Short answer: A frenectomy is a procedure that releases the thin band of tissue (frenulum) that connects the lip to the gums or the tongue to the floor of the mouth by cutting or reshaping it. A short or thick tongue frenulum can affect speech, breastfeeding and tongue movement, while a low-attached lip frenulum can contribute to a gap between the front teeth and gum recession. The procedure can be done under local anesthesia with a laser or a scalpel.
Inside the mouth there are thin bands of tissue running from the inner surface of the upper lip to the gums and from the underside of the tongue to the floor of the mouth. These structures are called frenula, commonly known as the lip tie and tongue tie. In most people they cause no problems, but they can sometimes be shorter or thicker than usual or attached very close to the gums. A frenectomy is a minor surgical procedure in which the frenulum is released by cutting or reshaping it in such cases.
In this article we explain what a frenectomy is, who needs one, the differences between laser and conventional methods, the procedure and recovery, and how it relates to orthodontic treatment.
What is a frenectomy?
A frenectomy is the surgical release or removal of the lip or tongue frenulum. There are three frenula in the mouth that are most often evaluated:
- Upper lip frenulum: Runs from the middle of the upper lip to the gums between the two front teeth.
- Lower lip frenulum: Runs from the middle of the lower lip to the gums of the lower front teeth.
- Tongue frenulum: Runs from the underside of the tongue to the floor of the mouth.
When these frenula become a problem depends on the person's age and symptoms. In infancy, releasing the tongue frenulum with just a small cut is called a frenotomy; frenectomy generally refers to the procedure in which the frenulum is removed or reshaped more extensively. In everyday use, the two terms are sometimes used interchangeably.
Who needs it?
A frenectomy may be necessary if the structure of the frenulum has a negative effect on speech, feeding, oral hygiene, gum health or tooth alignment. A frenulum that simply looks thick is not, on its own, a reason for the procedure; symptoms and examination findings are assessed together.
Conditions related to the tongue frenulum
A short or thick tongue frenulum is medically called ankyloglossia. In this condition, the tongue's range of motion can be restricted.
- In babies, difficulty breastfeeding, trouble latching and nipple pain for the mother
- The tip of the tongue taking a heart shape when stuck out
- The tongue being unable to reach the upper front teeth or the palate
- Difficulty producing certain sounds, for example “r,” “l,” “t” and “d”
- Difficulty with tongue movements such as licking the lips or eating ice cream
- Gum recession on the tongue side of the lower front teeth
Speech difficulties are not always caused by the tongue frenulum. That is why, when deciding for children, it helps to have a joint assessment by the pediatrician, a speech and language therapist and the dentist.
Conditions related to the lip frenulum
- A persistent gap between the upper front teeth (diastema)
- The frenulum pulling on the gums and causing gum recession
- Difficulty brushing the front teeth and plaque buildup
- In people who wear removable dentures, the frenulum preventing the denture from seating properly
The dentist pulls the upper lip upward and checks whether the gum between the two front teeth blanches. This simple test gives an idea of how deeply the frenulum is attached to the gums.
The lower lip frenulum matters mostly for gum health. If the gums in front of the lower front teeth are thin and the frenulum is strong, lip movements can constantly pull on the gums and speed up recession. In this case, a frenectomy is sometimes planned together with periodontal procedures such as a gum graft.
What is the difference between laser and conventional methods?
A frenectomy can be done with dental lasers or with the conventional scalpel method; both give effective results when done correctly. The choice is based on the structure of the frenulum, the patient's age and the dentist's assessment.
- Laser frenectomy: Because the laser seals blood vessels as it cuts tissue, bleeding is usually very minimal. Stitches are often not needed. Discomfort after the procedure is mild for many patients, and healing can be quick.
- Conventional (scalpel) frenectomy: The frenulum is cut with a scalpel, and the area is usually closed with dissolving stitches. It may be preferred for thick, broad frenula or when certain special surgical techniques are needed.
With both methods, the goal is to release the frenulum sufficiently and allow the tissue to heal in a healthy way. Regardless of the method, following the aftercare instructions directly affects the result.
What do the procedure and recovery involve?
A frenectomy is usually done under local anesthesia and completed in a short time. Releasing a tongue tie in babies can often be done in a few seconds with just topical numbing.
- Examination: The structure of the frenulum, where it attaches and the problems it causes are assessed.
- Anesthesia: The area is numbed with local anesthesia.
- Release: The frenulum is released by cutting or reshaping it with a laser or scalpel.
- Closure: Stitches are usually placed with the conventional method; with a laser they are often not needed.
- Instructions: Guidance is given on eating, oral care and exercises.
For the first few days after the procedure, there may be tenderness and mild swelling in the area. A white-yellowish layer forming on the wound surface is a normal part of healing and does not mean infection. Soft tissues usually heal within one to two weeks.
During recovery, keep the following in mind:
- Avoiding very hot, spicy and hard foods in the first days
- Cleaning the area gently, without straining it
- Using the oral care products recommended by the dentist as directed
- After tongue-tie procedures, regularly doing the tongue exercises given to prevent the frenulum from reattaching
How does it relate to orthodontic treatment?
A frenectomy is closely related to orthodontics, especially in treating a gap between the upper front teeth. A thick, low-attached lip frenulum can make it harder to close the gap between the front teeth or contribute to the closed gap reopening after treatment.
That said, in young children a gap between the front teeth is often temporary. As the incisors and canines erupt, the gap may narrow on its own. For this reason, the decision to perform a frenectomy in children is usually not rushed, and the eruption of the permanent teeth is monitored.
For adults and teenagers whose permanent teeth have all come in, the common approach is to close the gap orthodontically first and then perform a frenectomy if needed. This order can help ensure that the tissue formed as the frenulum heals does not interfere with the new position of the teeth and that a more stable result is achieved against relapse. In suitable cases, gaps between teeth can also be treated with Invisalign clear aligners; for details, see our treating gaps between teeth with clear aligners article.
Wearing retainers consistently after treatment is also very important to keep the gap from reopening. When a frenectomy and orthodontics are planned together, the timing of the procedure is decided jointly by the orthodontist and the dentist performing the surgery.
When should you see a dentist?
If you notice breastfeeding difficulties in your baby, limited tongue movement or speech problems in your child, or a gap between your front teeth that will not close or gum recession where the frenulum pulls, it is a good idea to have an assessment. At our clinic in Oran, Çankaya, the structure of the frenulum and its effects are examined; if there is an orthodontic need, the timing of the frenectomy is also discussed as part of the treatment plan.
Frequently asked questions
When can I eat normally after a frenectomy?
Most people can eat soft foods the same day or the day after the procedure. Avoiding very hot, spicy and hard foods for the first few days makes healing easier. A normal diet is usually resumed within a few days.
Is laser frenectomy better?
The laser method generally offers advantages such as less bleeding and often no need for stitches. The conventional method is also effective when done correctly and may be preferred in some cases. Which method is suitable is determined by the dentist based on the structure of the frenulum.
If a tongue tie is not released, will the speech problem be permanent?
Not every speech problem is caused by a tongue tie, and not every child with a short tongue frenulum has a speech disorder. If the tongue tie is thought to be affecting speech, a joint assessment by the dentist and a speech and language therapist is recommended.
Does a frenectomy alone close the gap between the front teeth?
In most cases, a frenectomy alone does not close the gap. The gap is usually closed with orthodontic treatment; a frenectomy is planned as part of treatment when a thick, low-attached frenulum is contributing to relapse.
