Gum And soft tissue surgery
A frenum is a naturally occurring muscle attachment, normally seen between the front teeth (either upper or lower). It connects the inner aspect of the lip with the gum. A lack of attached gingiva, in conjunction with a high (closer to the biting surface) frenum attachment, which exaggerates the pull on the gum margin, can result in recession. Additionally, an excessively large frenum can prevent the teeth from coming together resulting in a gap between the front teeth. If pulling is seen or the frenum is too large to allow the teeth to come together, the frenum is surgically released from the gum with a frenectomy. A frenectomy is simply the surgical removal of a frenum.
When Orthodontic treatment is planned or initiated, the removal of an abnormal frenum, with or without a gingival graft, can increase stability and improve success of the final orthodontic result.
Occasionally, the muscular band that attaches the underside of the tongue to the floor of the mouth is attached too close to the tip of the tongue. This can prevent proper tongue movement, which can affect speech and swallowing. In situations such as this, this muscular band can also be attached abnormally high up on the gum tissue behind the back of the lower front teeth. This can cause an excessive amount of traction on the gum tissue. This can result in the gums pulling away from the teeth, which may allow periodontal pockets and gum disease to develop in this area. This problem can be corrected with a simple surgical procedure known as a Lingual Frenectomy. In this procedure, the frenum is surgically removed, which then gives the tongue greater mobility and eliminates the traction on the gum tissue. This procedure can sometimes be performed under local anesthesia, but in our younger patients (14 or younger), we normally recommend that the procedure be performed under intravenous sedation.
The gum tissue can be very thick and large covering the tooth surface making the teeth look short. This can happen because of medications, bone that extends too close to the surface of the teeth, or inflammation due to gum disease.
A gingivectomy is a procedure that eliminates excess gum tissue. The term “gingivectomy” is derived from Latin:
- “gingiva” means gum tissue,
- “-ectomy” means to remove.
The following are some reasons a gingivectomy might be needed:
Cosmetics: To make the teeth look normal in size when the gum is covering too much of it, making the teeth look longer and more proportional.
Functional/Esthetics: To remove excess gum tissue (gingival overgrowth) that has formed as a result of certain drugs such as anti-seizure and organ-transplant medications, and certain high blood pressure medications.
Bone and gum health around the teeth: To shrink deep gum pockets. This procedure might require some bone work as well.