Interdisciplinary Management of Maxillary Midline Diastema With a Papillary Penetrating Labial Frenum Using Orthodontic Therapy and Diode Laser-Assisted Frenectomy: A Case Report.

Maxillary midline diastema is a common esthetic concern with a multifactorial etiology that includes aberrant maxillary labial frenum attachment. A papillary penetrating labial frenum may contribute to the persistence of a maxillary midline diastema and may warrant consideration during treatment planning. We report a 19-year-old woman with a maxillary midline diastema associated with a papillary penetrating labial frenum. Comprehensive fixed orthodontic treatment was completed over 16 months, achieving closure of the diastema. Because the aberrant frenum persisted after space closure, a 980 nm diode laser-assisted frenectomy was performed under local anesthesia (pulsed mode, 3 W). The procedure was completed with minimal intraoperative bleeding, good hemostasis, and without sutures, and postoperative healing was uneventful, with satisfactory soft tissue maturation at the one- and three-month follow-up visits, after which a bonded lingual retainer was placed. The patient reported minimal postoperative discomfort and was satisfied with the overall esthetic result; no standardized pain or satisfaction scale was used. This case illustrates the clinical value of interdisciplinary sequencing, with orthodontic approximation first, followed by frenectomy before definitive retention, in a patient with a persistent papillary penetrating frenum. Within the limits of a single case with short follow-up, diode laser-assisted frenectomy may serve as a useful minimally invasive adjunct to orthodontic treatment in appropriately selected patients.