What Happens If a Maxillary Labial Frenectomy Is Done BEFORE Ortho in Braces and Invisalign?

I. Introduction

  • Dr. Amanda from StraightSmile Solutions tackles a surprisingly common scenario: patients who get a frenectomy before orthodontic space closure.
  • Her firm stance: Frenectomies belong at the END of ortho once the space is fully closed.
  • Doing it early creates scar tissue that can prevent the space from ever closing properly.

II. The Standard Protocol

  • Frenectomy before ortho is not standard of care.
  • The scar tissue that forms can act as a physical barrier, preventing the central incisors from moving together.
  • When the procedure is done after space closure, the scar tissue forms in a space that’s already closed, with no interference.

III. Why Some Patients Do It Early

  • Occasionally, a patient gets excited after the consult and goes off to have it done without a referral.
  • Sometimes, a well-meaning oral surgeon or periodontist does it without checking with the orthodontist.
  • Dr. Amanda has seen this happen multiple times despite it being “wacky” and outside standard protocol.

IV. The Scar Tissue Problem

  • Laser frenectomies generally heal cleanly and cause minimal issues.
  • Scalpel frenectomies often create thick, fibrous, keloid-like scar tissue.
  • Moving teeth through that fibrous tissue is unpredictable.
  • In one case, the scarring was so botched that space closure became impossible without revision.

V. Protecting Yourself: The Consent Add-On

  • Dr. Amanda recommends a simple one-page supplemental consent for any patient with a pre-existing or pre-ortho frenectomy.
  • Language should include:
  • Space closure may not be fully possible.
  • Additional surgical revision may be needed.
  • Restorative fees may be required to close the space.
  • These are patient expenses not covered by insurance or the orthodontic fee.
  • Document it before starting treatment.

VI. The Bottom Line

  • Frenectomy before ortho creates risk. Frenectomy after ortho avoids it.
  • If a patient comes to you with an existing frenectomy (or had one done early), don’t automatically decline the case.
  • Do add a supplemental consent. Manage expectations upfront.
  • And if the space won’t close? You’re protected. The patient was warned. The fees are theirs.