A lack of attached gingival is sometimes associated with a high frenum attachment, which exaggerated the pull on the gum margin. A frenum is a naturally occurring muscle attachment, normally seen between the front teeth (either upper or lower). It is normal to have a frenum, but it should not pull on the gum margin or recession will occur. If pulling is seen, the frenum is surgically released from the gum with a frenectomy. Often a new band of hard gum is also added to re-establish an adequate amount of attached gingival. In many cases a frenectomy is needed prior or during orthodontic treatment to help close gaps between teeth.

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