Frenotomy for ankyloglossia associated with feeding challenges in infants: Effectiveness, technique, and safety-a systematic review and meta-analysis, part 2

Authors

• Vineet Dhar, Clinical Professor and Chair, Department of Orthodontics and Pediatric Dentistry, University of Maryland, School of Dentistry, Baltimore, MD, USA.
• Abdullah A. Marghalani, Associate Professor, Department of Preventive Dentistry, College of Dental Medicine, Umm Al-Qura University, Makkah, Saudi Arabia.
• Homa Amini, Clinical Professor, Division of Pediatric Dentistry, College of Dentistry, The Ohio State University and Department of Dentistry, Nationwide Children's Hospital, Columbus, Ohio, USA.
• Tegwyn Brickhouse, Professor, Department of Pediatric Dentistry, School of Dentistry, Virginia Commonwealth University, Richmond, VA, USA.
• Erica Caffrey, Clinical Assistant Professor, Department of Orthodontics and Pediatric Dentistry, University of Maryland, School of Dentistry, Baltimore, MD, USA.
• Jayakumar Jayaraman, Pediatric Dentist in Private Practice, Richmond, VA, USA.
• Martha Ann Keels, Adjunct Associate Professor, Department of Pediatrics, Duke University, Durham, NC and an Adjunct Professor, Department of Pediatric, University of North Carolina, Chapel Hill, NC, USA.
• Anna Messner, Professor, Department of Otolaryngology-Head and Neck Surgery, Baylor College of Medicine/Texas Children's Hospital, Houston, Texas, USA.
• Kimberly K. Patterson, Clinical Associate Professor, and interim chair, Department of Orthodontics and Pediatric Dentistry, Stony Brook School of Dental Medicine, Stony Brook, NY, USA.
• Nikhila Raol, Associate Professor, Department of Otolaryngology-Head and Neck Surgery, Baylor College of Medicine/Texas Children's Hospital, Houston, Texas, USA.
• Poojan Shrestha, Associate Professor, Department of Pediatric Dentistry and Dental Public Health, Adams School of Dentistry and an Adjunct Associate Professor, Department of Epidemiology Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC, USA.
• Christopher M. Stark, Neonatologist, Department of Pediatrics, Walter Reed National Military Medical Center, Bethesda, MD, USA.
• Harlyn K. Susarla, Pediatric Dentist, Department of Dentistry, Seattle Children's Hospital and a Affiliate Assistant Professor, University of Washington School of Dentistry, Seattle, WA, USA.
• Jennifer Thomas, Advocate Health - MidwestFollow

Recommended Citation

Dhar V, Marghalani AA, Amini H, et al. Frenotomy for Ankyloglossia Associated With Feeding Challenges in Infants: Effectiveness, Technique, and Safety-A Systematic Review and Meta-Analysis, Part 2. Pediatr Dent. 2026;48(2):33E-68E.

Abstract

Purpose: To assess the effectiveness, surgical techniques, and safety outcomes of lingual frenum release in infants with feeding difficulties. Methods: The protocol was registered with PROSPERO (CRD42024482618). Ovid MEDLINE, CINAHL, Embase, and Cochrane Library databases were searched from 1946 to May 2025 for studies meeting inclusion criteria. The population included mother-infant dyads with feeding difficulties where infants with restrictive frenum underwent surgical release. The primary outcome measured included feeding difficulties, technique comparison, post-care, and adverse events. Fourteen reviewers screened studies, performed data extraction, and assessed risk of bias (ROB). A Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach determined the quality of evidence. Results: Forty-seven studies qualified for analysis, including 8 randomized controlled trials and 39 observational studies. Maternal nipple pain reduction showed large standardized mean differences sustained from immediate through long-term follow-up. Maternal perception of breastfeeding showed improvement over time. Latch, audible swallowing, type of nipple, comfort, and hold (LATCH) scores showed large improvements in single-arm studies but minimal differences compared to controls in randomized clinical trials. Scissors and lasers appeared comparably effective based on limited evidence. The pooled adverse event frequency was 4%, with bleeding being most common. Conclusion: Very low certainty evidence supports frenotomy for documented functional impairment in carefully selected cases where conservative management has failed, emphasizing multidisciplinary evaluation and individualized decision-making with comprehensive informed consent.

Document Type

Article

PubMed ID

42050812