Dental Asia May/June 2018

Clinical Feature
Frenectomy / Frenotomy procedure
A frenectomy can be performed under topical or local anaesthesia
using a scalpel, electrosurgery, or soft tissue laser. Procedures
completed with electrosurgery probes have been advocated due to
their safety, only mild bleeding and the absence of post-operative
complications in comparison to conventional surgical methods.
However, electrosurgery can be associated with complications
such as burns and the production of surgical smoke from the burnt
tissue. The use of soft tissue lasers such as laser diodes, Er:YAG lasers
and CO 2
lasers have the advantage of shorter procedure duration,
absence of post-operative infections, and minimal pain, swelling and
scarring. 10 There may be slightly delayed healing in comparison to
conventional scalpel techniques; however, sutures are not required.
After excision of the frenum, the mother is encouraged to move
the lip and/or tongue by physically lifting the lip to separate it from
gingival tissues, and encouraging the infant to move their mouth
by touching their cheeks and lips during play. 10
Three randomised control trials have evaluated the eects of
frenotomy on mothers and infants when tongue-tie was considered
to be responsible for feeding problems. Hogan and colleagues
showed that 96% of infants in the frenotomy group had reduced
symptoms soon after the procedure, compared to 3% of infants in the
control group. 37 Dollberg, who conducted a double-blind crossover
randomised control trial involving 25 patients, demonstrated
decreased nipple pain and improved latching immediately following
frenotomy as compared to a sham procedure. 38 In the third study
of 58 neonates with breastfeeding difficulties, Buryk showed
signicantly greater reduction in nipple pain immediately following
frenotomy. 39 However, the main limitation of these randomised
control trials are based on subjective scoring from the mothers,
and potential bias due to the diculties of blinding an obvious
surgical procedure. Furthermore, there are no randomised studies
comparing the eectiveness of frenectomies vs frenotomies, or
the dierent success rates for the dierent treatment techniques
have been conducted. Therefore, further research is necessary
before specic techniques can be recommended for frenotomies
or frenectomies to release the lip and tongue in an infant.
Conclusions
Despite epidemiological studies pointing to an association with poor
breastfeeding ecacy and ECC, the specic link to either maternal or
infant factors has not been adequately investigated. If a relationship
could be demonstrated between poor feeding ecacy and ECC, this
would enable practitioners to better identify infants with a higher
caries risk and implement early preventative strategies.
Breastfeeding is a natural process that enables optimum
growth and health of the infant. If tongue-tie or lip-tie is identied
early as being a factor that impedes breastfeeding, then surgical
intervention can facilitate successful nursing for the mother and
infant, while avoiding stress for the mother and ensuring that the
infant thrives. DA
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