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. Lea says:

    Hi, my daughter is schedule for frenectomy this saturday, I want to show you her picture so that you can advise me if it is necessary, she’s only 6 years old…thanks

  2. meliza says:

    Since my baby was born i notice his gum connected tothe lip and i thought it wasnt issue.. should my baby needs the surgery at early age? His turning 1 yr ild thiscoming october.. i wonder where and wgen ge needs a surgery

    • Your baby is way too young to worry about at this age. Please relax and have him checked by a children’s dentist at about age 2. I would also recommend an exam by an orthodontist at age 7.

  3. Kay says:

    Hello
    My periodontist recommend that i do a Libial frenectomy on my lower….i have receding gum that expose my root. I will also be doing a gum graft. Do you think the Libial Frenectomy is neccasary? I don’t want to do a procedure that will not help my gums from receding more.
    Thank you.

    • A periodontist is an expert with the gums. Frenum pulls as you’ve described can cause recession and should be shortened surgically. My recommendation is to follow the diagnosis and treatment plan of your periodontist

  4. Allison says:

    Hey I have braces and they are costly. I was wondering since the braces have done closed my gap if I can go ahead and consult with a oral surgeon about my liberal frenulum causing the gap in between my front teeth BC I can’t pay for the braces anymore but I don’t want to take them off and I get another gap.

    • If your gap is closed and you are happy, you could end the orthodontic treatment and have the frenectomy. Please make sure that your orthodontist glues a retainer behind the teeth where the gap was closed however. That is the only way to make sure it doesn’t open back up, even with the frenectomy.

  5. Saundra says:

    My daughter is 5. Her baby teeth are in still in. Her two upper front teeth are way apart. You can see the tissue between them. Should I have her checked now to see if she needs it removed before she loses her baby teeth.

    • Your daughter is very young for a procedure like that. I would have her seen by your family dentist just to make sure there is nothing actually wrong, but what you’ve described sounds normal to me.

  6. Michelina L. Giuliano says:

    Good afternoon, my name is Michelina Giuliano, I have been in braces when I was younger for 5 yrs. but then the overbite came back again, I don’t know if the reason for that is because of the muscle under my tongue, my mom didn’t want me to have the surgery, but my dad did, so I never had the surgery done. Now, I have been in braces since the year 2010 and the orthodontist says they will come off in the next four months or so, but I am concerned being that the tissue is still there under my tongue, would you recommend me doing the surgery before the braces come off, or according to the orthodontist he said he will make the retainer to work around the muscle under my tongue, but would that even be possible? Thank you so much, Michelina Giuliano

    • Hello Michelina. I cannot diagnose or treatment plan specific patients over the Internet. I am only licensed in New Mexico. What your orthodontist is telling you sounds reasonable to me. I’m sure he wouldn’t recommend a procedure that is not necessary.

  7. Sherry says:

    My son is 12 and is in braces now. He got braces to fix an overjet/overbite. His teeth were perfectly straight with no spaces prebraces. Disappointinly, the ortho treatment created a space between his front teeth. The ortho sent us for periodontal consult for a frenectomy. The periodontist said his situation is not that bad, but I am so worried about this procedure and the discomfort. My son is so senstive to any kind of dental work.
    . If the tissue didn’t cause a space prebraces, why would it be preventing pulling the teeth completely together now?
    . You mentioned to pull teeth together first before doing frenectomy. However, they are saying he needs the frenectomy in order to completely close the gap. Does this make sense to you? I’m worrying about scar tissue developing and preventing the final closure.
    . Re: permanent bonded retainer, are most people able to remove after year without recurrence?
    . Do you have any thoughts about laser vs. classic frenectomy?
    Thank you!
    Sherry

    • I would be surprised if your son actually needs a frenectomy. If he didn’t have a space before braces, the frenum was not the cause after the braces went on. Something doesn’t sound right here.

  8. Lisa says:

    Hi!
    My son is 11 and he had a lingual frenectomy in October. His orthodontist is recommending that he have it done a second time becaue they did not get enough release the first time. Is common to have it done more that once.?

    • It is not common, but it does happen. Sometimes it is difficult to predict how the body will heal. I’m sure he would not recommend it if it was not necessary. Good luck!

  9. Ella Wharton says:

    Hello! I have had my braces for longer than 18 weeks and I used to have a gap between my two front teeth, I didn’t choose to have the frenectomy but I really don’t want my gap to open up again, will it?

    • Everyone is different, and I can’t predict. A long frenum is only one of the variables to consider after closing a gap. I believe the most important way to prevent the recurrence of your space it to bond a permanent retainer behind the teeth. A retainer is effective even if the frenectomy has not yet been performed.

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