The forum

THE

I

N CONTINUING INTER,NATIONAL

the discussion JOURNAL

FORUM which

appeared

OF ORTHODONTIA

in a recent

AND DENTISTRY

issue of the

FOR CHILDREN,

upon the subject of the advisability of the surgical removal of the maxillary labii frenum, of interest to our readers will be the comments of Dr. Sydney W. Bradley, of Ottawa, Canada. Dr. Bradley says: “Dr. Dewey answers Dr. Caine’s query concisely and definitely. If t,he frenum is abnormal, remove it; if not, leave it alone. Dr. Varney Barnes in his letter describes the abnormal frenum lucidly. “The best time for surgical interference with an abnormal frenum is when the permanent central incisors have erupted far enough to put bands on them comfortably. Before removing the frenum t,hese bands are fitted and cemented to place with whatever attachments the operator likes best. At present I am using the new Angle edgewise arch bands. If the movement of the incisors cannot be controlled in bringing them together, it, will be necessary to band the first permanent molars and use an alignment wire. After anesthetizing the tissues by infiltration, an incision with a straight bistoury is made around the lingual tuft of‘the frenum. This is grasped by a pair of small artery forceps and dissected away. Two incisions are next made between the teeth, carefully, so as to remove only the fibrous cord and not disturb the periodontal tissues. The cord is dissected away until you are well over on the labial. Then the excess tissue holding the lip down is removed with gum scissors, a V-shaped piece being removed with the apex of the V about 8 millimeters from t,he gingival border. A cautery may be used now to remove any loose ends of tissue remaining, but if the frenum has come Sutures may be used to bring the away nicely, this will not be necessary. edges of the freshly exposed labial surfaces together, but they are not absolutely necessary. The teet’h are now ligated with silk ligature and the patient is told to lift the upper lip upward and outward two or three times daily, to prevent the raw lip surfaces uniting with the raw alveolar surface. The teeth will move together nicely aided by t,he healing process. “ Some years ago, I decided not to remove any more frenums: as I thought that if some of my friends could get, away without doing it so could I. bllt I find there are a few cases each year which require surgical removal to obtain the best results with the least effort. Just recently I had a case under The treatment where the labial part only of the frenum had been removed. central incisors would drift apart several millimet.ers, if not held together. I decided to remove the lingual tuft of the frenum which impinged on the gingivolingual margins of the incisors. Since this has been removed, the central incisors are staying together nicely. I recall another case where it, was necessary to remove only this lingual tuft of tissue without disturbing the labial attachment which was normal, to keep the incisors together, and without its removal they separat.ed every time the appliance was removed.” SYDNEY W. BRADLEY. 977