What are the indications for a frenectomy?

Indications for Frenectomy

Frenectomy is indicated when the frenum causes functional limitations, aesthetic concerns, or interferes with oral health, requiring surgical intervention to correct these issues.

Types of Frenum and Their Clinical Significance

• The frenum is a mucous membrane fold that attaches the lip and cheek to the alveolar mucosa, gingiva, and underlying periosteum 1
• Common locations include labial (upper and lower lip) and lingual (under the tongue) areas
• Abnormal frenum attachments can cause various functional and aesthetic problems requiring intervention

Indications for Labial Frenectomy

Periodontal Indications

• Frenum attached too closely to the gingival margin, causing:
  • Interference with proper plaque control 1
  • Gingival recession due to muscle pull 1
  • Compromised periodontal health

Orthodontic Indications

• Persistent midline diastema (gap between teeth) that:
  • Compromises orthodontic treatment results 1
  • Causes recurrence of spacing after orthodontic closure
  • Creates aesthetic concerns for patients

Prosthetic Indications

• Interference with proper fit or stability of removable prostheses 2
• Limitation of denture border extension causing discomfort or poor retention

Indications for Lingual Frenectomy (Ankyloglossia/Tongue-tie)

Speech-Related Indications

• Restricted tongue mobility causing:
  • Development of frontal and lateral lisps 3
  • Difficulty with certain speech sounds
  • Delayed speech development 3

Functional Limitations

• Restricted tongue movement affecting:
  • Difficulty in breastfeeding in infants 3
  • Problems with eating (gagging, choking, or vomiting food) 3
  • Limited tongue mobility affecting oral functions 4
  • Reduced maximum mouth opening 4

Behavioral Issues

• Behavioral problems associated with ankyloglossia 3
• Frustration due to communication difficulties

Timing of Intervention

• For infants with feeding difficulties, early intervention may be necessary 5
• For children with speech issues, intervention between 2-7 years is common 5
• For orthodontic concerns, timing often coincides with comprehensive orthodontic treatment
• Mean age for lingual frenectomy with local anesthesia is approximately 7.6 years 5
• Mean age for lingual frenectomy with general anesthesia is approximately 2.8 years 5

Surgical Approaches

• Conventional surgical techniques (scalpel-based approaches) 2
• Laser-based techniques:
  • CO₂ laser offers a simple, safe treatment method with minimal bleeding 5
  • Nd:YAG laser reduces transoperative bleeding and surgical time 2
  • Laser techniques often do not require suturing 2

Post-Surgical Considerations

• Myofunctional therapy after lingual frenectomy significantly improves:
  • Tongue mobility 4
  • Maximum mouth opening 4
  • Overall functional outcomes 4
• Without proper post-surgical therapy, readhesion may occur (reported in approximately 4.8% of cases) 5

Contraindications and Cautions

• Very young age may be a relative contraindication in some cases 5
• Patients with bleeding disorders or other systemic conditions requiring special consideration
• Unrealistic expectations regarding outcomes, particularly for speech issues

Complications to Consider

• Potential for bleeding during conventional procedures 2
• Possibility of readhesion if proper healing is not achieved 5
• Temporary discomfort affecting oral functions
• Rare complications such as infection or damage to surrounding structures 3