What is fiberotomy or pericision?

February 14, 2021

  

One of the common dental problems a patient presents with is the maligned position of teeth. This can result in poor esthetics and compromised function of the oral cavity in terms of speech and chewing. In order to correct such improper positioning of the teeth, the dentist first looks at the age of the patient and the severity of malalignment. Based on this he or she decides whether the condition can be treated simply by wearing an appliance or if the patient needs to wear braces for a certain period of time.

The human teeth, be it milk or permanent, continue to move until they reach their final position in the oral cavity. This final position of the teeth is determined by the way they are fixed to the bone with the help of certain fibres. These fibres are a part of the gingiva. The minor movements of the teeth in the mouth are controlled by these fibres. These fibres run tactically from, around and through one tooth to another.

A patient who is wearing braces in order to move the teeth in the needed places can gradually see over a period of time how the relation of one tooth to the adjacent  has changed and is now in harmony. But this was achieved only when the teeth received the forces exerted through the braces. These forces act at the bony level. This leads to the teeth being pushed in the needed path. Subsequently, the fibres that run across these teeth also get stretched.

Once the teeth are properly positioned, the braces are removed. But this is not the end of treatment. The patient is given an appliance to wear which is called a retainer. As the name suggests, this appliance retains the position of the teeth that is now crafted through the braces. The wearing of the retainer keeps the fibres of the gingiva stretched, thereby maintaining the arch shape.

One can imagine the gum fibres as elastic bands. The reason why a retainer is given after removal of braces is to keep the fibres in their stretched position. Once the time frame for wearing the retainer (can last up to an year) ends, the treatment comes to a conclusion. However, there are cases where even after the removal of retainers the fibers that were supposed to be afixed by now, still possess elasticity. They try to retract back (just like a rubber band) to their original position. If this happens, then the teeth to move back to malalignment. In order to prevent this, the dentist may recommend a minor surgical procedure. This is called a fiberotomy or pericision.

'Fibero-' refers to the gingival fibers whereas '-tomy' refers to cutting. Pericision is derived from two words - 'peri' meaning border and 'cision' is from the root word incision. Both these words are often used interchangeably since both procedures involves cutting or incision of the fibres. These fibres need to be cut so that the teeth do not move again and stay in their expected position.

The dentist carries out this procedure by anesthetizing the area of interest. After this, using a blade of particular dimension, the fibres around the gingiva are incised. The depth of this incision is near the level of the bone. Once the fiberotomy is completed, no sutures or stitches are needed. The healing period can involve minor discomfort for the patient once the effect of the anesthesia wears off. In order to counter this, the patient is given an anesthetic. A swelling may or may not occur in the area where the procedure is carried out. This too regresses on its own. Finally, the dentist can prescribe certain mouth rinses which keeps the surgical area cleansed and free of infection. It takes 7 to 10 days for the healing of the gingival tissues but ensures great stability of the teeth after the removal of braces.

The orthodontist may ask the patient to wear the retainer even after fiberotomy. This procedure has great clinical results and relapse of the malpositioning of the teeth is often avoided. Moreover, rotation of teeth can also be prevented through this procedure. Modern advances include the usage of lasers instead of scalpel or blade to perform the fiberotomy.

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