dr amanda with straight smile solutions straightsmithsolutions.com and today we're going
to talk a little bit more about maxillary labial phrenectomies and of course i'm not a periodontist
but i've done a lot of ortho cases that involve maxillary labial phrenectomies as well as i've had
one myself i have so much content on this subject why you need it when you need it how you tell if
you need it staging of it how it works with braces how it works with the liners healing from it
um measuring for it i mean referring for it so i recommend before you listen to this video that you
go back into my youtube channel and listen to all the other videos this will build on those
so to reach those you're gonna go to my youtube channel which is straight smile solutions you
may or may not be in there right now if you're not go into the search bar of youtube and put
in straight smile solutions that takes you to my youtube channel which has almost 7000 videos today
um as well as playlists if you should have a green banner when you scroll a little bit and
over to the right towards the top there's a tiny little magnifying glass not in the corner but kind
of top right and you can put in any keyword like phrenectomy um and you can watch all those videos
okay so i'm assuming you already listened to those other videos because i'm not going to repeat stuff
i'm going to talk about extra extra big freedoms and complications that can happen and
um when doctor just asked me a question today and i realized i didn't have this covered so
i needed to make supplemental content um so when you have an extra big and this one's actually not
that big and the vast majority not to sound like i'm pigeonholing or anything like that but the
vast i always everyone i've always seen that's had a big freedom has always been african-american or
african descent black americans um that's just how it's been i've never seen a caucasian or an
asian person with a big freedom like this a big big gap so um it's just how it is and i think
that i think they're absolutely beautiful and some people choose to leave them some people with um
ortho just choose to reduce them a little bit um i've had plenty of patients you know i even think
i had a denture patient that asked us to make one you know so i mean first of all never assume that
a patient wants it all the way closed a matter of fact whenever i see a patient who has one i say
would you like this clothes do you want it fully closed because sometimes it's just part of their
personality i mean just who they are it's part of their identity and they don't want it fully
closed they might want to close a little bit so that when they're talking they're not
quote spitting corn or you know heard all kind of funny analogies um or you know leaking or
making funny squeaky noises but anyways okay so let's assume they want it fully closed because
if they don't want it fully closed i really don't they probably don't need the phonectomy
but if they want fully closed they're probably going to need to get the phrenectomy because
i've never seen one where they didn't have to get one and get it fully closed and remember remember
remember if you're taking this as an ortho case if you've never done a maxillary labial for nectar
before surgery please don't try to attempt it because if you botch it um all kind of weird
and i'm not a periodontist but all kind of weird scar tissue things can happen so please refer this
patient out if you don't know what you're doing um have a i much prefer a periodontist an oral
surgeon do i don't think i've ever referred to os they usually butcher it um they're good with
big jobs and back teeth and pulling out teeth but not this kind of intricate work um and what was
i going to say yeah never assume you may want it fully closed ask first um i'm not going to
repeat any other stuff but one challenge that can happen with these extra big ones and this one's
not even that big this was the biggest stock photo that i could find that i could share i have seen
other photos but i don't have releases on them to show them i've seen ones much bigger than this um
as you start to close the space slowly slowly slowly and don't forget a lot of times these are
caused by bolt and discrepancy so you can only close the space as much as the lower teeth will
allow you to when you start hitting contact you're either going to have to usually in these big guys
you're going to have to probably pull out a lower incisor i mean easiest way to tell is to throw it
into invisalign where they have the bolton tab and see what the bolt and discrepancy is that's
a really easy way to tell and you know simulate it and then you have an idea because sometimes it's a
no-go if they have to pull out a tooth i mean there's only so much ipr that can be done for
clearance right especially if they have a little more crowding and everything shifted forward but
as you start to close it what's usually going to happen is that the tissue all this extra
tissue that's here right i mean although there is some remodeling that happens as you go a lot
of times it just can't keep up with the amount of supposed place space closure that needs to be done
so you're going to have to sometimes send them intermittently to the periodontist to
get a gingivectomy or gingivoplasty as you go because it's all that tissue is just gonna swell
up and balloon up even if they have great hygiene and it turns into an infection and
food gets trapped underneath it and it looks nasty and then that balloon prevents the space closure
right so sometimes you have to go get them to get it sliced off that might be something you can do
in your office if you've had some surgeries i mean it's not the full frenectomy but just the slice of
the extra tissue maybe you can do that but that's up to you and i'd rather you run that by your
periodontist first because some periodontists get really upset if you start messing with their sight
that they're going to have to do it for anecdomine remember you always always always on these cases
send to perio first before you even contract start the case because on these cases what has happened
to me more than once if i didn't do that you know patients like yeah yeah yeah i have a periodontist
yeah we're good we already talked okay fine we start the order we get to the point where we're
ready to do this or maybe we finished it um okay you need to go get yours time for you to go get
the phonectomy now oh i don't have the money you know my insurance is not going to cover it okay
well it's not going to stay closed then you know not no bonded retainer in the world is going to
keep that closed um and we can only keep braces on for so long or you know letters on for so long
so you want to make sure that they are committed contracted put a deposit down i mean whatever it
means give your paradise a call i mean i don't try to get two in the middle of the finances
but i want to know they're locked in stone to this treatment plan and they are fully committed to it
because i don't want to spend a year and a half closing a space and then we give up
and now it becomes a whole issue like would they relapse who's responsible for the relapse right
it can add with the gingivoplasty and the ferectomy depending on if they're getting
sedation i can add easily a couple thousand two you know and that's a separate feed than what
you're charging right so maybe you're charging five or six thousand they're charging three to
five thousand if they're getting iv sedation which i mean i think it's super unnecessary
but there's plenty of phobic people out there um that that are asking for that right now it's a ten
thousand dollar case right so and then there's a timing thing it's not like they can just get the
frenectomy whatever they want there's a very detailed timing and when it needs to be done
and it has to be done in that small window and i can't always predict exactly when it's going to be
so they need to have the money ready to go so i feel a lot better that they've signed the contract
they put a deposit down for the periodontist and we're ready to go and that they're aware that they
might need to come in for a gingivoplasty or two and what the cost would be if that
would be extra or not okay so that's pretty much all i gotta say all right thanks so much