheses, ensuring better retention of tooth position, and achieving
aesthetic appearance.
Conclusion: The Z-plasty frenectomy surgery treatment resulted in successful and rapid healing after the oper
ation, 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.