Association between superior labial frenum and maxillary midline diastema - a systematic review

Twelve-Year Follow-Up of Laser Frenectomy during Early Mixed Dentition

Median maxillary labial frenum (MMLF) is one of the oral freni, found on the inner side of the centre of the upper lip. Maxillary midline diastema (MMD) is commonly associated with highly attached frenum, and frenectomy during early mixed dentition is controversial. A 6-year-old boy came with a chief complaint of unpleasant spacing between the two upper front teeth. A median maxillary high attached labial frenum with midline spacing of 5 mm was diagnosed. A consensus was made with the child's father to remove the frenum by laser. Diode laser frenectomy was done, and subsequent follow-up for 12 years revealed no relapse and complete closure of the diastema. Frenectomy during early mixed dentition could be a suitable option for the closure of midline diastema.

Associations among the occurrence or types of maxillary canine impaction, labial frenum attachment types, lateral incisor anomalies, and midline diastema in patients with and without impaction: A case-control study

INTRODUCTION

We tested whether the labial frenum attachment types may affect the occurrence or type of maxillary canine impaction.

METHODS

This case-control study was performed on 96 subjects (48 with maxillary canine impaction [20.50±4.99 years, 32 females], 48 controls [21.94±3.79, 31 females]). Types of canine impaction (buccal/palatal, bilateral/unilateral, left/right), types of upper lip middle frenums (mucosal, gingival, papillary), the anatomy of lateral incisors (impacted, peg shaped, small, normal), and the midline diastema were evaluated clinically and radiographically. Associations were examined using multiple binary logistic regression, 3-way repeated-measures ANCOVA, and Fisher tests (α=0.05, β=0.2).

RESULTS

The numbers of mucosal, gingival, and papillary frenums in the case group were '29, 14, and 5', respectively; in the control group, they were '25, 21, and 2' (Fisher, P=0.248). The numbers of mucosal, gingival, and papillary frenums were respectively '25, 11, and 1' in the palatally impacted canine subgroup; they were '4, 3, and 4' in the buccally impacted subgroup (Fisher, P=0.010). Abnormal laterals were present in 12 cases and 4 controls; normal laterals were observed in 36 cases and 44 controls (Fisher, P=0.053). Abnormal laterals were seen in 10 cases with palatally impacted canines and 2 cases with buccally impacted canines; normal laterals existed in 27 cases with palatally impacted canines and 9 cases with buccally impacted canines (Fisher, P=0.705). Lateral anatomy was not associated with frenum attachment (Fisher, P=0.827). Greater midline diastemas were seen in cases with maxillary canine impaction, papillary frenums, and abnormal laterals (ANCOVA, P≤0.016).

CONCLUSIONS

Buccal type of canine impaction is positively associated with papillary labial frenums. Canine impaction is 3.6 folds more prevalent in cases with lateral abnormality. Midline diastema is positively and independently associated with canine impaction, papillary frenums, and abnormal laterals.

What is a superior labial frenulum? An anatomical and histological study

Anatomy of the superior labial frenulum (SLF), at first glance, seems to be well established. However, existing studies on the SLF lack description of the incisivus labii superioris (ILS), which cannot be ignored when discussing the SLF. We believe that thorough understanding of the SLF necessitates the anatomical knowledge of the ILS. This study aimed to elucidate the anatomical relationship between the orbicularis oris (OO), ILS, and SLF. A total of 20 formalin fixed human cadaveric specimens were used for gross anatomical and/or histological observation. For histological observation, all specimens were stained with Masson-trichrome. The SLF was a mucosal fold between the gingival mucosa and alveolar mucosa with connective tissue deep to it. The connective tissue attached to the alveolar bone in the junction between the right and left ILS. Skeletal muscle fibers other than orbicularis oris was found in one specimen, which were considered the ILS. During a frenulectomy, removal of the connective tissue bundle is required to prevent recurrence of the high SLF insertion.

Modified frenectomy technique to eliminate the aberrant labial frenum - A report of two cases

Introduction

A modified frenal treatment for aberrant frenum is presented in this report to reduce scar tissue formation and maintain the attached gingiva.

Description

The case report describes two cases in which a V-shaped incision removed the aberrant frenum and then the flaps of the frenum were sutured at the mid line.

Results

The results showed reduced scar tissue in the mid line and the tissue healed with adequate attached gingiva.

Take-Away Lessons

The modified frenotomy technique presented here is ideal for a large frenum that could expose the underlying connective tissue that could reduce the scar tissue formation.