Before I discovered and developed the Gillespie Approach, I spent two years in surgical residency in the 1970s learning about oral soft tissue and bone techniques. I was fortunate to have been under the tutelage of twelve surgical instructors during my training. I left periodontal work in 1997 and retired my dental license to pursue this therapy full-time.
I wanted to give you some insight about the finer points of an oral tie surgery for a young child. I cannot speak about infant oral tie surgery, because I am not an expert in that field.
A common oral tie was a frenum just above the upper front teeth causing a problem. The biggest issue was to find a way to excise it completely to avoid reattachment. The following was my frenectomy procedure:
I numbed the area with lidocaine and epinephrine. If I did not use epinephrine, the bleeding was profuse, and even with the best suction, seeing the bone clearly was close to impossible.
I took a hemostat and clamped as much as the frenum as possible, deep into the mucobuccal fold. As the surgical assistant held it, I took a #11 surgical blade and cut around the top edge, freeing up the upper lip. I then cut deep to the bone to free up that attachment. The assistant removed the hemostat with the excised tissue.
I knew from histology that connective tissue fibers ran between the two front teeth and behind into the palate and incisive canal. I removed that soft tissue also. This canal had to be fully anesthetized otherwise the patient experienced sharp pain. I then took a curette and scraped the bone to remove any remaining connective tissue fibers.
I applied a surgical dressing because it was too painful for the patient to leave with the area unprotected. Every patient also left the office with an ice pack to apply immediately for three hours. This kept the pain and swelling down.
The patient would return in a week for a healing check. I never remember any reattachment because the connective tissue was completely removed.
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