Surgical Techniques for Correcting Aberrant Frenal Attachment: A Clinical Review C. S. Baiju 1 Karuna Joshi 1 Ria Virmani 1 Gunjan Gupta 1 Pawandeep Kaur 1 1 Department of Periodontics and Oral Implantology, Sudha Rustagi College of Dental Sciences, Faridabad, Haryana, India Dent J Adv Stud Address for correspondence Karuna Joshi, MDS, Department of Periodontics and Oral Implantology, Sudha Rustagi College of Dental Sciences, Faridabad, Haryana 121002, India (e-mail: karunajoshi1903@gmail.com). Introduction A frenum is a fold of mucous membrane, maybe with enclosed muscle fibers, which attaches the lips and cheeks to the alveolar mucosa and/or gingiva and underlying periosteum. 1 It can be categorized as long and thin or short and broad. 2 The maxillary and mandibular labial frenum are commonly at- tached below the respective alveolar crests. 3 Knox and Young in their histological examination observed the presence of the epithelium and muscle fibers in the labial frenum (orbicularis oris—horizontal bands and oblique fibers). While Henry, Levin and Tsaknis found an appreciable presence of dense collage- nous tissue and elastic fibers but a lack of muscle fibers in the frenum. 4 It has been noted that the connective tissue between the inferior portion of the incisivus labii superioris (ILS) muscle conformed to the inferior labial frenulum and the extent of the inferior part of the ILS correlated to the folds of the upper alveolar mucosa. 5 Mirko et al classified it, depending upon the extension of attachment of fibers: 6 a. mucosal attachment of the frenum, insertio in mucosam, means an attachment of the frenum to the mucogingival junction. b. gingival attachment, insertio in mucosam fixam, stands for an attachment of the frenum to the attached gingiva. c. papillary attachment, insertio in papillam, means an attachment of the frenum to the papilla. d. papillary penetrating attachment is in those cases when the attachment of the frenum passes right up to the papilla while inserting in attached gingiva. A frenum encroaching on the gingival margin may com- promise the status of gingival health, either due to an obstruction in the plaque control or due to a muscle pull. These hygiene problems are usually more pronounced in the mandibular anterior areas. 7 Keywords ► frenum ► frenectomy ► frenotomy ► scalpel techniques Abstract Frenum is a fold of mucous membrane, usually with enclosed muscle fibers, which attaches the lips and cheeks to the alveolar mucosa and/or gingival and underlying periosteum. Different types of frenal attachments have been observed and classified. Frenum with abnormal attachments may lead to mucogingival problems while hampering gingival health, as they cause an interference in the plaque control or may create a muscle pull. This condition may require management that can be usually performed with frenectomy and frenotomy procedures. Frenectomy is the complete removal of the frenum, while frenotomy is the incision and relocation of the frenal attachment. The present article is a compilation and review of a series of clinical cases of frenal excision through different surgical approaches. DOI https://doi.org/ 10.1055/s-0041-1736263. ISSN 2321-1482. © 2021. Bhojia Dental College and Hospital af filiated to Himachal Pradesh University. All rights reserved. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial-License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/ licenses/by-nc-nd/4.0/) Thieme Medical and Scientific Publishers Pvt. Ltd., A-12, 2nd Floor, Sector 2, Noida-201301 UP, India THIEME Review Article Published online: 2021-10-18