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 results the best possible. 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 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 well above the level of the teeth. In some cases however, it extends between the front ones 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 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 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. Because he has over 25,000 readers each month, it is impossible for him respond to all questions. 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?

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

  1. LaBeth Smith says:

    My daughter is 11 weeks and we just noticed the her top lip is attached to her gum. She is a breastfed baby and has never been able to purse her top lip. She has had trouble keeping her weight up because she can’t fully get around the nipple. Could getting it clipped help her, and cause her to start gaining her weight. She weighed 8 lbs 5 oz when born and at 11 weeks is only 9 lbs 14.5 oz

    • This question is not in my area of specialty. I think I would consult with a pediatric dental specialist to find out if and when a frenectomy would be recommended. Good luck!

    • Dr H says:

      LaBeth, I came across your comment when searching more information about frenectomies for children. I am a dentist currently in a pediatric residency training program. I agree with Dr Jorgensen that you should find a pediatric dentist in your area, but expect that some will have more knowledge on the subject than others. Also, take a look at this article from Dr Kotlow, an expert in laser frenectomy procedures.
      http://www.kiddsteeth.com/articles/aldmaxfremarch05b.pdf

  2. Elisa says:

    Thank you for posting this information. Our orthodontist recommended a frenectomy to be done on our 8 year old daughter, and we complied. Now I wish we hadn’t because he hasn’t even put anything in her mouth yet, much less closed the gap. Her lip seems to pull farther above her teeth when she smiles, at least for now. We will know to question this procedure when it comes time for our son to receive treatment.

    • Hi Elisa. I’m not sure exactly why your orthodontist recommended clipping your daughter’s frenum without closing the space. The only time I’ve seen this be effective is BEFORE the permanent incisors come in when it is obvious that the frenum is big and bulky.

  3. anam k says:

    Im getting married in 6months and I dont want ortho done because I dont want to get married with braces on.i need to have a frenectomy done because its caused a gap inbetween my two front teeth.is their any way maybe I could have a frenectomy first and then get veneers. Please help

    • There is really not enough information here to give an opinion. Why are they doing the frenectomy? Frentectomies without braces are usually not performed unless the frenum is causing a problem with gingival recession. As for the sequence of your veneers and other dental work, ask your restorative dentist. He’s the one that sees the entire picture. Good luck!

  4. D Ward says:

    My child has had braces for 3.5 years, everything was going fine and the braces were due to come off today. My child never had a gap between her two front upper teeth, they always looked lined up and straight but the teeth on the sides were crowded and 2 had to be removed.

    Closing the gaps from the removals has been going well with everything lining up. Last month there was a very small sliver of a gap in the side teeth so a double chain was used to finish closing the space.

    Today at the appt. before proceeding with the removal of the braces, the orthodontist noticed a slight gap between the two upper front teeth and all of sudden is recommending a frenectomy. The braces stayed in and a chain has been added to close this newly formed gap.

    Every visit I have been present and there has never been a gap until today. I think the gap has been created from moving the front teeth toward the back rather than moving the back teeth toward the front to close the gap from the removals.

    What would you recommend we do to proceed?

    • Spaces come and go during treatment. There is nothing unusual with what your child has experienced. There is nothing more discouraging to a patient, a family, OR AN ORTHODONTIST than to have a space show up right at the end of treatment. Frenectomies are sometimes needed if the tissue between the teeth is preventing space closure. Be patient and work with your orthodontist on this. I guarantee that he’s just as anxious to finish the treatment as you are. Good luck!

  5. Jude says:

    I’m 14 years old and have always had a gap between my teeth ever since I can remember. We recently changed our dentist and my dentist advises me to go through the procedure of having my frenulum removed in order for my gap to hopefully close up. Why has this just been mentioned now and not when I was smaller? What are the long term effect that could happen to my mouth/lips if I go through this?

    Many thanks,

    Jude

    • From what I have seen in my 25 years in the field, performing a frenectomy at age 14 without orthodontic treatment will not have any affect upon your gap at all. Had the frenum really been the cause of the gap, removing it before the permanent incisors were all in may have helped. Performing this procedure alone without orthodontic force to bring the teeth together will not give you the result you seek.

  6. Adrienne says:

    My daughter is 5 years old, she still has all of her baby teeth. She also has a bulky frenum causing a space between her front 2 teeth. Her dentist recommends a frenectomy now before her permanent teeth come in. I have read your article but my concern is that if they remove the frenum now isn’t there still a chance that scare tissue will develop causing a permanent gap when her permanent teeth come?

    • Actually, if the permanent teeth are NOT in and it is obvious that the frenum is very large, I would be FOR doing it BEFORE they come in. I don’t like doing it after they have come in unless the procedure follows orthodontic space closure. Good luck!

  7. DR. ABHI says:

    sir can you quote any reference article regarding your views about frenectomy post orthodontic treatment?

    • I do not have a reference Dr. Abhi, but I do have 23 years of experience. My experience is that if a frenectomy is done BEFORE the eruption of the permanent centrals in cases with very thick frena, the centrals may come in better. If performed after the eruption of the centrals, I have not seen self-correction and in some cases I have seen the gingival heal between the teeth in the diastema with no change in tooth position. By closing the space and then performing the frenectomy I guarantee that the teeth are where I want them and the healing then occurs with the teeth in their desirable positions.

  8. A Curry says:

    I am 31 and I have a large gap between my two front teeth. i also have a very thick frenum and have had it my whole life. I did a consult with an orthodontist years ago and he recommended a few things that I needed to take care of before getting braces. One of them was a frenectomy.

    I’ve recently tried the Orthofill otho-bands to close my gap as an alternative option and I only had them on for 2 days before I experienced pain in my frenum. It seemed that the bands were squeezing the frenum and when I couldn’t take the pain any longer, I took them off and it has been about a week and my frenum is still very tender, sore, & healing.

    My gums were swollen for a few days and the swelling has almost subsided. I can’t imagine getting braces and having this pain all over again. My frenum protrudes downward just a little between my two front teeth. Do you have any suggestions regarding orthodontic treatment before or after removing the freneum? I want to be armed with some information when I choose my next orthodontist. Thanks in Advance!

    • I would highly recommend AGAINST using any home remedy for moving your own teeth without the supervision of a doctor. I am aware of cases where the bands slipped down below the gum line and actually caused the front teeth to be lost! Soreness is part of having teeth moved, but you should not do this on your own EVER!

  9. Mel says:

    I am 19 and have a gap between my two front teeth, caused by a large frenum. I am not too concerned about closing the gap. I would just like the frenum removed as it is quite annoying and sometimes painful/sore. Would you recommend a frenectomy?

  10. Ruth's Mom says:

    My 20 month old has a very thick frenulum and a large space between the front incisors. It was first pointed out by the dentist who recommended we “keep an eye on it.” He mentioned that it is already a “grade 3” but i am unclear what that means. I do not want to put her through a frenectomy unless it is necessary, however she also has been very slow to speak and gain new words/sounds. She has excellent receptive language skills, and does not have any indication of other social/communication disorders. Could the attachment be causing her slow acquisition of language? If so, when should it be corrected?

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