Frenectomy:

What is a Frenum?

A frenum is a naturally occurring muscle attachment, normally seen between the upper and lower front teeth. It connects the inner aspect of the lip to the gum tissue around the teeth.There is also a frenum between the tongue and gum tissue.

An excessively large frenum can prevent the teeth from coming together resulting in a gap between the front teeth. This creates a "spring like action" pushing the teeth apart. This must be removed to allow the space to remain closed after the braces are removed (case example). Sometimes extra thickness of the adjacent gums are also removed with esthetic crown lengthening (case example??). When Orthodontic treatment is planned or initiated, the removal of an abnormal frenum can increase stability and improve success of the final orthodontic result.

Frenectomy

If a frenal pull is seen or the frenum is too large to allow the teeth to come together, the frenum is surgically released from the gum with a Frenectomy. Today frenectomies are performed with a laser to decrease problems and speed recover. Sometimes soft tissue grafting to re-establish an adequate amount of attached gingiva is completed at the same time. If needed sedation can be used to keep you comfortable and relaxed.

Before Frenum Prevents Space Closure	After Frenectomy Allows Space to Remain Closed

Frenal Pull and Gum Recession

A lack of attached gingiva, in conjunction with a high (closer to the biting surface of the tooth) frenum attachment creates tension on the gum tissue (called a frenal pull) and can result in recession (case example?). This occurs most frequently on teeth with prominent roots (link prominent roots WHERE?).

When Orthodontic treatment is planned or initiated, the removal of an abnormal frenum, with or without a soft tissue graft, can increase stability and improve success of the final orthodontic result.

Note: If a patient already has recession, it must be treated prior to starting orthodontic treatment.

Frenal Pull with Gum Recession	Frenum and Recession Treated with Soft Tissue Graft and Frenectomy

Tongue Tied

A frenum can also occur between the tongue and gum tissue. This can result in a condition called "Tongue Tied". This can create problems with normal development of the roof of the mouth (palate), normal tooth eruption, and speech problems. The solution to this problem is the frenectomy.

Before Frenectomy Unable to move tongue	After Frenectomy Can Move Tongue

                                                                 

Circumferential Supra-Crestal Fibrotomy (CSF)

A CSF may be completed at the time of a frenectomy. This procedure prevents teeth from rotating back into the wrong position.