Search Results (5)

Background/Objectives: The labial frenum is a variable oral structure with potential impacts on infant feeding, speech development, periodontal health, and aesthetics. Several classification systems have been established, but the age-related natural history and its relationship with midline diastema remain incompletely defined. This study aimed to systematically evaluate age-related changes in maxillary and mandibular labial frenum morphology and tension, and their association with midline diastema across pediatric age groups. Methods: A cross-sectional study was conducted on 1068 patients (ages 1 day–47 years) presenting for routine dental examinations at two pediatric dental clinics. Frenum morphology was classified as mucosal, gingival, papillary, or papillary-penetrating. Palpable tension was assessed by manual lip pulling and recorded as present or absent. Midline diastema was defined as ≥1 mm spacing between the maxillary central incisors, measured at the incisal midline with a periodontal probe. Data were analyzed using Pearson’s chi-square tests with Bonferroni correction for multiple comparisons, and logistic regression was applied to evaluate independent predictors. Inter-examiner agreement was assessed using Cohen’s κ. Results: Among 1068 participants, maxillary frenum morphology varied significantly by age. In children < 3 years, papillary and papillary-penetrating insertions predominated (65.7%), while gingival and mucosal insertions were more frequent in older children and adults (72.8%). Palpable tension declined sharply with age, from 92.5% in infants to <10% in adults. Midline diastema was significantly associated with papillary-penetrating frena (RR = 3.47, 95% CI 2.45–4.91) and with the presence of tension (RR = 1.68, 95% CI 1.34–2.11). Logistic regression confirmed both phenotype (OR = 6.2, 95% CI 3.8–10.1) and tension (OR = 2.1, 95% CI 1.5–2.9) as independent predictors of diastema. In contrast, mandibular frena showed minimal variation by age and limited functional impact. Conclusions: The maxillary labial frenum demonstrates predictable developmental change, migrating apically and losing tension most prominently between 3 and 6 years of age, while the mandibular frenum remains largely stable. Papillary and papillary-penetrating phenotypes with palpable tension carry the greatest risk of midline diastema. These findings emphasize that management should prioritize functional symptoms and growth trajectory rather than appearance alone, with frenectomy reserved for cases of demonstrable impairment. Full article

Background/Objectives: The maxillary labial frenum (MLF) is a connective tissue structure attaching the upper lip to the maxillary alveolar process. Its morphology varies significantly among individuals and is often most prominent during early childhood. While hypertrophic or low-attaching frena have been associated with diastemas, feeding issues, and speech impairments, there is no causal evidence supporting early surgical intervention. This review aims to examine current evidence regarding the timing and necessity of frenectomy procedures and to evaluate the implications of early versus delayed intervention. Methods: A narrative review was conducted using twenty peer-reviewed articles published in the past 10 years, with one additional article from 2012 included for its ongoing relevance. Databases searched included PubMed, the NIH database, the Reference Manual of Pediatric Dentistry, and journals from the American Academy of Pediatrics. Inclusion criteria were English-language, peer-reviewed studies that addressed the morphology, classification, diagnosis, management, and outcomes of MLFs across age groups. Excluded were studies focusing solely on mandibular, buccal, or lingual frena; non-English publications; case reports; and articles lacking full-text availability. Results: The literature suggests that premature frenectomy, prior to the eruption of permanent maxillary canines, typically between 9 and 12 years of age, is associated with frenum regrowth, surgical complications, and orthodontic relapse. Additionally, a lack of standardized diagnostic criteria contributes to inconsistent clinical decision-making. Conservative management, including monitoring, is strongly recommended as the frenum often migrates apically as the maxilla develops. Factors such as airway obstruction and developmental delays should be ruled out before considering surgery. Conclusions: There is insufficient evidence to support early surgical intervention for MLF-related concerns. A conservative, individualized approach, delaying frenectomy until after permanent canine eruption, may minimize complications, improve long-term outcomes, and allow the frenum to migrate apically as the patient develops. Standardized diagnostic tools are urgently needed to guide clinical decision-making. Full article

Purpose: The purpose of this systematic review was to systematically explore improvements in gastrointestinal symptoms 1 week and 1 month following the frenotomy procedure, compared to before the procedure for infants under 12 months of age using meta-analysis calculations. Methods: Studies were selected that presented data on breastfed infants under 12 months of age, with gastrointestinal symptoms and reflux, who underwent surgical correction for restricted maxillary labial frenum and/or ankyloglossia, and/or maxillary buccal frena. Case reports, letters to editors, previous systematic reviews, in vitro and animal studies, and only abstracts were excluded. An integrative literature review was carried out in MEDLINE via PubMed, EBSCOhost, Scopus Embase, Web of Science & Cochrane Library from April 2016 to March 2023. Risk of bias was evaluated using the Modified Newcastle‐Ottawa Scale. GRADE profiler (GRADEpro) was used to rate the quality of evidence. We conducted meta-analysis using random effects modelling with the RevMan Software 5.4. Results: Out of the 90 studies identified, nine studies were included, seven were prospective cohort studies, one was a prospective randomized trial, and one was a retrospective analysis. Gastroesophageal reflux symptoms showed statistically significant improvement in I-GERQ-R scores after 1 week (effect size = 3.40, p < 0.00001) and 1 month (effect size = 6.37, p < 0.00001) as compared to before release. Kotlow Class 3 and Class 4 lip tie, Coryllos Type 3 and Type 4 tongue tie showed maximum symptoms and the greatest improvement after release. Conclusion: Tethered oral tissues should be considered as a potential etiology in the differential diagnosis of gastrointestinal reflux in infants. Full article

Background: The maxillary labial frenum (MLF) is a soft tissue fold connecting the upper lip to the alveolar process. Abnormal attachment can cause periodontal, functional, and esthetic problems. Differential diagnosis is important and can prevent unnecessary interventions. This study aims to summarize the current evidence on the assessment and management of abnormal MLF. Methods: A thorough review of the literature was conducted. Five online databases were searched for relevant peer-reviewed human studies. Article screening and data extraction were performed independently by two reviewers using predefined inclusion/exclusion criteria. Information about article type, study design, participants’ characteristics, interventions, and outcomes was extracted and synthesized. Results: 52 articles met the review criteria. MLF is a dynamic structure characterized by a wide normal morphological variation. MLF assessment in infants has not been standardized. Studies in pre-adolescents reported a change in the thickness and position of the MLF observed over time, resulting in a lower prevalence of abnormal MLF morphology. Studies in adolescents and adults reported variable differential diagnosis criteria. Lasers appear as the most advantageous frenectomy modality. Conclusions: There is a need for more objective MLF diagnostic protocols and treatment guidelines, which could prevent unnecessary surgical interventions. Full article

Aim: To investigate the association between mid-line deviation of the mandible, as determined by upper to lower labial frena, and signs and symptoms of Temporomandibular Disorders (TMDs). Materials and Methods: The current study was original research conducted on a sample of 439 medical records of TMD patients treated at Tufts University. All patients underwent a clinical examination revealed a detailed information regarding temporomandibular joints, history of pain, and comprehensive intra-oral findings. Subjects were divided into three groups: 1. No frenal deviation, 2. Deviation to the right, and 3. Deviation to the left. Results: Signs and symptoms of TMD tend to occur more likely on the side of the frenum deviation. The signs and symptoms that were significantly associated to frenum position were TMJ crepitation sounds and locking, right muscles pain on palpation (medial pterygoid and sternocleidomastoid), and “reported locking on the left TMJ”. Subjects with aligned frena showed a statistically significant increase in the range of motion to the right side. The results also revealed a highly significant association between maxillary plane canting and mandibular frenum position. Left posterior cross bite was significantly more prevalent in the left frenum deviation group. Conclusion: Expression of TMD signs and symptoms was more prevalent on the side of frenum deviation. TMD population showed a higher prevalence of left mandibular frenum deviation. Several signs and symptoms were significantly associated to frenum position. Full article