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?

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

  1. Joshi says:

    I am 27 year old. Due to large labial frenum, I have developed gap between my front two teeth. There is no pain or problem I face due to this gap. My dentist suggested a frenectomy (and braces) as the gap might increase over the years? Is it possible for the gap to still increase at this age?

    • Your body will change for the rest of your life, but in my experience I’ve never seen a frenum at 27 cause a diastema to increase in size. If you’re happy with things now, I wouldn’t worry.

  2. Bryan says:

    My eight year old daughter, Hannah, will need braces soon, as her upper front teeth are now about half way in and she has issue with the frenum being between her two front teeth. Her twin sister has braces now and her orthodontist told me that Hannah should have a frenectomy now before getting braces. In reading this post, it appears this may be faulty as the teeth are already coming in, though be it they are really crooked and spaced. What do you recommend?

    • There are many ways to “skin a cat.” My opinion is that it is BEST to do it after space closure. I’m sure that there are many other doctors who can show good results doing it the other way too.

  3. Alexa says:

    I want to have a frenectomy done. Will the gap close after the surgery without braces? If so, how long do you believe it will take and can it open again? Thanks!

  4. Sarenity says:

    My daughter is 1 and a half. Her frenum is extremely low causing a well sized gap between her two top front teeth. The dentist she saw at 6 months said it may fix its self as she gets more teeth in. The dentist she saw at her checkup today says most likely when she is 6 or 7 we will have to do a procedure. Will it fix it’s self? And if not should I really wait until she’s older or push the issue to get it fixed now?

  5. Cyndi says:

    My daughter is 8-1/2. Her frenum is low. For the past month it has been sore and she has not wanted to brush her two front teeth. I have scheduled a frenectomy but have my doubts as to weather this is the proper thing to do right now. She has a small space between her teeth. Please advise.

  6. L. Charles says:

    I recently had my teeth bonded to close the majority of my gap. It was a quick cosmetic fix but now I am experiencing discomfort because my frenum is creating pressure on my teeth and the tissue keeps getting caught in the very small gap left behind. Should I get a frenectomy to relieve this pain?

  7. Tina says:

    I have a 5 yr old boy turning 6 soon. He has been attending speech therapy for the past few years as he has a speech delay. I took him to a new dentist yesterday for the first time who found an issue and advised that he is tongue tied and needs to have a frenectomy. Do you recommend this?

  8. Jojo says:

    I am scheduled for frenectomy tommorrow and I am Hoping to get some advice, would it be better if the spaces Between my front teeth would closed first before undergo frenectomy? and would it be possible to close the space between my teeth even without taking out my frenum?? thankyou!

    • Orthodontists are trained differently and it’s inappropriate for me to diagnose your case without examining you personally. I prefer to close the space first, but this is a discussion you need to have with your local orthodontist.

  9. David says:

    Thanks for your insightful article!

  10. Destiny Moore says:

    I have a issue with the frenulum under my toungue. It is white in the middle and looks like it is ripping. Underneath the white part is two “balls” attached to my frenulum. The “balls” arent huge but they are decently sized. It hurts really bad, but I have no clue what it is. What could it be?

    • It sounds like you have an ulcer on your frenum and the sublingual salivary duct openings are swollen. I would see your local dentist to see if there is anything worse going on and see if he can help you.

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