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the palatal mucosa. Maintenance of orthodontic closure of a significant diastema would require a palatal bonded retainer regardless of whether a frenectomy has been undertaken, owing to the fact that such space closure is predominantly unstable. As such, there is no automatic requirement for an additional frenectomy. Furthermore, undertaking a frenectomy too early and removing the interdental fibres leads to scar tissue formation, generating an obstacle which may lead to difficulties in subsequent diastema closure. Therefore, frenectomy is almost always contraindicated prior to orthodontic treatment. When a frenectomy is indicated, the timing should be agreed between the orthodontist and surgeon. The frenectomy may be undertaken when the incisor teeth are orthodontically aligned and space closure is imminent or partial space closure has been undertaken, ie during orthodontic treatment. As such, the surgeon has interdental space to carry out the procedure safely, and space closure may be instigated or resumed immediately following surgery. Theoretically, the subsequent scar tissue formation may help to keep the diastema closed. However, it is imperative to point out that as stability remains an issue, a bonded retainer will still be indicated. Therefore, the presence of a labial frenum with interdental fibres passing through to the palatal mucosa is not, per se, an indication for a frenectomy. The principal indications for an upper labial frenectomy are the presence of a low (inferiorly attached, towards the gingival margin), thick and fleshy frenal attachment, which may be unattractive, a potential obstruction to maintenance of good oral hygiene, or causing recurrent trauma with tooth brushing, and/or tethering of the upper lip by the frenum, leading to hypomobility of the philtrum of the upper lip. These situations are uncommon. The maxim remains for all practitioners – when in doubt, refer. However, it is worth repeating that the simple presence of a labial frenum, or a maxillary dental midline diastema, should not be a habitual reason for referral or an unconsidered indication for frenectomy. F. B. Naini and D. S. Gill, London

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