Dr. Anish Goyal, MDS
Invisalign Certified Dentist
Dr. Goyal holds a Master of Dental Surgery (MDS) and is a certified Invisalign provider, practising at Dental Arch, Gurgaon. He treated this case together with Dr. Sharma.
Full profile →Summary
A gap between the upper front teeth is one of the most common smile concerns we see. Closing it for good depends on one question: why is the gap there? In this patient, the answer was a high maxillary labial frenal attachment. Treating only the gap would risk relapse. Treating only the frenum would leave the gap in place.
Our team planned the two together. We used digital intra-oral scanning, computer-controlled local anaesthesia, dental laser frenectomy and Invisalign clear aligners, each in the order that serves the final result.
The patient and the presenting concern
A 25-year-old patient came to us unhappy with a visible space between her upper central incisors. She wanted a discreet, comfortable and long-lasting solution, and preferred not to have fixed braces.
Clinical findings
- A midline diastema of approximately 2 mm between teeth 11 and 21
- A thick, low-inserting maxillary labial frenum running into the papilla between the central incisors
- Papilla blanching when the upper lip was lifted (positive tension test)
- Otherwise healthy gums, with no active periodontal disease
Why this gap doesn't close on its own
A midline diastema can have several causes: a tooth-size discrepancy, small or missing lateral incisors, habits, or a thickened labial frenum. When a high, fibrous frenum extends between the central incisors, it can hold them apart.
Closing the space with aligners alone, without addressing the frenum, can lead to relapse, where the gap slowly reopens. That is why we established the cause before choosing the treatment.
Diagnosis and treatment plan
After a full clinical examination, photographs and a digital scan, we diagnosed a diastema associated with a high maxillary labial frenal attachment. We planned two phases, coordinated from the start by Dr. Anish Goyal and Dr. Neha Sharma:
- Laser frenectomy to release the abnormal frenum attachment
- Invisalign clear aligners to close the space and align the front teeth
The technology behind the plan
1
Digital intra-oral scan
A quick, comfortable 3D scan replaces impression trays. It gives accurate records and lets us simulate tooth movement before treatment starts.
2
Computer-controlled anaesthesia
The anaesthetic is delivered slowly at a controlled rate, which reduces the discomfort normally linked to injection speed and pressure.
3
Dental laser frenectomy
A precise soft-tissue release with minimal bleeding, a clean field and, for most patients, a comfortable early healing phase.
4
Invisalign clear aligners
Planned from the digital scan, they close the space with gradual, controlled movements, without brackets or wires.
Step 1: Scanning and comfortable anaesthesia
We captured a detailed 3D model of the teeth and gums with our digital intra-oral scanner, which also allows us to show patients the planned movement in advance.
For the frenectomy, we used a computer-controlled local anaesthetic delivery system. Many patients feel anxious about injections near the front of the mouth, and slow, controlled delivery helped keep this patient relaxed throughout.
Step 2: Laser frenectomy
Using a 10-watt BIOLASE diode laser with a sapphire tip, applied in contact mode with pulsed (non-continuous) emission, the frenum was released precisely under local anaesthesia. Compared with a conventional scalpel technique, laser frenectomy offers:
- Precise soft-tissue release with minimal bleeding
- Often no need for sutures, and none were required in this case
- A cleaner surgical field
- Reduced swelling and discomfort in most patients
The patient received post-operative instructions on oral hygiene, diet and care of the healing site. Paracetamol was advised for any discomfort, and antibiotics were not required.
See the difference for yourself
Drag the handle left and right to compare the same patient before the laser frenectomy and after healing.
Before
After healing
Where the case stands
Phase 1, laser frenectomy: complete. The frenum has been released and the tissue has healed smoothly, as the slider above shows.
Phase 2, Invisalign: 18 aligners over an estimated 3–4 months, started immediately after the frenectomy. The aligners are designed from the digital scan and worn as directed. Permanent retention (a fixed retainer) follows, to protect the result and help prevent relapse.
We will add final photographs to this case report once aligner treatment is complete.
Why a multidisciplinary approach matters
Good outcomes come from treating the cause as well as the cosmetic concern. In this case, that meant bringing soft-tissue surgery, orthodontic planning and digital technology together in one sequence.
| Challenge | Our solution |
|---|---|
| Diagnosing the true cause | Clinical assessment and digital records |
| Accurate planning | Intra-oral scanning and 3D treatment simulation |
| Patient comfort | Computer-controlled local anaesthesia |
| Releasing the frenum | Precise dental laser frenectomy |
| Closing the space discreetly | Invisalign clear aligners |
| Long-term stability | Frenum release plus retention |
Meet the treating team
Dr. Neha Sharma, MDS
Invisalign Certified Dentist
Dr. Sharma holds a Master of Dental Surgery (MDS) and is a certified Invisalign provider, practising at Dental Arch, Gurgaon. She treated this case together with Dr. Goyal.
Full profile →Technology used in this case
Frequently asked questions
Is a laser frenectomy painful?
The procedure is performed under local anaesthesia, so patients do not feel pain during it. Mild soreness afterwards is usually manageable.
Can a midline diastema be closed without a frenectomy?
Sometimes. If a high frenum is the cause, treating only the gap can lead to relapse, so we assess this first.
How long does treatment take?
It depends on the size of the gap and the complexity of the case. Laser healing takes days to weeks, and aligner treatment generally takes several months.
Is Invisalign suitable for closing a gap between the front teeth?
In many cases, yes. Suitability depends on your individual examination, which is why we begin with a consultation and a digital scan.
Have a gap between your front teeth?
Not every diastema has the same cause, and the right treatment starts with the right diagnosis. Book a consultation to find out whether a combined frenectomy and Invisalign approach suits you.
Landline: 0124-4181454
This case report describes one patient's treatment and is published with her consent. Results vary between individuals, and suitability for any treatment can only be determined after a clinical examination.
Invisalign is a registered trademark of Align Technology, Inc. BIOLASE is a registered trademark of BIOLASE, Inc. Logos are shown to identify the technology used and do not imply endorsement.