Definition & Overview

A frenectomy is a procedure performed to remove the frenula, or small folds of tissue found in various parts of the body that are responsible for keeping an organ from moving too far from its correct position. Also known as a frenotomy or a frenulectomy, the procedure is most commonly performed in various parts of the mouth as part of orthodontic treatment. The procedure is now performed using advanced surgical techniques that help minimise wound contraction, bleeding, and scarring.

Who Should Undergo and Expected Results

Frenectomy is commonly recommended for those who:

  • Are undergoing orthodontic treatment - In many orthodontic-related cases, the frenum is attached too low on the gums, forcing the gap between two of the patient’s teeth to become larger than normal. In some cases, the gap closes as the patient grows older and permanent teeth come in. If it does not, however, the patient may choose to have braces to close the gap, in which case removing the frenulum is necessary.

  • Are in the process of getting dentures - A frenectomy helps the dentist achieve the best fit for the dentures, especially in cases wherein there is tissue attached to the centre of the upper lip. If the procedure is not performed but the patient went on to use dentures nonetheless, there is a high risk of the dentures feeling loose due to the frenulum.


Are diagnosed with ankyloglossia, a congenital condition wherein the frenulum under the tongue is unusually short and thick causing a condition commonly known as a tongue-tie. In severe cases termed as complete ankyloglossia, the tongue is completely attached to the floor of the mouth causing severe complications related to feeding and speech.

These problems may also cause symptoms such as:

  • Clicking jaws
  • Painful jaws
  • Inability to speak clearly
  • Inability to open mouth widely
  • Difficulty eating
  • Inflamed gums
  • Loose dentures


Regardless of the specific problem, the degree of frenulum interference varies greatly. In mild cases, a frenectomy is usually unnecessary. In general, the procedure is only recommended in cases wherein the frenulum causes pain, restricts speech development, or puts the patient at risk of permanent dental issues that cannot be resolved by other treatment options. The procedure is widely performed on paediatric patients.

How is the Procedure Performed?

A frenectomy can be performed using a variety of techniques. The safest and most efficient involves the use of CO2 surgical lasers, which helps improve the precision and accuracy of the treatment. It also minimises bleeding and reduces the risk of complications, mainly because the laser does not cut the frenectomy but simply vaporises it. The process is not painful and is, in fact, comfortable even for young patients, with babies even sleeping through it. CO2 laser frenectomies also guarantee faster ablation, predictable tissue response, protection from infection, and practically instant haemostasis. Moreover, comparative results show that scarring is reduced significantly in incisions made with CO2 lasers as compared with incisions made using a traditional surgical scalpel.

Despite this, a frenectomy is performed under anaesthesia, which effects usually extend up to 30 to 45 minutes after the procedure. In most patients, sutures are no longer necessary, as the laser energy stimulates a healing response from the body.

Possible Risks and Complications

The risks associated with a frenectomy include:

  • Relapse – Due to the mouth’s fast healing tendency, it is possible for the frenulum to reattach during the recovery period, especially if there are two raw wounds that are near to each other.
  • Wound contracture – Wounds can sometimes contract inwards during the recovery process.
  • Infection


These risks are less likely to occur in cases where laser frenectomy is used instead of the traditional cold steel technique.



References:

  • Devishree, Gujjari SK., Shubhashini PV. “Frenectomy: A review with the reports of surgical techniques.” J Clin Diagn Res. 2012 Nov; 6(9): 1587-1592. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3527809/

  • Parhad S., Prasad V., et al. “Frenectomy using diode laser.” National Journal of Integrated Research in Medicine. http://www.scopemed.org/?mno=179222

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