What is a frenectomy?
Frenectomy is the name given to a minor surgery that consists of cutting and removing the frenum, which is a thin “fold” of fibrous tissue (like a membrane) present in the mouth.
In some cases, it is sufficient to section or partially cut this frenum, aiming to change only the level of its insertion in the soft tissues, in order to divide it or reduce its size, in which case we start to call this minor surgical operation a frenotomy, instead of a frenectomy.
Lingual, labial frenectomy
In dentistry, there are basically 2 types of frenum:
Labial frenums
Labial frenums (upper lip Frenectomy and lower) located in the median line, visible when we raise the Frenectomy upper lip or lower the lower lip, and which extend from the inside of the lip to the vestibular gum (front), both in the upper and lower jaw;
Lingual frenum
Lingual frenum, located on the underside of the tongue tie (below the tongue tie), and which is inserted from the tongue tie to the floor of the mouth.
Depending on the type of frenum, we call it lingual frenectomy, in the case of section of the lingual frenum, and labial frenectomy in the case of the labial frenum. In this case, we subdivide it int (frenulotomy) Frenectomy upper labial frenectomy, which, as the name suggests, is performed on the frenum of the upper lip, and lower labial frenectomy, which, as the name suggests, is performed on the frenum of the lower lip.
Lateral to the labial frenum, there may also be other wider fibrous “folds”, called bridles, which are almost identical to the frenums. They differ only in their location and width, which can vary from a few mm to 1 cm, while the frenums are generally no more than 1 to 2 mm.
Although these “membranes” do not tend to have a low insertion and do not imply as many limitations as frenulums, they sometimes have to be removed, particularly when they cause functional interference, or become inconvenient for the stability and retention of prostheses, or even when they interfere with orthodontic correction.
The surgery to remove and eliminate the fibrous tissue of the bridles also follows a protocol identical to that of frenulum removal, but in this case the procedure is called bridectomy, due to its different name.
Indications
Frenectomy surgery is indicated in the following situations, depending on the type of frenulum considered, namely:
1. Labial frenectomy:
Presence of interincisor diastema (teeth separated due to space between the two central incisors), associated with the presence between them of low-inserted frenulum fibers, at the level of the interdental papilla, thus preventing the natural closure of this space;
Possible limitation of lip mobility, resulting from a very low insertion of the labial frenulum;
Aesthetic reasons, mainly in situations of a high smile, that is, when the person exposes, when smiling, a larger portion of the anterior/upper gum, the so-called gummy smile;
Changes in phonetics (normally associated with the presence of a large diastema);
When it interferes with orthodontic correction (orthodontics);
When it interferes with the stability and retention of dental prostheses.
2. Lingual frenectomy:
Limitation of tongue tie movements when the frenum is too short, inserting itself too close to the tip of the tongue tie;
Changes in speech (phonetics), for the same reason;
Disorders or difficulty in chewing, also for the same reason;Traumatic injuries, resulting from the frenum “rubbing” on the lower incisors, due to the great proximity between the two structures.
Cases of a very short lingual frenum that causes the tongue tie to become “stuck” (ankyloglossia) are more prevalent in newborns and infants, and can cause feeding problems, including sucking.
Therefore, lingual in babies is a procedure that is often necessary to correct these limitations. If the problem is correctly diagnosed, the surgery can be performed regardless of age, as long as the baby does not have any specific contraindications for it.
As for the ideal tongue-tie surgery age limit is to perform a labial frenectomy, there are some considerations to take into account, as there are situations where it is possible to identify very marked situations of a more hypertrophied (thicker) than normal frenum as early as 2 years of age, with a poor prognosis for regression. Therefore, in these cases, surgery can be considered immediately. However, there are situations in which an abnormal frenulum between the ages of 2 and 4 can naturally evolve into a normal situation at the age of 8 or 9, as a consequence of the natural elongation of the tongue tie.
Therefore, we often remain in expectation, waiting for the possible and natural regression of the frenulum, unless there is strong evidence that the impediment to the closure of interincisor diastemas is caused by this labial frenulum, and that this is implying some type of disorder.
Therefore, it becomes somewhat debatable to indicate exactly from what point onwards and age at which labial frenectomy should be performed, although there is some agreement that this procedure can or should wait until the canine teeth have fully erupted, which normally occurs between 11 and 13 years of age. These teeth will exert mesial forces that may cause the frenum to move away from the interincisal region, promoting the natural closure of the diastema.
How is the surgery performed?
Surgery is generally simple and can be performed in two different ways, which we will now describe:
Conventional surgery – performed with a normal or conventional scalpel, with incisions being made to cut or section the frenum, in order to partially or completely remove it. After this procedure, the soft tissues are sutured with absorbable or non-absorbable stitches, the latter of which will have to be removed later (between 7 and 10 days).
Laser surgery – laser basically differs from conventional surgery in that it uses a scalpel, which is replaced by an electric scalpel, which has a similar function but allows for shorter surgery times, since in addition to cutting, it also promotes immediate coagulation and sterilization.
Furthermore, as a general rule, it does not involve suturing, and as such it also reduces edema and trauma to soft tissues that may be associated with sutures. For these reasons, the post-operative period is easier, which is why laser is increasingly being considered in pediatric dentistry and in adults.
Frenectomy surgery, regardless of the surgical method or technique used, is painless, since the operation is performed under local anesthesia and the post-operative period, as a rule, does not involve any significant symptoms.
Frenectomy (frenillo) – risks, complications
Frenectomy is a surgery that presents low risks, however some post-operative complications may occur, such as pain, minor bleeding or excessive bleeding (mainly in lingual frenectomy), edema, inflammation or infection (although rarely), among others of lesser importance.
During the surgical procedure, in addition to the possibility of excessive bleeding, there may be a risk of injury to neighboring structures (mainly in cases of lingual frenectomy), if the technique is performed incorrectly.
In any case, these risks and complications are usually reversible, leaving no noteworthy sequelae.
Frenectomy | post-operation
In general, recovery from frenotomy surgery is quick, and the patient does not need to rest after the operation. You can therefore resume your activities immediately after surgery, as long as you follow certain post-operative precautions to reduce recovery time and thus promote healing, namely:
Avoid hard foods in the first few days (prefer slightly pasty foods), especially in cases of lingual frenectomy;
Avoid very hot foods for at least the first two days, and after (lip tie surgery) surgery, it is also beneficial to apply cold (ice packs, for example) locally, in cases of labial frenectomy;
Especially take oral hygiene care, and brush the surgical area with gentle pressure and with appropriate brushes (with very soft bristles), complemented by mouthwashes with antiseptic solutions;
Take the medication prescribed by your dentist (usually painkillers and/or anti-inflammatories) as prescribed.
In labial frenectomy, the price may vary depending on the type of frenum and the technique or method
considered.
Frenotomy vs. frenectomy – The main differences between them
There are no major difference between both of them. Frenotomy and Frenectomy both known as same procedure. It is like the little bit tissue fold in baby’s mouth. You may also hear the words when discussing about this procedure.
Best of example of is that if someone says trim or clip , Outcome will be the same in both cases.
Cost of a Frenectomy
Just as an example, we can say that the average cost of the surgery is relatively low, but only the dentist can calculate exactly how much a surgery for frenectomy cost , after a clinical evaluation during a medical consultation.