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?

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

  1. Robert says:

    My 8 yr old daughter has braces to create more space and close the gap in her front teeth. She woke up this morning with pain in her front teeth and a painful lump behind it. Orthodontist is recommending a Frenectomy. She has her adult molars, but not incisors. The orthodontist removed the chain from around the front teeth, which has relieved the pain and we are watching the teeth to see if they move. Does she sound like a good candidate for a frenectomy? Also, is this procedure done simply for appearance reasons i.e. the gap? Thank you!

    • She does sound like a good candidate. The frenum goes between the teeth and can be pinched behind the incisors causing the symptoms you described in your daughter. I think your orthodontist is on track!

  2. John says:

    I have a diastema about 5.3mm wide due to a large labial frenum. Is it possible to close the gap and if so what steps should be taken?

  3. Susie says:

    Like some of the others have posted, my daughter’s orthodontist is recommending a maxillary labial frenectomy after just finishing her phase 1 treatment. He says it to to prevent a gap or a “black diamond” shaped gap in her front teeth that will eventually not be able to be corrected if it does occur. She DID NOT have a gap, not before her orthodontic procedure and I paid to have braces put on her front teeth to prevent one from forming while expanding her palate. It is not really the extra $300 that bothers me (although I was not excited about it) but It seems a little unnecessary and perhaps in “prevention” of something that might not occur. My instinct is to not do this. She still has many baby teeth (including canines) and my instinct is a to wait and see. Is the ‘point of no return’ on this in your 20’s or before exiting grade school? When can you begin to notice that it might be a problem? Is there any medical reason, besides cosmetic, that I should feel urgency?

    • I have never done a preventative frenectomy after expansion. The gap created by an expander comes from the expansion and not a frenum. I would not have a preventative frenectomy done on my child.

  4. Caroline Floyd says:

    My 17 year old son has completed his orthodontic treatment to close a gap between his two front teeth. His braces have been off a few months now. He is very good at wearing his retainers nightly. The orthodontist has recommended a frenectomy, his frenum is low and joins the gum just above the two front teeth. He would prefer to not have it done, and is happy to wear his retainer nightly on an on-going basis. Does he run the risk of the gap coming back if he only relies on the retainers rather than having the frenectomy? Thanks.

  5. Lala says:

    Hi Dr. Jorgensen,
    I am 30 years old and got braces mainly to close the gap between my two front teeth. My teeth became level and gap closed in altogether 10 months (the gap actually closed in a shorter amount of time, maybe about 8 months). Even though my gap came together without any issue and relatively quickly, in my opinion, my orthodontist suggest I still consult a dentist about a frenectomy to prevent the gap opening after my treatment is complete. My orthodontist said he would be placing a bonded retainer behind my gap once I get my braces removed and that I of course would be wearing traditional retainers for 24 hours a day and then transition to only wearing them at night. With that said, I really don’t want to get a frenectomy because of the added cost and mostly because I am afraid there is a chance too much will be removed and leave me with a small gap at the very top of my teeth that won’t close (I hope that makes sense). So my question is, is it really necessary to get a frenectomy if I will have bonded retainers along with traditional retainers that I plan on wearing religiously at night? Thank you.

    • Only your orthodontist can determine if you need a frenectomy. In my experience, if you get a bonded retainer behind the teeth after the space is closed, it will stay closed whether or not you have the frenectomy. Conversely, with out a bonded retainer your gap will probably come back whether or not you have the frenectomy.

  6. Candace says:

    My daughter is 9. She has only lost 3 teeth in her life. Our dentist is recommending a frenectomy because 2 of her 3 permanent teeth are growing very crooked because of this frenulum. She tore her frenulum when she was a toddler. I read it is best to wait until teeth have grown in but i worry we cannot do that. I am 39 and still have primary teeth as does my 15 year old. Is this procedure recommended in my daughter’s case?

    • The need for a frenectomy can only be determined by your local dentist or orthodontist who is providing care for your daughter. As you read in my article, I believe that the best time for a frenectomy is after the upper centrals are well aligned and the braces are off.

  7. Rebeccah says:

    I just had my third child and all three have a tight/thick upper frenum. We weren’t aware of this with our first and nursing her was a painful nightmare. With our second child I noticed it right away and had a pediatric dentist laser it at 10 weeks old to protect the nursing relationship. This baby (9 weeks on Friday) is being bottle fed and is having a lot of trouble eating. He is gaining weight just fine but his feeds take forever and he is very fussy during them because he can’t flange the top lip to get a decent seal. Would your practice perform a frenectomy on a newborn? It was the best thing we ever did for our middle child!

  8. Bri says:

    Can a long upper frenulum cause deformities / changes in upper lip shape?
    I’m 23 and had braces as a teenager but recently noticed my cupid’s bow seems to be receding?

  9. A.Palanimurugan says:

    My daughter is 4years old.She fell down from top level.Her layer cutted which is in between upper lip and gum.Is it possible to rejoin?. Injection, para ibupruben sp and cotrimaxole sp given by child specialist.Please give me essential tips if any. Thanks and regards -A.Palanimurugan

    • I’m sorry to hear about your daughter. I am not an expert in dental trauma (especially with young children). You need to have her seen by a children’s dentist (a pedodontist).

  10. Mukami says:

    Hello Dr Jorgensen.

    My baby has got a the frenulum extending all the way to the tip of his tongue as well as on his upper lip. Would you advise to have both cut in the same set up or should we release the tongue and then the upper lip later. The baby is 5 months old.

    Thank you

    • This is a better question for a pediatric dentist. My opinion is that if the frenum is affecting the child’s ability to eat or talk, the procedure should be performed. These issues are separate from the orthodontic reasons I discuss in my article.

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