Dr. Greg Jorgensen
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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. yen yen says:

    hi. I have braces for 6 months now. I dont have gaps in my front teeth before. The dentist said she has to move the front line so she created a gap between my front teeth now. She suggested now for a frenectomy she said it is necessary to close the gap and to prevent it from developing a further gap after removing the braces. My question is, is it really necessary for a frenectomy?

    • A frenectomy is only needed if you have a large frenum that is impinging between the two front teeth and “causing problems.” Only your local specialist can determine if you would require that procedure. Not all patients with a space need it, only those whose frenums really are a problem

  2. Alice Carr says:

    I had a large space between my two front teeth before I had my upper braces, and when I got them off my space was closed, but I noticed shortly after that a space was forming between those teeth, and didn’t receive my upper retainer for about a week since they wanted the teeth to settle. They claimed that if I wore the retainer the space would close, and it does seem a little smaller and none of my other teeth have shifted. It seems like the two front teeth are a little diagonal, so could it be possible that I might need a frenectomy? It seems like the tissue could be preventing them from going back together. The teeth did do their own natural shifting which is expected, but I’m just curious to know.

  3. Ellie says:

    I’ve been receiving orthodontic treatment for hypodontia and peg lateral incisors which have caused spacing between teeth, I’ve always had an oversized frenum that separated my two front teeth. Now the space has closed between my front teeth, but this seems to be causing inflammation to my still oversized frenum. When will the frenectomy my orthodontist assured me of likely be performed?

  4. Barkha says:

    I had midline diasthema. I am on orthodontic treatment and space is almost closed. Approx 0.5 mm of space is still left. At this stage only my frenectomy is done.so will the remaining space of 0.5 mm will close on further orthodontic treatment?

    • Good question for your orthodontist. They usually close easily. The tricky party is keeping them closed! That will require a bonded retainer behind the teeth where the space was originally

  5. Kitt says:

    Hi doc, I started invisalign to close a 6mm midline diastema, and I’ve just reached the over-correction stage. Unfortunately, the gap hasn’t quite closed. What’s happened is that the central incisors have tipped towards one another, it’s clear the frenum is preventing the gap from fully closing.

    My ortho insist I continue into the over-correction stage, the only problem with that is that the pain experienced with the over-correction trays is the worst I’ve felt after 30 some trays of invisalign! I’m also not convinced that the over-correction will fully close the diastema. I believe I’ll need to get a frenectomy or maybe I’ll need conventional braces to finish the job. I’m not sure what to think anymore, what do you recommend?

    • I can’t diagnose what is happening from here, but I know that closing a 6mm space with clear aligners is difficult because it is hard to move the roots together. I would consider putting cosmetic brackets on the for the last few months to move the roots and close the remaining space. Ask your orthodontist about it.

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