Reverse Frenulectomy

Q: Dr. Eppley, I am interested in a reverse frenulectomy procedure. About one month ago while my tooth was being filled a dentist without my knowledge and permission did lower a lower lip frenulectomy with laser. This has caused lower lip ptosis. My orofacial esthetics is altered in a very bad way. And since most of my mandibular teeth are missing I have lost the proper reinforcement for my temporary partial dentures. Do you do the frenulum reattachment procedure? If yes do have any experience in successfully restoring it?

A: The three frenal attachments in the mouth (maxillary, palatal and mandibular) are mucosal bands of tissue that connects a soft tissue mobile structure to a fixed bony non-mobile structure. In the case of the mandibular frenum it attaches the lower lip to the front part of the tooth-bearing part of the lower jawbone. (alveolus) Inside the mucosal frenal bands are thin muscle fibers which connect the orbicularis muscle to the bone. Cutting the frenum normally would not cause a lip ptosis or oral incompetence because it is done for high or abnormal frenal attachments. What may happen in more normal frenums that undergo release may be different.

There is no specific procedure for recreating the actual frenal band. (aka reverse frenulectomy) But the effect of doing so can come from two types of vestibular procedures. A horizontal vestibuloplasty can be performed that raises the level of the midline alveolus and brings the lip closer to the alveolus. The other approach is a midline vertical vestibular suspension where a suture attachment is done which most closely resembles a frenulectomy recreation. Either procedure is performed under local anesthesia.

Dr. Barry Eppley

Indianapolis, Indiana