Labial Frenectomy for Older Children and Teenagers for Orthodontics

A labial frenectomy is a relatively simple surgical procedure that can have a significant impact on a person's oral health and overall well-being.

The American Association of Oral and Maxillofacial Surgeons (AAOMS) says that an oral surgeon releases the frenulum bands or removes them in a frenectomy.

“Labial frenectomies are simple procedures that can be performed at any age after the permanent teeth have erupted,” says AAOMS. “Although a labial or lingual frenectomy is a common procedure, it is oral surgery and should still be performed by a qualified professional. Oral and maxillofacial surgeons are the experts in face, mouth, and jaw surgery.”

A frenectomy is not to be confused with a frenotomy, which Stanford Medicine describes as a procedure where the lingual frenulum is cut but not completely removed. This procedure is often performed on babies and younger children with a condition known as "tongue-tie.”

A labial frenectomy is not limited to infants and young children but is increasingly performed on older children and teenagers, particularly in the context of orthodontics as it can contribute to improved oral function, orthodontic success, and overall well-being.

Understanding Frenum, Frenotomy, Frenectomy and Frenuloplasty

In the realm of oral health and medical procedures, the terms "frenum," "frenotomy," "frenectomy," and "frenuloplasty" are interconnected but have distinct meanings and applications.

Understanding starts with the frenum or frenulum – the thin band of connective tissue found either beneath the tongue (lingual frenulum) or connecting the upper lip to the gums (labial frenulum).

Colgate Global Scientific Communications describes it in lay terms as: “Have you ever felt around your mouth and felt the thin band of tissue above your front teeth that connects to your upper lip? Or lifted your tongue, and saw another thin piece of tissue connected to the bottom of your mouth? That’s called a frenulum, or frenum, and it’s a normal part of your mouth.”

The two basic types of frenum, lingual frenulum and labial frenulum, are described by Colgate as:

• Lingual Frenulum: The lingual frenulum is located between the base of the tongue and the floor of the mouth—if you look in a mirror and lift your tongue, you should be able to see it. Lingual frenulum comes in all different sizes, and in some cases, might restrict the use of the tongue.
   
• Labial Frenulum: A labial frenulum connects the lip to the gum, located between the upper and lower front teeth. When a frenulum is too wide or long, it can create a space between the two front teeth and other dental issues.

When that tissue is too taught and impairs oral functions, then some common procedures may be needed:

• Frenotomy: A frenotomy is a minimally invasive surgical procedure involving a small incision or snip in the frenulum to release its tension or restriction. The primary objective of a frenotomy is to enhance the function and mobility of the affected body part, typically the tongue or lip. Frenotomies are quick, low-risk, and often require little to no anesthesia. This procedure is commonly performed in infants and young children with conditions like "tongue-tie" or "lip-tie."
   
• Frenectomy: A frenectomy is a more involved surgical procedure compared to a frenotomy. It typically involves the complete removal or significant modification of the frenulum, not just a simple incision. Frenectomies are usually performed when a frenulum is causing significant functional issues or impeding orthodontic treatment. This procedure is common in individuals of all ages, including older children, teenagers, and adults. Frenectomies can be more complex, may require local anesthesia, and involve sutures to close the incision site.
   
• Frenuloplasty: A Frenuloplasty is a surgical procedure aimed at revising or altering the frenulum's attachment, particularly in cases where it is causing discomfort or functional issues. Unlike a frenectomy, a frenuloplasty does not typically involve the complete removal of the frenulum. Instead, the procedure focuses on adjusting the attachment to alleviate symptoms or improve function. Frenuloplastia can be performed in both children and adults, depending on the specific needs and circumstances.
   

Labial Frenectomy for Orthodontic Reasons

In older children and teenagers, a labial frenectomy is often considered in the context of orthodontic treatment.

The decision to undergo this procedure may be influenced by several factors, including:

• Gaps and Spacing: A prominent labial frenulum can contribute to diastema or a gap between the upper front teeth. Orthodontists may recommend a labial frenectomy to address such spacing issues.
   
• Alignment: A restrictive frenulum can interfere with the movement of the upper lip during orthodontic adjustments. This can hinder proper alignment and bite correction. By performing a frenectomy, orthodontic treatment can progress more smoothly and efficiently.
   
• Speech and Comfort: In some cases, a restrictive frenulum may affect speech or cause discomfort, especially when orthodontic appliances are in place. A labial frenectomy can alleviate these issues.
   
• Gum Recession: The Cleveland Clinic says that some frenum can cause gum recession, which can lead to gingivitis, cavities, and mobility issues.
   

“If the labial frenum connects closer to the front teeth within the gum tissue, it can create spacing issues and hygiene problems,” says the AAOMS. “Although many parents and patients worry about the gap for cosmetic reasons, extra space between the teeth can make it easier for food to become stuck and contribute to gingivitis. If a lower labial frenum attachment causes excess tension, it may result in root exposure and gum problems in the affected teeth.”

Labial Frenectomy: A Procedure Overview

A labial frenectomy is typically performed by an oral surgeon, periodontist, or occasionally by a dentist experienced in surgical procedures.

The steps involved in the procedure include:

• Assessment: The surgeon evaluates the patient's condition, assessing the length and thickness of the labial frenulum and its impact on oral function and orthodontic treatment.
   
• Anesthesia: Local anesthesia is administered to numb the area, ensuring the patient's comfort during the procedure.
   
• Incision and Removal: Using a scalpel or laser, the surgeon makes a precise incision in the frenulum and removes or modifies the excess tissue.
   
• Closure: The incision site is sutured using dissolvable stitches.
   
• Post-Procedure Care: Patients are typically provided with post-operative care instructions, including guidelines on maintaining oral hygiene, diet, and required follow-up appointments.
   

Benefits and Risks of Labial Frenectomy for Orthodontics

If you or your child are considering a labial frenectomy for orthodontic reasons, consult with a qualified oral healthcare professional to discuss the procedure in detail.

Some of the benefits of choosing a labial frenectomy include:

• Improved Orthodontic Outcomes: A labial frenectomy can enhance the success and efficiency of orthodontic treatment by eliminating restrictions caused by the frenulum.
   
• Enhanced Comfort: The procedure can alleviate discomfort associated with orthodontic appliances.
   
• Aesthetic Improvements: Addressing diastemas and alignment issues can lead to a more aesthetically pleasing smile.
   

A labial frenectomy is generally a safe procedure, but it carries typical surgical risks, such as infection or bleeding.

These risks are minimal, and post-operative discomfort is usually manageable. Healing generally takes a few days to a week.

The board-certified oral surgeons at Northwest Oral & Maxillofacial Surgery can provide parents with a comprehensive consultation to determine if their older children or teenagers need a labial frenectomy.

Northwest Oral & Maxillofacial Surgery - Technology Forest

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