Dr. Greg Jorgensen
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Rio Rancho, NM 87124

The Jorgensen Orthodontics Blog

What Is a Frenectomy and When Is It Necessary?

Posted by Dr. Jorgensen on June 1st, 2011

 

customer service represenatative beautiful smiling on phoneOrthodontic treatment involves more than just putting braces on your teeth. The teeth are just one part of your smile. Sometimes your orthodontist will recommend other procedures to help make your orthodontic treatment result the best it can be. One such procedure is a frenectomy.

Successful orthodontic treatment creates a smile that is attractive, healthy, and stable. Achieving a stable result requires that your orthodontist consider the size and shape of the teeth, the position of the teeth in the bone, the pressure from the lips and tongue, and the condition of the surrounding soft tissues. Thick gums can affect the position of the teeth before, during, and after treatment. One of the most common conditions related to the gum tissues is a space created by a thick band of tissue lying between the upper front teeth known as the “frenum.” The procedure used to reshape, shorten, or remove this tissue is known as a “frenectomy.”

You will find the frenum connecting the inside of the upper lip to the gum tissue between the roots of the upper front teeth. Normally the frenum blends into the gum tissue above the level of the teeth. In some cases however, it extends between the incisors and appears to push them apart creating a space. In most cases however, the frenum was present when the permanent incisors came into the mouth forcing them to come in spread apart. Not only can this tissue prevent the front teeth from coming into the mouth next to each other, it can also push them apart after orthodontic treatment. Dentists perform frenectomies to keep this from happening.

There is some controversy about the best time to remove this tissue. Sadly, merely clipping the frenum after the permanent incisors have come in will not make them to go back together on their own. A “standalone” frenectomy is only effective at closing a space if it is performed before the teeth have come in (making it essentially a preventive measure). If your dentist or orthodontist notices that your child’s frenum is too long before the permanent teeth poke through, removing the extra tissue may allow them come in next to each other.

If there is already a space between the teeth, the best time to do the frenectomy is after your orthodontist has closed the space with braces. This is most effective for two reasons. First, if the teeth are brought together and the frenum reevaluated, it may be discovered that the tissue is not actually pushing the teeth apart at all and that the procedure may not be necessary. Second, if a frenectomy is deemed necessary after the space is closed, it is best to have the teeth in their desired positions while the tissue is healing. Scar tissue that forms between the teeth as a result of the surgery might actually make the space harder to close during treatment and force the teeth back apart afterwards. Therefore the best time to do a frenectomy is after the space has been closed.

One added precaution that should be taken after closing a space and performing a frenectomy is stabilizing the incisors with a bonded retainer for at least a year. This not only holds the space closed in the short-term, but it also gives the bone and gums around the teeth a chance to adapt to their new position so they’ll be more stable in the long-term.

NOTE: The author, Dr. Greg Jorgensen, is a board-certified orthodontist who is in the private practice of orthodontics in Rio Rancho, New Mexico (a suburb on the Westside of Albuquerque). He was trained at BYU, Washington University in St. Louis, and the University of Iowa in the United States. Dr. Jorgensen’s 25 years of specialty practice and nearly 10,000 finished cases qualify him an expert in two-phase treatment, extraction and non-extraction therapy, functional orthodontics, clear aligners (Invisalign), and multiple bracket systems (including conventional braces, Damon and other self-ligating brackets, Suresmile, and lingual braces). This blog is for informational purposes only and is designed to help consumers understand currently accepted orthodontic concepts. It is not a venue for debating alternative treatment theories. Dr. Jorgensen is licensed to diagnose and treat patients only in the state of New Mexico. He cannot diagnose cases described in comments nor can he select treatment plans for readers. Please understand that because he has tens of thousands of readers each month, IT IS IMPOSSIBLE FOR HIM TO RESPOND TO EVERY QUESTION. Please read all of the comments associated with each article as most of the questions he receives each week have been asked and answered previously. The opinions expressed here are protected by copyright laws and can only be used with written permission from the author.

What Is a Frenectomy and When Is It Necessary?

201 comments so far in response to “What Is a Frenectomy and When Is It Necessary?”

  1. Tonya Davis says:

    I took my son 11 yrs old to dentist today concerned about the gap between his front teeth.  The dentist wants to do a frunelectomy on my son due to skin from upper lip to between front 2 teeth prior to putting braces on front 4 teeth to close gap. Everything I’m reading about says its not necessary until after braces have closed the gap first. Please give me some advice regarding this because if we can close the gap without the fronelectomy I would rather go that route. My son is very worried about this procedure but fine with the braces.  Please give me your opinion on this subject.  My sons dentist said he can do procedure in his office but yet he is not an oral surgeon.  I need answers because I am very concerned.  My email is tonyadavis40@hotmail.com 
    Thanks in advance for your reply.
    Tonya Davis

    • In my experience it is better to close the space THEN do the frenectomy. The gum tissue heals so fast that I like having the teeth in their new position before performing the procedure. Good luck!

  2. Elysewilliam says:

    Frenectomy is a surgical procedure that involves removal of the frenulum, a thin band of fibrous tissue covered with mucous membranes. Bridle sores can be found after the elevation of the upper lip and connects the center of the upper lip to the gum tissue between the two front teeth. Lingual frenulum was found extending from the floor of the mouth to the midline of the tongue. For more detail visit.. http://www.identalhub.com/article_types-and-techniques-of-frenectomy-84.aspx

  3. CJ says:

    I have braces and am close to getting them off, but lately i noticed a very small gap opening up between my two front teeth. My orthodontist recommended a frenectomy but i am very unsure about it. It is a laser procedure and I know very little about it. Are there many risks in this procedure and is it really necessary? It wasn’t even that big of a gap. This would delay me getting my braces off and the space already closed up because he put new bands on my teeth. Should I go through with a frenectomy? 

    • If your doctor feels that a frenectomy is needed, you may really need one. The procedure is very simple and there are very few risks. A frenectomy alone will not guarantee that your gap will not reopen after the braces come off. The best way to do that is with a fixed or bonded retainer behind the two front teeth. Ask your orthodontist if that is also something that you can have to keep your front teeth together. Good luck!

  4. Cathy says:

    I was told to have to procedure done before braces. I aked both ortho and peri which would be better, to have it done before or while braces are on. they both said before. the ortho said either way, it doesnt matter.
    I just had this procedure done today & am terrified now about scar tissue and not being able to close the space.

    • Hi Cathy. No need to panic! The key is that after the space is closed your orthodontist will need to make sure that the new position is maintained a little longer until the fibers in the healed tissue have reorganized and matured so that the space doesn’t just open right back up. Although what I have described is the best approach in my experience, it doesn’t necessarily mean that you’re going to have a problem. Just be sure and communicate your concerns to your doctor and keep your eye on the area after treatment so that you can report any changes before they become too big. Good luck and no worries!

  5. Missy Mander says:

    How far apart do ur teeth have to be to do frenectomy? I am very worried about the surgury. When i was little i promised myself i would never have a surgury no matter what and this is my first surgury i am very worried IM JUST 10!!!!

    • Hi Missy. A frenectomy is a simple procedure that should not cause you any problems at all. I can assure you that your doctor would not recommend it for you unless it was necessary. It is OK to be nervous when you are doing something unfamiliar or new. That is normal. I’m sure that you will do fine and the outcome will be a healthier smile. Good luck with your procedure!

  6. Shannon, Virginia says:

    While my son (5 years old) was at the dentist today for a routine cleaning the dentist informed me that he will need surgery to clip the “frenum” on his upper lip when he is 7-8 years old. He has not started getting in his permanent teeth yet. 
    My question is; should I go ahead and schedule an appt with an orthodontist now to try to have this corrected before he starts getting his permanent teeth in? The dentist said to wait until he was 7-8 years old. Can you think of a reason for waiting?
    We have also met our yearly health deductible so I’m thinking to go ahead and get it over with while we don’t have to pay for the surgery. 
    Any advice is appreciated. 
    Thanks.
    Shannon

    • Hi Shannon. I would have your son evaluated by an orthodontist right away. Here’s why. If he really does have an abnormally large or thick frenum, it would be ideal to have it out of the way before the permanent teeth come in (around age 6). If you wait until after they come in (7 or 8), the will come in with a space in between that may have to be closed orthdontically. Your orthodontist can tell you if your son really needs this procedure or if it would just be overkill. Good luck!

  7. Dionne says:

    For those wondering about the procedure…don’t panic!!  I’m one of the biggest chickens on earth, and I had the procedure done.  It wasn’t bad.  I’m in my final months of braces, and had to have this done between my two front teeth and upper lip.  I was numbed very well, and I didn’t feel a thing.  It was only about 20 minutes long.  I had to eat soft stuff for the first few days.  Good luck to everybody!!!

  8. Angela says:

    If done too early will it grow back? Our son is almost 4 and we are noticing when he smiles it looks like his upper lip is glued down. He says its painful if we touch it. Our dentist didnt even look at it and said its too early and it will grow back. Is this true?

    • If performed correctly, a frenectomy will NOT grow back. I think that your dentist is concerned about the age of your son however. He is very young for this procedure and what I imagine your dentist is worried about is that he’s just not through developing. Maybe he feels that there will be too much change over the next few years to try and estimate how much correction will be necessary. I think that I would at least wait until the upper front baby teeth have fallen out before I would perform the procedure. If done before the permanent ones come in, that would be plenty early. Good luck!

  9. Serena says:

    My child just returned from his routine cleaning and the dentist said he should probably have a frenulectomy.  He will be 5 this month. Last year, he banged his 2 upper teeth pretty well causing severe bleeding and loose teeth. I took him to the dentist and that was when they told me that his skin is larger than normal hence the bleeding and that his teeth may fall out ( they didn’t but they turned gray for a month!).  I’m thinking that his 2 upper teeth will fall out sooner b/c of this accident.  I don’t fully trust our dentist’s opinion all the time and I’ve found a 50/50 split on opinions on whether I should do this procedure.  We will be canceling our insurance soon so I’m wondering if I should/need to get it taken care of now or wait another year when I think he will start losing his teeth. He’s not bothered by it at all and it doesn’t seem to hamper his smile ( I can see all his teeth).  Also, should an orthodontist do it or can a dentist do it too? ( again, I don’t always believe or trust our dentist but we live in a small town with few dental choices).

    • Hi Serena. I sympathize with living in a small town. I grew up in a town of 10,000 and we didn’t have any specialists to choose from either. In the case of your son’s frenectomy, I would seek the opinion of a pedodontist or children’s dentist before doing anything. 5-years-old seems very young, but I would follow the advice of someone who sees children that age every day. You may need to travel to a bigger community to find a children’s dentist, but it will be worth it for your peace of mind. Good luck!

  10. Aria says:

    I got my braces off 7 months ago and I was wearing a retainer. Just recently, my gap started to open up, and he recommended a frenectomy. But do I need to get braces again to close the gap before the frenectomy? My orthodontist is saying that I should wear my retainer after the frenectomy and my gap will close, but I am skeptical. Thanks!

    • I don’t that it will close after the frenectomy if it won’t close before. Retainers aren’t great at closing spaces (unless there is a visible “overbite”). I prefer to close the space first and get the frenectomy done afterwards. Good luck!

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