Frenulums and frenectomy
Maxillary labial frenulum
It is very common to see young children with a large labial frenulum which inserts between both primary incisors up to the palatine papilla. This frenulum is the cause of space between both incisors. This is absolutely normal. The extra space is used to accommodate future permanent teeth which will erupt starting at 6-7 years of age. The prevalence of interdental space in the primary dentition is 70% of cases for the maxilla and 63% of cases for the mandible.
The direction of growth of the maxilla (green arrows) is downward and a lengthening of the alveolar bone and the gingiva occurs as the child’s face grows. The insertion of the frenulum will gradually migrate upward as the dentition migrates downward.
Evolution of dentition and selfclosing of an interincisal diastema
The picture on the right shows the eruption of upper central incisors. The attachment of the labial frenulum has migrated superiorly, but we can see its insertion up to the incisive papilla. A diastema between both central incisors is obvious.
A year later, the lateral incisors erupt. They apply a force which makes the central incisors become closer to one another. The space between both incisors is used to accommodate the alignment of the lateral incisors. When the eruption of lateral incisors is completed, the diastema will generally be closed completely or in part.
If the diastema remains at this age, we have to wait for the permanent canines to erupt, because the same force and movement mechanism applies.
If space is still there despite these steps, we then have to think about closing this space with orthodontic movements and brackets. A frenectomy has to be considered only after the closing is completed. In all cases, a permanent retention using a wire bonded on the back of the teeth is recommended.
Persistance of interdental space and treatment
Here is a teenager who shows a diastema and excessive space between incisors. At this stage, a frenectomy is useless and contraindicated, because the space between both central incisors will not close by itself, even if the frenulum is removed. An orthodontic closing with brackets was performed. There was no frenectomy. The interdental papilla is healthy.
This other case about a 55-year-old female adult shows the presence of a hypertrophic labial frenulum and a very large space between both incisors. The closing resulted in a pinch in the gingival tissue ( C ). A frenectomy was necessary. The final picture ( E ) shows adequate embrasure and interdental papilla.
I present a case whose treatment lasted 16 months. At the end of treatment, you will notice that the diastema between the two incisors is closed, but there are spaces on each side. These spaces were filled with composite restorations on the lateral incisors.
At the beginning of treatment, I indicated to the patient that he would likely need a frenectomy at the end of orthodontic treatment. Now the patient is satisfied with the result, it was never acted on the recommendation of the frenectomy and I confess that the picture 9 months post treatment demonstrates satisfactory results, although we note the presence of labial frenum . In other words, it does not harm him.
For more details, refer to this link orthodontisteneligne du Dr Jules Lemay