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?

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

  1. Patience says:

    I just got my braces of today and I notice a big frenum between my teeth, but my ortho recommend I get the frenectomy so the gap doesn’t come back. And is ok to get the frenectomy after braces treatment? I’m not sure what to do please help.

  2. Tim says:

    My son had a frenectomy done with a laser and now has bone loss in front of his two incisors. I worry later in life these teeth will come loose and require a bone graft for implants. Is using a laser for this procedure normal?

    • Using a laser for this procedure is perfectly normal and unless there is something that I’m not aware of, I doubt that the frenectomy had anything to do with his bone loss. I’ve been at this for over 20 years and I’ve never heard any correlation between the two ever. You should see a periodontist and see what is really going on.

  3. Teresa says:

    I had braces a year ago but there is big gap between my front teeth that will only close when wearing braces. My dentist did a frenectomy but in the top of my lip and gums. However I have too much extra tissue between my front teeth that gets swollen when I wear my retainer. Is there a laser or some treatment to remove that skin so my teeth can stay together? Thank you

    • There are many things that can cause the gap between your teeth to come back once it is closed. The frenum and other tissues are just one of them. Others include the bite, the shape of the teeth, and the size of the teeth. In my patients I always place a bonded retainer behind the upper front teeth to keep them together after the braces come off. It complicates brushing and flossing somewhat, but it is the only way I know to keep that gap closed permanently.

      • norma says:

        Hi doctor…ive had the same problem…i had the frenoctomy done and after my braces where off…my teeth open up again…now i have the same middle gap and two other ones on the sides of my front teeth..and i do feel i have still more gum tissue to be removed…i dont know what to do…specially without having money to fix them and before i already spended like $1700.00 just in the braces…i need some help or advice what should i do?

        • Your gap will NOT close on its own after a frenectomy alone. Only orthodontic treatment will close your space. Once closed, a permanent bonded retainer must be placed. Only after the space is closed and stabilized, THEN you should be evaluated for the need of a frenectomy. Timing and sequence in these cases is critical.

  4. Ana says:

    After the diastema is closed, and the frenectomy is performed, will the patient have to wear the bonded retainer for LIFE? Or can they take it out after a few years, and then wear a normal Hawley/Essix retainer at night….
    Will the diastema come back if the bonded retainer is not worn for life?

    • Midline diastemas are one of the most unpredictable problems I face. I typically keep the bonded retainer in for at least a year. After a year I leave it in until the patient wants it off or it comes loose. At that time we have them continue wearing a Hawley retainer and monitor the recurrence of the space. Nothing is permanent in these human bodies… except death!

      • Ana says:

        Sorry for all these persistent comments, but do you recommend getting braces again for a 1 mm gap that has re-formed due to the frenum? Since my ortho didn’t warn me about the frenectomy, I am left with this permanently. My parents will not pay for braces again, but in a few years, is it worth it to go through 2-3 years of braces to close the diastema and wear a bonded retainer for life, for the sake of aesthetics? Or should I rely on a spring retainer? I feel very ugly, almost, because of this diastema, as none of my other friends who got their braces off have this, and I do. My parents were not warned by my dentist when i was a child either, or this could’ve been prevented.In addition, do you know of any patients who have a midline diastema again after several year despite wearing braces, bonded retainers, and a Hawley? Will future treatments ever be able to correct this?

        • Closing diastemas is easy. Keeping them closed is not. They can be caused by the gum tissue (frenum), tongue pressure, or the size of the teeth in the area (just too skinny). It may be that the best treatment for you is to have your front teeth bonded or veneered. Not only is this faster and cheaper than another two years of braces, it may be more stable if your problem is caused by the size of your teeth. Ask your orthodontist or primary care dentist if veneers might be a more stable option for you.

          • Ana says:

            My orthodontist wants me to do a frenectomy and then use spring retainers to close the gap that has reformed. Will a spring retainer close this space? Or should I just resort to cosmetic dental options like tooth bonding and veneers? Thank you so much for your information, as this really did inform me.

          • A frenectomy MAY be helpful if it is the only problem. If the problem is the size of the teeth, then the spring retainer will only re-distribute the space, not eliminate it. If everything else is good, bonding the teeth may be a faster and more stable way to get your gap closed.

  5. Abigail says:

    Some peoples gaps close due to the eruption of the wisdom teeth, but is it true that if you have a frenum the wisdom teeth will not close the gap??? I wouldnt want to get braces if eventually the gap will close. Also after i get braces, Hopefully they will cut the frenum, will wisdom teeth eruption destroy my fixed teeth?

    • It is a fallacy (not true) that wisdom teeth cause spaces to close when they come in. Even if they did put pressure on the very back teeth, there is no way that they would affect a space between the two front teeth. Closing a midline diastema generally requires braces in addition to a frenectomy. Don’t waste your time waiting for your wisdom teeth to close your gap. It’s not happening!

  6. Kristen says:

    I have a 2 mm diastema between my two maxillary middle (first)incisors. I am supposed to have a frenectomy tomorrow with a periodontist. They are using a scalpel. Is laser better than scalpel? I don’t have a problem with my labial frenulum being attached too low on my gums. I just have a lot of tissue between my two front incisors, so I assume they’ll just cut that tissue and place sutures? They won’t need to cut my labial frenulum, right? I’m concerned because I’ve read that doing so can change your smile (making it appear “gummy”). I see that you recommend the bonded retainer for a year at least. Do you think that using the removeable retainer every night would be sufficient instead of having this bonded in my mouth? I’m concerned about it making brushing and flossing difficult. My dentist plans to place rubber bands between my 1st and 2nd maxillary incisors, bilaterally, to close the diastema, then place veneers on both of my 2nd incisors to fill in the space. The 1st incisors are already big enough and she said putting veneers on them would make them too big and unattractive, so putting veneers on my second incisors (which are small) would look better. Do you think this is a good plan? Any possible complications I should be aware of from the frenectomy? Thank you!

    • It doesn’t matter what instrument your doctor uses to perform the frenectomy, the results will be almost identical. As for the gummy smile, I don’t see how the two are related. I’ve never seen that in my patients, so you shouldn’t worry. Lastly, the discussion about tooth sizes makes perfect sense. If he didn’t add the buildups on the laterals, your two centrals might end up being really big afterwards. Good luck!

  7. MBryan says:

    My son is 5 1/2 years old and his dentist recommended doing a Frenectomy b/w his front teeth now. He hasn’t even lost his baby teeth yet. Is this too soon?

    • It may not be too soon if your son has a very long, thick frenum. In fact, if your doctor noticed this BEFORE the permanent teeth are in, having the frenectomy will allow the permanent teeth to come in better than they would have otherwise. Good luck!

  8. Giselle says:

    Hi Doc,

    My daughter turned 10 yrs old in July. She was born with the space between her teeth. No one else in the family has this. Her orthodontist has recommended that she does surgery to have the extra skin clipped. We went for a consultation and the surgeon said that she’ll be put to sleep for the procedure which would take about 15 ,minutes. My husband and I are not comfortable with her having to be put to sleep ( he said this would make it easier for everyone)The space is not very big, so we were wondering if putting her to sleep is necessary and also, if she would have to wear braces afterwards, to close the space once the gum has been clipped? Please advise us!

    • The frenectomy procedure is very simple and straight forward. Unless a child has severe behavioral problems, I see no need to have them put to sleep for this. In fact in over 20 years of practice, I’ve never heard of a child needing to be put to sleep for such a simple procedure. I think you should ask your doctor about this or go elsewhere.

  9. Kailee says:

    Can I get your input on a baby with an upper frenulum problem? She’s 11 months old and it is attached to the gums behind her front two teeth and comes right between them. It’s very thick and it is already starting to separate her teeth. It’s also difficult to brush her top front teeth because her upper lip is so attached. Is she too young to have a frenectomy? I don’t want her to have speech problems or gaps in her teeth. Thanks!

    • I have three children of my own and I don’t think I would have put them through this at age 11 months. I would wait until your daughter is more like 5 and then have it done when her primary teeth are lose and ready to fall out. That way the tissue will be fixed before the permanent ones come in. Good luck!

  10. Erica says:

    Hi! My daughter just turned one and we were told at her dentist appointment that she would likely need her frenulum removed in the future. I recently had mine removed so I know how painful it can be. My worry is that she bites into it sometimes and it even bleeds. I don’t want to put her through the procedure so young, but I don’t want her biting herself either. When would you recommend removing it?

    • The best time to remove it is when it is determined that it is causing a problem. That may be at age 6 or 7. The younger the patient is, the easier the recovery, so don’t be afraid to have it done if it is necessary.

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