Tongue and Lip Ties in Kids and Adults: When to Trim the Frenum (Frenectomy)

Dr. Amanda with Straight Smile Solutions

• Focus: tongue and lip ties in children and adults.
• Builds on prior content about maxillary labial frenectomies (timing with braces/Invisalign/Phase 1).
• Offers an orthodontist’s perspective on when trimming is necessary vs. avoidable.

Why/When Frenectomy is Indicated

• Upper lip ties:
  • If a gap (diastema) between teeth exists, pulling the lip shows blanching and a visible tissue tag.
  • Must close the space first with orthodontics before trimming → prevents scar tissue from blocking closure.
  • Procedure timed after Phase 1, Phase 2, or comprehensive treatment and retention.
• Lower ties:
  • Usually less of a concern unless affecting orthodontic closure/retention.
  • Signs to trim:
    • Space reopens quickly (within 12 hours) after removing the power chain/aligners.
    • Persistent relapses despite retention.
  • Requires bonded (permanent) retainer after trimming.

Testing Before Deciding on Surgery

• With braces:
  • Remove power chain near the end of treatment → monitor if spaces pop open.
  • If reopening occurs → frenectomy + bonded retainer.
  • If not → surgery is often unnecessary.
• With Invisalign/aligners:
  • “Day off” test → patient skips aligner wear during the day (under orthodontist’s supervision).
  • If spacing reappears, → frenectomy may be indicated.
  • Orthodontist verifies results in person, not just the patient’s word.

Clinical Decision Making

• Avoid trimming too early (can complicate closure).
• Base decision on relapse behavior rather than routine trimming.
• Collaboration with an OMT (orofacial myofunctional therapist) may guide lower tie management.

Key Takeaway

• Frenectomy should be timed strategically after space closure and retention testing.
• Not every tie requires trimming; only pursue it when relapse or spacing proves persistent.