In the primary dentition, a decrease in diastema width was observed in 94.7% with a mean closure of -1.4 ± 1.0mm (range +0.7 to -5.1mm). No adverse outcomes were noted other than minor pain and swelling. In total, 109 patients were included: 95 patients with primary dentition (39% male mean age 1.9 years +/- 1.5 years) and 14 with mixed dentition (43% male mean age 8.1 +/- 1.3 years) with a mean follow-up of 18.0 ± 13.2 months. Most (75%) of the treated kids are unlikely to need braces for a gap in their teeth because now their gap is to a “normal size” of less than 2mm. Scar tissue did not form when it was treated before braces. 94% of the time, a year or two later, the gap closed up. Because of that one opinion piece (there was no patient data to back up his claim) then all the textbooks said “this is the order: braces first, then lip tie.” So that’s what is taught. The concept that early treatment of a lip tie would cause “scar tissue” that would prevent gap closure was proposed by Bishara in 1972 (so 50 years ago) who said that you should close the space with braces first, then treat the lip tie. People want to accept research that goes along with their preconceived ideas of what is correct and deny research that challenges these long-held assumptions. So when we try to submit the data, they don’t want to publish it because they have a confirmation bias to go with what has already been published. What we found goes against what is taught in pediatric dental and orthodontic programs. This is the first study to ever look at this question years after performing a frenectomy, fully removing the restricted tissue, and measuring the gap digitally after time has passed to note the changes. ![]() We take before photos of every lip or tongue-tie we treat, so we could use our x-ray software to digitally measure the gap before the procedure, and use that same software to measure the gap after the procedure. We took every patient we had ever treated for lip tie and tried to get as many post-op pictures as we could when they came back for their cleaning, fillings, or we just emailed, called, and texted parents to see if they could send us a close-up photo of their child’s teeth. ![]() So a few years ago, we set out to quantify this closure and assess the risk of the gap not closing after treatment. The only issue is that other providers think there will be “scar tissue” that will prevent the gap from closing when they try to do braces ten years later. The procedure is quick, has minimal risks, and high satisfaction from parents. The main reasons we treat lip ties are for breastfeeding and related issues (poor seal on the bottle or breast, which leads to air swallowing, which leads to gas, colic, reflux, etc.) as well as toddlers with issues with oral hygiene (they fight when brushing the top teeth), issues with B, P, M, and W sounds (bilabial sounds), and cosmetic concerns (you can’t see their teeth when they smile, or a large gap in the teeth). It at the very least decreases in size, typically to a normal width that is much more likely to close spontaneously in the future. When the lip tie is properly removed (not just a clip or snip with scissors), the gap closes up almost always (94% of the time). Clinically, we see the answer to these questions on a daily basis in patients we treated for a lip tie several years earlier when they were a baby or a toddler (or adolescent). These are common questions in pediatric dental practices across the country. Is it safe to treat a lip tie early? Does early treatment of a lip tie prevent gap closure? Does it help the gap close?
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