Types And Techniques Of Frenectomy

Frenectomy also called Oral Frenectomy, frenulotomy, frenulectomy is a surgical procedure wherein a thin layer of tissue called frenulum or frenum observed on various parts of the body is removed.

So far as the dental area is concerned, frenectomy is either performed inside the middle of upper lip , which is called labial frenectomy, or under the tongue, called lingual frenectomy. Frenectomy as it is a very common dental procedure in dental world and is performed both on children and adults.

Labial frenectomy is very common with patients undergoing denture treatment in order to get the proper fit of dentures or patients who have tissues attached to centre of upper lip and causing recession of gums or gap between the upper front teeth called central incisors. 

In the case of lingual frenectomy, the dentist removes the tissues / lingual frenum developed too close to the tip of the tongue which is either causing speech problems or hindering the development of teeth. Lingual Frenectomy is quite common in the case of children diagnosed with tongue tie  or clipping of tongue problem.

Here is some more details of labial and lingual frenectomy. In case the readers have some more questions, dedicated dentists on our panel will be more than happy to offer free dental advice online.

Standard Frenectomy

An incision is made across the base of the frenum at its attachment to the incisive papilla.The dissection is carried down to the periosteum,and the incision is then extended along both sides of the frenum to its attachment on the labial mucosa. The specimen is placed on traction and excised from the lip. This results in a bell shaped defect. Relaxing incisions are made at the mucogingival line. The labial flaps are advanced. The diamond shaped defect is allowed to heal.

Standard Frenectomy

 

Laser Frenectomy

The lip is streached to delineate the frenum using a carbon dioxide laser,the frenum is outlined. Then the band is excised to the periosteum. Relaxing incisions are made at the mucogingival line. Hemostsis is achieved by defocusing the beam. 

 
Laser Frenectomy

 

 

Mandibular Labial Frenum

The midline mandibular labial frenum is normal. But when it attaches on the interdental papilla ,between the lower incisors, it creates an adverse periodontal environment. This leads to food and plaque accumulation. The patient may develop chronic inflammation, a periodontal pocket and a recession of the attached gingival. Failure to eliminate this abnormal frenum pull may lead to bone loss and mobility of the lower central incisors.

Mandibular Labial Frenectomy

Techniques of Frenectomy

Excision

The frenum is excised. The wound edges are undermined, relaxing incisions are made and wounds closed. (As shown in the diagram)

 
 
Labial Frenectomy Frenum excised
 

Excision and Z-Plasty Closure 

The band is excised and the wound closed using a “Z” Plasty rotational flaps  

Mandibular Labial frenectomy Z-Plasty incision

 
 

Lingual Frenum or Tongue Tie

 

A prominent lingual frenum, attached high on the lingual alvelor ridge, is seen commonly in infants. This causes decreased tongue mobility and the fear of future speech impairment. The lingual frenum becomes less prominent during the first 2-5 years of life. Children in mixed dentition may complain of difficulty moving their tongue. A lingual frenum with high attachment on the alveolus may contribute to gingival inflammation and recession in relation to the central incisors. Lingual frenectomy is performed more commonly for one of the above reasons than for speech articulation problems.  

 

Techniques of Lingual Frenum

Excision and V-Y Closure

 

The frenum is cut from the attach menton the alveolar ridge. Then a traction is applied with forceps. Parallel incisions extending along the floor of the mouth and ventral surface of the tongue are made and the band of tissues is removed. Relaxing incisions are then made at a junction of the floor of the mouth and the ventral surface of the tongue converting a straight line defect to a ‘V’. The defect is then closed as ‘Y’ with 4-5 chromic catgut sutures. This process accomplishes excision of the frenum and simultaneous lengthening of the lingual sulcus. 

Excision and Z-plasty Closure

An alternative is frenectomy with single or multiple Z-plasties to lengthen the ventral surface of the tongue.Two large triangular flaps are created on the ventral surface of the tongue. The flaps are transposed as ‘Z’ plasty. This improves the tongue’s mobility without endangering the submandibular ducts.

Laser Excision

Tongue Tie may also be corrected using Carbon dioxide laser. Traction is applied to the tongue to identify the frenum. With the laser set at 7watts in the pulsating mode, the frenum is outlined. Then, using a continuous mode, the frenum is excised. Relaxing incisions are made at the junction of the floor of the mouth and the ventral surface of the tongue. Hemostasis is achieved by defocusing the beam and lasering the bed. 

 

 

 User Comments on -  Types And Techniques Of Frenectomy


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Posted By : sony on 17-Jan-2014 09:24 AM
good
 


Posted By : Cierra on 16-Jul-2013 08:09 PM
Hi, I have a small gap between my front teeth that my orthodontist explained was a result of my "frenum"? which is rather long and does appear to go between my teeth. He suggested I get a frenectomy, I am now assuming the labial type, to aid in closing the gap I mentioned before. He has told me I need braces but I would much prefer the new Invisalign for my active lifestyle. I wondered if the frenectomy surgery is performed after the gap between one's front teeth is closed (by means of braces or other) or before. I read that scar tissue resulting from the frenectomy can hamper the gap's chance to close but I also saw that one needs the operation before dentures- and possibly a system like Invisalign? I am going to see another orthodontist soon but I would appreciate your advice. Thanks.
 


Posted By : Dr.Ritz on 08-Nov-2012 03:23 AM

Hi LIZA,If frenectomy has been done beneath your tongue;you will get a feeling that your tongue has grown longer..but its just a feeling..the actual fact is that now your tongue is more freely movable than it was before.before frenectomy you would have had a restricted movement of tongue.

 


Posted By : liza on 08-Nov-2012 02:38 AM
Does your tongue get longer after a frenectomy?
 


Posted By : Dr.Ritz on 03-Nov-2012 03:01 AM

Hi LIZA,Upper lip swelling is quite normal after frenectomy. It is a part of normal healing process.Apply ice pack to the outside of the upper lip for the first 24 hours.After 24 hours,discontinue using ice.Do not use warm compress.Brush your teeth gently in that area.

 


Posted By : Lizaahoo on 03-Nov-2012 01:02 AM
Is upper lip swelling normal after frenectomy?? If it is normal, for how many days will it stay?? What can i do to reduce the swelling?? Thanks in advance...
 


Posted By : Dr.Ritz on 24-Sep-2012 10:38 PM

Hi LIZA,Every patient is different and your child might or might not benefit from early treatment.Based on the growth of your child's jaws and other factors,the ideal time for braces might be earlier or later than another child.For a safe approach to planning orthodontic treatment for your child,have an orthodontic evaluation and then return to the orthodontic office,as recommended,for periodic growth checks until your child has reached the ideal time to start braces.This will save you valuable time in treatment and expense,while still providing excellent results.After the tongue tie surgery,your child may have a little oozing of blood from the cut.It is not painful.Your child will be able to drink again about two to three 2-3 hours after the operation.She should be able to eat normally the next day.There is very little aftercare needed after the operation. Your child can clean her teeth as long as care is taken not to brush under the tongue.She can return to school in a couple of days.Any sport can restart in a week or so.I hope that helps.Good luck!!

 


Posted By : liza on 24-Sep-2012 02:11 AM
Nice article. Well i want to know that my child in 11 years old with spaces in the upper front tooth. so, should i get the treatment done to prevent any future problems of wait till his whole teeth are out. Also he is finding bit dissucult in speaking few words. I suppose tongue tie problem. If i get my daughter treated immediately so what would be the consequences and what after care needs to be taken. Any help would be appreciated.
 


Posted By : Dr ritz on 06-Sep-2012 07:28 PM

Dear SHERYL,

In case of maxilla if the frenum is not very high then we wait till the eruption of the canine teeth. As when the canine teeth erupts then because of movement of the teeth the gap is closed and the tissue shrinks of its own. But if the tissue is very thick and causing the problem in the normal eruption of the adult teeth then the frenectomy can be done. Before starting the braces treatment the orthodontist assess the problem and if needed the frenectomy has to be done before the braces treatment.

 


Posted By : Sheryl on 06-Sep-2012 10:41 AM
Our pediatric dentist is recommending a Max Frenectomy for my 6-year-old daughter. He identified the problem early on when she had a gap between her two front teeth caused by the extra piece of skin. He recommended that she have the procedure now that her first front baby tooth has fallen out (just this past weekend) - and the adult tooth is already beginning to come in and visible. I have seen mixed reviews on what to do online. Some say the scar tissue will get in the way of the teeth growing in straight anyway at this point, so to just wait for the surgery until after the teeth or fully in or after braces (if they are needed). What do you recommend?
 


Posted By : Dr.Ritz on 15-Jun-2012 09:24 PM
CLAIRE, its better that you wait until the permanent tooth comes as sometimes it has been seen in most of the cases that lip tie problem gets treated with the eruption of permanent dentition. so, wait until the baby teeth falls.
 


Posted By : Claire on 15-Jun-2012 08:15 PM
My 1 year old daughter has a class 4 upper lip tie. Unfortunately this has only just been diagnosed. Why are you recommending to wait until permanent teeth come in? Thanks
 


Posted By : Dr.Ritz on 06-Jun-2012 10:09 PM
MELANIE, you can go to the homepage of identalhub and on the top right corner where you see "Find a Dentist" enter the necessary details and it will show you the results...
 


Posted By : Melanie on 06-Jun-2012 07:47 AM
I am looking for an oral surgeon that performs the frenectomy with a laser in the Wayne, NJ area. Any assistance would be helpful.
 


Posted By : Dr Ritz on 13-May-2012 07:08 PM
Amber, Ideally for labial frenectomy, one has to wait till permanent teeth comes and that is at the age of 6-7 years, because when the permanent teeth come, by that time the tissue which is in between the baby teeth recedes if it has to recede. If it recedes itself then there is no need for frenectomy otherwise it can be done. Yes laser surgery can be used to do frenectomy and it is very convenient painless option and healing is quick. so you can wait for your daughter and can get the frenectomy done if needed only after the eruption of permanent teeth.
 


Posted By : Amber on 12-May-2012 07:46 AM
There seems to be a lot of conflicting information on this topic. I don't know all of the dentist lingo...but here is the situation: My daughter (currently 14 months) has a little bit of gums in between her two front teeth. Can this go away on its own? Some things I have read say yes, some say no... Also, can laser surgery get rid of it? She also has where it is attached to the top of her lip...can all of this be done in one laser procedure?
 


Posted By : Dr Ritz on 15-Apr-2012 06:54 AM
Renato Goncalves,You should not panic about this as at this age it is normal to have the labial frenum attached to the ridge. the frenectomy is done after the eruption of the permanent teeth and that too if it is still enlarged. In most of the cases with the eruption of the permanent teeth the labial frenum becomes normal If this procedure has to be done it is done after the eruption of canine and it is a very simple procedure with no complications.
 


Posted By : Renato Goncalves on 15-Apr-2012 12:12 AM
I just noticed today that my 1 year old daughter has her labial frenum attached all thee way to the bottom of her upper gum and her milk teeth are coming in with a pretty big gap between them. Not trying to brag but my daughter has always been so beautiful that there isnt one person who can bear to see her and not stop to play with her. I would hate to have this problem affect her appearance or speech in the future so my question is: should i get this procedure done now while she is young or should i wait until her permanent teeth come in? I seem to find mixed advices online as some say its better to get it done as early as possible but others seem to think its pointless and the permanent teeth would still come in with the gap even after the surgery is performed. Any inputs on this subject would be greatly appreciated as i am freaking out a little about my daughter having this problem and needing surgery. Also the comments i found online so far kind of scared me a little and got me thinking there could be a lot of complications after this procedure is done such as speech problems and weight loss (not so much in babies but still worry me). Thank you in advance for your help!
 


Posted By : manasi on 03-Apr-2012 10:34 AM
What is the othr name of classical technique in frenectmy surgicl procedure?
 


Posted By : Alana on 28-Feb-2012 02:07 PM
When I was 10, back in 2000 I got a lingual frenectomy. I'll be 23 this year, and in the past year or so have had discomfort with my tongue, like sticking it out or lifting it up. Also experience a little difficulty with speech. More like I can say the word, it just sounds funny. As a child I could not stick my tongue out at all, I can now but it isn't comfortable. I believe that some of the frenulum may have grown back.
 


Posted By : Dr Ritz on 16-Feb-2012 09:56 AM
Karah's and Alyssa's, It is difficult to comment whether your daughters need surgery at this stage or they should wait with clinical examination. However normally frenectomy is done when permanent teeth have erupted and the dentist can go for braces treatment. After Frenectomy, the braces are put to close the gap.
 


Posted By : Karah's and Alyssa's on 16-Feb-2012 08:07 AM
Dentist says both of my daughters need a labial Frenectomy ages are 5 and 7. From what I have read most recommend waiting till they are older to have this procedure done unless pain is associated with the space between the front two teeth. I have read to wait until braces have closed the gap (with permanent teeth in) because scar tissue can develop between the teeth preventing them from coming together. Any advice?
 


Posted By : Dr. Ritz on 11-Feb-2012 09:06 AM
Briannas mom, You can wait if you think that labial frenum has grown back. The gap in the milk teeth is not always because of high labial frenum. It is normal so you can wait till permanent teeth comes out and after that if the frenum is still high then you can go for Labial Frenectomy again. The permanent front teeth comes at age of appox 7 years of age. You can visit a Paedodontist for this.
 


Posted By : briannas mom on 11-Feb-2012 06:28 AM
My 17 month old had both her lingual and labial frenulums clipped at 6 months. I think the labial has grown back because her front teeth are now separated. Should I address this problem now or wait until shes a bit older? And if now, what type of specialist should I see?
 


Posted By : Dr. Ritz on 10-Feb-2012 10:01 AM
Robert, the intervention of tongue tie depends on severity and the symptoms. If the tongue tie is causing problem even in feeding then it is done frenectomy is done even in infants otherwise whenever it is diagnosed and depending on problems caused by tongue tie the treatment is done. For this you have to take your grand child to an oral surgeon who will evaluate it and do the needful at appropriate time.
 

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