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Year : 2014? |? Volume : 3? |? Issue : 1? |? Page : 1-2 |
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The maxillary labial frenum
Elizabeth A Boutsi
Consultant, Dental Department, Lavrio Public Health Center, Lavrio, Attica, Greece
| Date of Submission |
10-Mar-2014 |
| Date of Acceptance |
10-Mar-2014 |
| Date of Web Publication |
11-Apr-2014 |
Correspondence Address:
Elizabeth A Boutsi
Post Box 18076, Pagrati, Athens-11610
Greece
DOI: 10.4103/2278-9588.130428
How to cite this article:
Boutsi EA. The maxillary labial frenum. J Cranio Max Dis 2014;3:1-2 |
How to cite this URL:
Boutsi EA. The maxillary labial frenum. J Cranio Max Dis [serial online] 2014 [cited?2014 Sep 7];3:1-2. Available from:?https://craniomaxillary.com/text.asp?2014/3/1/1/130428 |
The maxillary labial frenum is a fold of the mucous membrane connecting the lip to the alveolar process. It consists mainly of connective tissue and epithelium, with some nerve fibers. Elastic and collagen fibers are found to traverse the entire length of the frenum, originating in the periosteum, which covers the anterior maxillary alveolus. No microscopic differences have been found between an abnormal or aberrant maxillary labial frenum and one of a more normal configuration or position. [1]
There are two types of classification concerning the different types of frenum. The one introduced by Placek et al.,[2] is a morphological-functional classification of the type of the labial frenum attachment, aiming to help clinicians identify functional problems that require intervention. The four types of frenum attachment are defined as mucosal, gingival, papillary, and papillary penetrating, depending on whether the attachment is located in the mucogingival junction, the attached gingiva, the interdental papilla, and through the interdental papilla right up to the palate, accordingly. The other classification by Sewerin [3] describes the different types of normal variation in the morphology of the frenum. Those eight types are as follows: simple frenum, persistent tectolabial frenum, simple frenum with appendix, simple with nodule, double frenum, frenum with nichum, bifid frenum, and frenum with two or more variations at the same time.
The authors of the present study [4] examined the incidence of the different morphologic types of the maxillary labial frenum using the classification according to Sewerin in primary, mixed, and permanent dentition in a remarkable study population of 3,000 Indian children. The most prevalent type found by the authors in all three kinds of dentition was the simple frenum, which was found to increase with age. From 60% in the primary dentition, it increased to 78% in the permanent dentition. The second most frequent type was the persistent tectolabial frenum, which decreased gradually with age, from 21.2% in the primary dentition to 5.6% in the permanent dentition. The results of this study agree with the findings of several researchers. [5],[6],[7],[8] Although the classification used in the different studies is not always the same, one can discern the same tendency: As the authors mention, the labial maxillary frenum tends to decrease in size and clinical importance, and as the children grow older, it grows from wide and thick to become thin and small. The labial frenum is a dynamic and changeable structure and is subject to variation in shape, size, and position during the different stages of growth and development.
Most of the times the maxillary labial frenum is mentioned in a clinical setting, it is in relation to the midline diastema. While the frenum is considered to play a role in the development of the diastema, sometimes it is thought it can be a result of it. A lot of researchers have found the midline diastema to be more frequently present in younger ages, while it decreases as the child grows older and the maxillary labial frenum migrates upwards, further away from the alveolar ridge. As the authors very correctly state, surgical intervention in children of a young age may not have been necessary, as the diastema has a self-corrective capacity. With the eruption and approximation of the maxillary anterior teeth, the frenum usually undergoes pressure and becomes atrophic. If the central incisors do not contact, there is no physiologic reason for the frenum to atrophy. The diagnostic test to determine abnormality is to pull the upper lip forward and see whether blanching of the tissue occurs interproximally from the labial to the lingual. The majority of investigators believe that surgical resection of the frenum should be postponed for consideration, after the eruption of the six maxillary anterior teeth, if there still is a persistent diastema; [9] and a recent review of the literature points out a tendency by orthodontists to suggest posttreatment removal of the frenum. [10]
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