Date: Thursday, November 15, 2007 12:13 AM
From: "ESCO automatic digest system" <LISTSERV@LISTSERV.UIC.EDU>
Subject: ESCO Digest - 12 Nov 2007 to 14 Nov 2007 (#2007-82)

There are 2 messages totalling 254 lines in this issue.

Topics of the day:

  1. Re: Frenectomy
  2. Re: Frenectomy

Date: Tuesday, November 13, 2007 11:21 PM
From: SCOTT SMORON <scottsmoron@COMCAST.NET>
Subject: Frenectomy

I have a laser, just to lay that out.  But I cannot imagine "selling" this
procedure to any kid at that age.  Period.  It will migrate apically.
Re-eval in a year or two.

Hasn't everyone seen the kid who had a baby tooth pulled by an oral surgeon
who did the friendly helpful thing and tack on the frenectomy then had to
deal with the lack of tissue between the centrals years later?  This
procedure would be more likely to CAUSE the black triangle that wouldn't be
apparent for years!

Most of the periodontists I work with are interested in esthetics and they
all prefer to do such a procedure once they are in the permanent dentition
and the space is closed.

The rational described by this dentist would mean, to me, that about half of
kids need a frenectomy at age 6...because for many kids the frenum is low as
these teeth erupt.

I hope I'm not in left field on this...but I have seen this scenario too
many times played out several years down the road, with a distema, a lack of
soft tissue, and parents unhappy until some IPR is done to close the space,
leaving two hugely flush centrals with no papilla.

Scott Smoron

Date: Tuesday, November 13, 2007 4:32 AM
From: David E. Paquette <davep@PAQUETTEORTHO.COM>
Subject: Frenectomy


There are no indications that I can recall.  I agree with your presumption about the apical migration.  I have always treated a low frenum as a transient issue that disappears once the diastema is closed.  I rarely see them try to reopen.  The only indications I am aware of is (1) if the fibrous tissue dissects the bone at the midline through to the palate preventing apical migration due to attachment on the palatal side and (2) if the attachment to the lip is so far towards the external surface that it distorts the lip on smiling.  I must admit that I can count on one hand the number of frenectomies I have done or prescribed in 28 years.  I have had a laser for several years and the simplicity doesn't change the treatment plan in my eyes.

I might add that one of my competitors down the street does one on just about everyone it would seem from the second opinions I see.

Dave Paquette