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. 

 

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Comments

  • sony

    sony 17 - January - 2014, at 09:24 AM

  • good

  • Cierra

    Cierra 16 - July - 2013, at 20:09 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.

  • Dr.Ritz

    Dr.Ritz 08 - November - 2012, at 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.

  • Lizaahoo

    Lizaahoo 08 - November - 2012, at 02:38 AM

  • Does your tongue get longer after a frenectomy?

  • Dr.Ritz

    Dr.Ritz 03 - November - 2012, at 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.

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