The Maxillary Frenum - Lawrence A. Kotlow, DDS

Preventive Pediatric Dental CareLawrence A. Kotlow DDSPractice Limited to Pediatric Dental Care340 Fuller RoadAlbany, New York 12203

Patient comfort and safety1. All children are treated using the most up-to-datesafe technology available.2. All oral surgery treatments are completed using upto three different lasers.3. The use of lasers promote healing and reduce postsurgical discomfort.4. Lasers eliminate the need for sutures in mostpatients.5. All treatment is completed using microscopes toreduce damage to adjacent oral structures.6. All needed x-rays are taken using computers andresult in reduced patient exposure to radiation andreduced environmental contamination due toelimination of many of the materials and chemicalsused when taking conventional dental x-rays.

The Maxillary Frenum:When is the best time forrevising this abnormality ?Primary dentitionMixed dentition

Maxillary FrenectomyInfant dentitionage 10-18 monthsMixed dentitionage 6-8When timed correctly, the frenectomymay allow the teeth to grow togetherand close the space naturally.

Infant frenectomy diagnosis andtreatment recommendationsLawrence Kotlow DDS PC

Evaluating the Infant Maxillary Frenum1. Is the frenum creating adiastema (gap) between themaxillary central Incisors ?2. Will revision of thefrenum prevent anorthodontic problem suchas a gap or diastema fromdeveloping or remainingin when all the permanentteeth erupt into themouth ?

Infant Maxillary Frenectomy3.Does the frenum interferewith normal lip position ?Does this effect eating ?Does the lip get stuckbetween the front teeth ?4. Does the frenum makeoral hygiene care difficult ?Is there bleeding ? Doesthe frenum contribute tocaries formation or posttreatment home care?

Infant Maxillary Frenectomy5. Has the frenum area been subject torepeated trauma ?

Classifying Infant Maxillary Frenums•Class I: normalMost people do not have any significantfrenum attachmentKotlow frenum classifications

Classifying Infant Maxillary Frenums•Class II: variationsFrenums that insert into the area of attached gingivaabove the teeth ( interproximal area). In most cases, inchildren, this will not create any significant problems.As adults age and the gingival tissue normally recedesthis frenum many need to be revised.

Frenum attachments that insert into the areabetween the teethClassifying Infant Maxillary Frenums•Class III: variations

Classifying Infant Maxillary Frenums•Class IV: variationsFrenums that insert into the anterior papillaor palate behind the teeth

Emmy’s FrenectomyPre-op1 week24 hours6 month evaluation48 hrsEmmy age 5 years

Infant Maxillary TreatmentBEFORE TREATMENTRESULTS AFTER TREATMENTBEFORE TREATMENT RESULTS AFTER TREATMENT

Which photo do you like ?Before frenectomy2 years after frenectomy

Maxillary Frenectomy in older childrenIn older children, where the maxillary frenumattachment is abnormal, I will usually recommend itbe revised when the permanent central incisors justbegin to erupt into the oral cavityThis allows the normal eruption pressures of thepermanent lateral incisors to assist in pushing thefront teeth together.

Revising the maxillary frenum when thepermanent front teeth are eruptingExcellent healing after six days

Maxillary FrenectomyThe soft tissue attached between the teeth isremoved and when indicated small piece of bonecan also be removed when using the Erbium Laser.

Maxillary FrenectomyThe revision is completed with littlediscomfort or bleedingThe surgical site does not require stitches

Maxillary Frenectomy1 week post-op

Laser Maxillary FrenectomyPre-treatment6 months post -op

Maxillary revision with the LaserPre-treatment12 months after treatment

6 weeks post treatment5 months post treatmentMandibular frenectomy

Home care afterlaser revisionof maxillaryfrenectomy

3. After you pull the area apartplace a small amount ofVitamin E or Vaseline insurgical site with your finger.1. Brush the front teeth gently toremove all the plaque thataccumulates daily to allowproper healing of surgical area.2. Two times a day, morning andevening, for the upper frenumarea, pull the lip upward or forthe lower frenum area ,downward to prevent the areafrom healing together.

4. Rinsing with warm salt waterafter eating will help the areato heal.5. A small white patch in thesurgical site is normal and isnot any type of oralinfection.6. If your child seems to beuncomfortable after thenumbing wears away, youmay give the child Tylenol orsimilar pain medications.

Updates in 21 st centurypediatric dentistry• Lawrence Kotlow DDS• Board certified pediatric dentist• Advanced proficiency certification in Erbium lasersurgery by the Academy of Laser Dentistry• In private practice since 1974• Written many articles and lectured both nationallyand internationally in treating the abnormallyattached maxillary frenum in infants and children• These articles are available to view on this website: KIDDSTEETH.COM

Please feel free to ask anyquestion concerning thisprocedureFor more information go to KIDDSTEETH.COMand read the articles I have written