Frenectomy Timing — ORE Part 1 MCQ

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HardOrthodonticsFrenectomy TimingORE Part 1

A 12-year-old has a persistent maxillary midline diastema associated with a papillary-penetrating upper labial frenum. Following orthodontic assessment, fixed appliance treatment is planned to close the diastema. In the absence of another indication for surgery, when should frenectomy be undertaken?

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Correct answer: C — After orthodontic closure of the diastema

Explanation lettering: C = shown as A · D = shown as B · A = shown as C · B = shown as D

A is correct. Where a maxillary labial frenum is considered contributory to a persistent diastema requiring orthodontics, frenectomy is usually deferred until the diastema has been orthodontically closed. Performing it first may create scar tissue and does not address other causes of spacing; evidence-based reviews advise against frenectomy before orthodontic management because of relapse risk. Early mixed-dentition treatment is inappropriate because many midline diastemata reduce naturally with development. Eruption of the permanent lateral incisors is a minimum developmental milestone for avoiding treatment of a physiological diastema, but it is not the preferred operative timing in this orthodontic scenario. Exfoliation of primary canines is unrelated to the indication or timing of frenectomy.

Reference: Khan et al. Association between superior labial frenum and maxillary midline diastema - a systematic review. 2022. https://pubmed.ncbi.nlm.nih.gov/35248905/