Dr. Greg Jorgensen
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Rio Rancho, NM 87124

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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?

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

  1. Tracey says:

    Hello, I have an 11 year old who has always had a thick frenum and gap between her teeth. We have been seeing an orthodontist, although we are only in the observation phase, and the Doctor wants to wait for her 12 year old molars to come in before we do braces. She also mentioned getting a frenectomy, just as you said once braces are on. However over the last 4 months, as her teeth have been coming in the gap has closed and the frenum was squashed between her teeth, this caused her some pain and the orthodontist, said that she had not seen this before, but recommended having the frenectomy since the teeth were together. I was apprehensive and did not immediately pursue this surgery, About 2 weeks later my daughter said it no longer was sore and the swelling had gone. I don’t know what to do. My daughter has a beautiful smile and reading one of the posts earlier it mentioned that their daughter’s smile was altered and now her gums are visible above her teeth when she smiles due to the new frenum position. Is this what normally happens? I don’t want to do anything to change her looks, but the orthodontist and also her dentist keep telling me she needs this procedure.
    Any advice would be very much appreciated.

  2. Vickye Burton says:

    I want to know the cost of the procedure and if medical covers it. Also can your regular dentist perform it in the office or do I need to go to a gum specialist?

  3. Laszlo says:

    My son is 8 years old and the orthodontist has recommended a frenectomy. There is a space between his 2 top middle teeth, which has closed more over the last year or so, but a gap is still evident. My question is: can this procedure wait till he is 10 or 11? And I’m not sure if ‘closing the gap first’ with braces (as advised in this blog) is intended for this procedure Should the gap be closed first before surgery? Your advice is appreciated.

    • In my experience (and I say that because I do not have a scientific article to show you), doing a frenectomy alone may not have any affect on that gap. In fact, the gap may remain and the tissue may heal between it. My preference is to close the space and then do the frenectomy. A frenectomy is effective at 10 as you asked.

  4. Ashley says:

    Hello,
    I am 21, and my orthodontist suggested a frenectomy. I have never had a gap in my teeth, except for a tiny keyhole at the very top which has been there since my first round of braces five years ago; my teeth are shaped like corn kernels, not rectangles, so they won’t touch from top to bottom. Until I had braces the first time, my front teeth overlapped, like my Mom’s and my Grandmother’s do. At this point, am I likely to acquire a gap if I forego the frenectomy? Thank you!
    -Ashley

    • The triangular space between the front teeth due to the shape of your teeth is not related to your frenum. If your orthodontist is recommending a frenectomy at your age, there must be another reason. Perhaps he has detected a problem with your gums in that area. Ask him to explain why you need this procedure now.

  5. Ashley says:

    Hello,
    I am 21, and my orthodontist suggested a frenectomy. I have never had a gap in my teeth, except for a tiny keyhole at the very top which has been there since my first round of braces five years ago; my teeth are shaped like corn kernels, not rectangles, so they won’t touch from top to bottom. Until I had braces the first time, my front teeth overlapped, like my Mom’s and my Grandmother’s do. At this point, am I likely to acquire a gap if I forego the frenectomy? Thank you!
    -Ashley

    • The triangular space between the front teeth due to the shape of your teeth is not related to your frenum. If your orthodontist is recommending a frenectomy at your age, there must be another reason. Perhaps he has detected a problem with your gums in that area. Ask him to explain why you need this procedure now.

  6. Tina says:

    we were just told my 9mth old has a class 3 lip tie and needs a frenectomy. Her two top teeth are in and one already has a cavity (within 3wks of coming in) so there are obvious signs of decay. I am concerned about braces in the future and if we do it now (they will use a laser) could scar tissue prevent the gap from closing when she gets orthodontics?

    Thank you,
    Tina

    • These are questions that you need to pose to your orthodontist. I don’t think that the scar tissue would prevent the gap from closing, I just feel more confident doing it in reverse order (braces first).

  7. Bella says:

    Hi. I’m 26 years old and I just had my braces put in and I have a gap in my front two teeth. I actually should mention I have a few gaps but really tiny ones. My orthodontist said I might need a frenectomy at the end of the procedure. The thing is, my mother had braces and also had her frenum removed but her teeth spaced out even more. She also didn’t wear her retainers so that could be a reason why overtime they got worse. My orthodontist said I will be getting bonded retainers plus regular retainers so that the gap won’t come back again. So my question is should I do a frenectomy. I also have a 80% overbite that is being corrected as well with speed bumps/ turbos plus rubber bands. My dr said the way my top teeth overlap over my bottom teeth is what’s causing the spaces. I guess my question is will the bonded retainer help in keeping the space closed or should I go with the frenectomy at the of procedure as well?

    • I cannot diagnose the need for a frenectomy over the Internet. You need to either trust your doctor or get a second opinion. The most important thing you can do to keep the gap closed is the bonded retainer however. In my experience it is the only sure way to prevent a space from reforming after appliance removal.

  8. stephanie says:

    My 12yo daughter’s braces are scheduled to be removed in the next month or two. Her frenum is bulging out between her braces and she has a gummy smile. I never noticed these things before braces. They want the perio to do a frenectomy and a gingivectomy before the braces are removed (please excuse spelling). They say it will take 2 hours. They want to put her under conscious sedation using 1mg of Ativan. I am a little concerned about the drug and the extent of the procedure. It sounds really painful. Do you have knowledge of this type of procedure and would you have it done on your child all at once? Thanks fr your time.

    • I think that this sounds excessive to me. I do frenectomies and gingivectomies under local anesthesia all the time. I have not problem with my own child having the procedures if they need the, but I would not have him or her sedated for it. I would also ask what is going to take two hours. The procedures you’re describing should take no more than 20 to 30 minutes tops.

  9. Farlin Hilaire says:

    Hey my name is Farlin and I got my braces a week ago and my teeth looked great, but as days went by I seeen a difference in my teeth and I was wearing my retainer. My two front teeth is opening up again. Should I get braces again for the top and do the frenec soon as possible

    • Your space re-opening may or may not be related to a long or thick frenum. Sometimes it is due to narrow upper teeth or the way the lower teeth fit up under the top ones. The key to keeping a space closed is a bonded lingual retainer however.

  10. Kristin says:

    My 15 year old daughter just had a frenectomy yesterday as we’ve entered into the final stage of her orthodontic work and so her top two front teeth will close. The frenectomy was preformed traditionally and not with a laser. She’s got stitches in and is hysterical that she can’t smile or do certain movements in her singing (she hopes to pursue a career in voice). Is this something that will go back to normal (the ability to smile/perform certain mouth movements)once healed and if so for how long? Also, will there be any permanent change now in her looks/smile? Any insight would be helpful.

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