Frenectomy is a mucogingival surgical procedure that involves the removal of the frenum. This procedure is done to alter the defects that hinder the mucogingival relationships (the relationship between the gingival margin and the mucogingival junction).
The frenectomy procedure is also carried out to improve the aesthetics as a part of periodontal surgery. When the procedure doesn’t involve the complete removal of the frenum, its termed as ‘frenotomy’, where the frenum is surgically repositioned.
What is a Frenum?
A frenum is a fold of mucous membrane in the vestibule of the oral cavity that has muscle fibers which attach the lips and cheeks to the gingiva and the underlying periosteum (periosteal bone).
There are many frenal attachments in the mouth.
- In the maxilla (upper jaw)
- Labial frenum
- Buccal frenulae
- In the mandible (lower jaw)
- Labial frenum
- Buccal frenulae
- Lingual frenum
Frenectomy: When Is It Needed?
The frenum becomes problematic when the attachment of the muscle fibers in the frenum is too close to the marginal gingiva. This condition is termed as a ‘high attachment of the frenum’.
This high attachment pulls the gingival margin away from the teeth. This may result in gingival recession and the teeth become prone to plaque accumulation, and calculus formation. It also affects the periodontal health of the teeth. To prevent these from happening, frenectomy procedure is carried out in case of ‘high frenum attachments’.
To Prevent Ginigival Recession and Periodontal Problems
The gingival margins become inaccessible to brushing in some cases, which leads to poor oral hygiene along with gingival and periodontal problems. These cases too require surgical intervention.
To Improve the Aesthetics (appearance of the face)
The labial frenum with high attachment in the maxilla (upper jaw) usually causes a midline diastema (a gap in between the two central incisors). This will affect the overall appearance of the person and compromise the aesthetics, especially in individuals with a high lip line. So frenectomy is done in these individuals to treat the midline diastema and improve the appearance of the face.
To Improve The Stability of The Denture
The high frenum attachment i the mouth also compromises the retention and stability of the denture in case of individuals who use either a partial or a complete denture. So the frenum removal procedure becomes vital for improving the retention of the denture in such individuals.
Frenectomy is also recommended in case of tongue tie. This is a congenital condition. Tongue tie, also called ankyloglossia, is a condition where the lingual frenum (a tight band of tissue) ties the tongue tip to the floor of the mouth. This restricts the movement of the tongue and may hinder with the process of breastfeeding.
Why Is Frenectomy Done?
Frenectomy is done
- To relieve the tension created by the fibers on the gingival margins.
- To prevent a gingival recession.
- To create access for better brushing and cleaning of the tooth.
- Prior to orthodontic treatment, to enable the closure of the midline diastema in the upper central incisors.
- Prior to prosthetic treatment, to improve the retention and stability of the prosthesis, either a complete denture or a partial denture.
- To correct the problems associated with ankyloglossia.
Frenectomy Clinical procedure
There are two types of procedures involved in the treatment of defects related to frenum in the mouth.
Frenectomy is a procedure which involves complete removal of the frenum and its fiber attachments. This type of procedure is usually done in case of corrections required with large midline diastemas.
Frenotomy, on the other hand, is just a relocation of the frenal attachments more apically. This procedure is done when there is the presence of a deep vestibule (the area between the cheeks and the teeth) to accommodate the frenal relocation, or it is done along with procedures involving deepening of the vestibule, such as free gingival graft.
Frenectomy and frenotomy may be done along with other periodontal surgeries or done separately according to the need. The defects of the frenum are most commonly seen in the labial frenum of the maxillary and mandibular regions.
The surgical procedure is carried out by a trained general dentist, periodontist or an oral surgeon, in the clinic under local anesthesia. The surgical incisions are made as needed, followed by completely excising the frenum or relocating it to a new area in the mouth.
The wound is then cleaned and dressing or suturing is done accordingly. Follow up may be needed for redressing of the surgical wound or for the removal of sutures. It may take from a few weeks to a month for the surgical wound to heal and for the formation of new fibers, in a new position in the mouth.