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?

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

  1. Sarah says:

    Hi, my daughter was recently recommended by a dentist for two Frenulectomy-separate procedures. One is to separate the tissue underneath of the tongue to prevent her from being tongue tied. Another is to separate the tissue between the two front teeth to prevent them from creating a space in between. My daughter is 11 year and 8 months old. Her previous 3 dentists never mentioned the problems before. And she never complained any pain or discomfort with these two places. There’s no language development delay with her and she speaks normally. There’s indeed a small gap between the front teeth. But I think it’s becoming smaller, at least no worse at all. But the dentist assistance told me if she doesn’t do the surgery, the gap would become bigger and the tongue tie affects her sleep. Is that true? I care for my daughter but I don’t want her to go through unnecessary procedures. What’s your opinion? Can you give me some advice? I’m thinking to find a second opinion. Is it necessary? Thank you very much in advance!

  2. Yaya says:

    I recently got a frenectomy done a week ago. When is it okay to remove my braces after getting the frenectomy done? I’m supposed to get my braces removed tomorrow so I wanted to know if I should keep my braces on longer or would it be okay to remove them even though I got the frenectomy done last week.

    • If I was your orthodontist I’d place a bonded retainer behind the front teeth even if you had a frenectomy done. It would be a shame for your front teeth to develop a space following treatment if the tissues hadn’t yet healed all the way.

  3. Joanna says:

    Hello,

    I am a 39 yr old female who is having a gum graft done on the lower left side – one tooth. The Periodontist I saw also wants to do a Frenectomy in front – lower lip and I don’t see why. It MAY cause gum recession but has not yet. I would have to pay for it as a separate procedure since it is several teeth away from where the gum graft will be performed. I don’t want to be cut three places in my mouth all at one. What would you suggest? Can I hold off on the Frenectomy and have it done IF/WHEN any gum recession occurs in the front lower teeth?
    Thanks.

    • A frenectomy is a PREVENTATIVE procedure. If you wait until your frenum causes recession, doing the frenectomy is too late. I would follow the advice of your periodontist.

  4. Lillian Schaeffer says:

    This is some great information, and I appreciate your point that a frenectomy can prevent the incisors from coming in with a gap. My son hasn’t started teething yet, and I noticed that his frenum extends farther down than I think is normal. I’ll definitely look into taking him to a professional to see if a frenectomy would be a good idea. Thanks for the great post!

  5. Kriz says:

    Hi, I got my barces in for almost 2years now, I just want to ask if should I undergo frenectomy or not because my main reason of having braces is to close my diastema. After having my braces on, the gap closes. But in the long run there is still a very small gap in between my teeth that if you sip, you will feel that there is an air coming in which means there is still a tiny gap. What should I do? Thank you very much

  6. Jayden Ford says:

    I had frenectomy surgery Thursday, and I was wondering when would I be able to smile and laugh again without it hurting? Also, how long does it take to completely recover? Please answer this question,it would mean a lot!!!

  7. Sulin says:

    Hello…
    My sister had diastema between the lower central incisors with highly attached frenum, a dentist closed the diastema for her by composite material without doing frenectomy, will it be ok without any problem or she has to do frenectomy to maintain the result???

  8. Rita says:

    Surgeon said it was necessary to suture lining of my lip to gum tissue, because there was not enough gum left to cover the bone. Upper front area, approximately ten teeth. Have had issues with this right from the start (it is now August, and surgery was done in February) Mucosa is swollen, red, and very tender, and at last, about two months ago, surgeon told me he can repair it with laser surgery. Before next appointment, he e-mailed me to say, at the scheduled appointment he will advise me of the limitations of this laser procedure. Arrived at the appointment with some apprehension, sure enough, was told it is so “limited” he can not do it, but a gum grafting would be best. ??? Did I want to go to a periodontist !!!
    Went to Periodontist, who examined mouth for $180.00, and immediately called the surgeon to tell him about the bone spur (that has been a concern of mine as well, but surgeon continued telling me “it was nothing”). After phone consultation periodontist returned to my chair, and said I should go to a prosthodontist, of the three different problems he had identified, he said he can do them, not all at once, of course, but first needs someone to tell him what to do.
    I feel I am being given the runaround. What would you do?

    • You need to find one of these doctors, or a new one who will be the “general contractor” for your case. This will be the doctor that should explain the entire treatment plan and how each procedure in the various offices work together to give you the best result. If none of the current doctors seems able to do this, find another dentist who can.

  9. Larry Miller says:

    My teeth have always been good with very few cavities. I recently underwent 28 treatments of radiation on my throat. Would radiation cause my teeth to deteriorate to the effect that I have lost fillings, had new fillings put in, and they fell out. I recently went to a new dentist, and was told that all of my top teeth need replaced, and several of the back bottom teeth need to be pulled, and a new partial be put in place. It was also said that I need a frenulectomy, and I am not sure why. I am almost 82 years old. Any advice?

    • Radiation therapy does reduce the production of saliva which can affect your dental health. I’m sure that is related to your dental issues. My advice is to find a good dentist to help you fix the things that your not happy with

  10. Jade says:

    My daughter had a frenectomy done when she was in sixth grade as she had a gap between her two front teeth that seemed to be getting bigger, since then she has had braces and is due to get them off in a month or so but since her front teeth have been pushed together, there is excess gum that looks inflamed between her teeth and covers the teeth making it difficult for her to floss… Do you think a second frenectomy would be necessary to remove the excess?

    • If she has extra tissue, she may need an additional soft tissue procedure, but probably not another frenectomy. She may need a gingivectomy to remove the “bleb.” I would also ask that a permanent bonded retainer be placed at least for the first year to hold the gap closed after the braces are removed.

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