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Highlights
- Early treatment of a lip-tie does not form scar tissue that prevents diastema closure.
- Treating lip-tie in the primary dentition yields present and future cosmetic benefits.
- Treatment of a maxillary frenum provides benefits to families with minimal risks.
- Providers should consider treating a lip-tie for oral hygiene or cosmetic concerns.
- Treatment of a frenum can occur before or after orthodontics if it causes a problem.
Summary
Background
Maxillary frenectomy in children is a common procedure, but concerns about scar tissue affecting diastema closure prevent many clinicians from treating prior to orthodontics.
Objectives
To determine if maxillary frenectomy is safe and if diastema size is affected by early treatment.
Materials and methods
Pediatric patients with hypertrophic maxillary frena were treated under local anesthesia with diode laser and CO2 laser. Diastema width was compared by calibrating and digitally measuring initial and postoperative intraoral photographs.
Results
In total, 109 patients were included: 95 patients with primary dentition (39% male; mean age 1.9 years ± 1.5 years) and 14 with mixed dentition (43% male; mean age 8.1 ± 1.3 years) with a mean follow-up of 18.0 ± 13.2 months. No adverse outcomes were noted other than minor pain and swelling. In the primary dentition, a decrease in diastema width was observed in 94.7% with a mean closure of −1.4 ± 1.0 mm (range +0.7 to −5.1 mm). In the mixed dentition, a decrease in diastema width was observed in 92.9% with a mean closure of −1.8 ± 0.8 mm (range 0 to −3.5 mm). 74.5% of patients in the primary dentition and 75% of patients in the mixed dentition with preoperative diastema > 2 mm improved to < 2 mm width postoperatively.
Conclusions
Frenectomy is associated with cosmetic and oral hygiene benefits and when performed properly, does not impede diastema closure and may aid closure. Technique and case selection are critical to successful outcomes. IRB ethics approval was obtained from Solutions IRB protocol #2018/12/8, and this investigation was self-funded.
