Messner AH, Walsh J, Rosenfeld RM Clinical consensus statement: ankyloglossia in children. Otolaryngol Head Neck Surg. 2020; 162:597-611 https://doi.org/10.1177/0194599820915457
Delli K, Livas C, Sculean A Facts and myths regarding the maxillary midline frenum and its treatment: a systematic review of the literature. Quintessence Int. 2013; 44:177-187 https://doi.org/10.3290/j.qi.a28925
Mirko P, Miroslav S, Lubor M. Significance of the labial frenum attachment in periodontal disease in man. Part I. Classification and epidemiology of the labial frenum attachment. J Periodontol. 1974; 45:891-894 https://doi.org/10.1902/jop.1974.45.12.891
Webb AN, Hao W, Hong P. The effect of tongue-tie division on breastfeeding and speech articulation: a systematic review. Int J Pediatr Otorhinolaryngol. 2013; 77:635-646 https://doi.org/10.1016/j.ijporl.2013.03.008
Policy on management of the frenulum in pediatric dental patients. The Reference Manual of Pediatric Dentistry.Chicago, IL, USA: American Academy of Pediatric Dentistry; 2021
Naini FB, Gill DS. Oral surgery: labial frenectomy: Indications and practical implications. Br Dent J. 2018; 225:199-200 https://doi.org/10.1038/sj.bdj.2018.656
Minsk L. The frenectomy as an adjunct to periodontal treatment. Compend Contin Educ Dent. 2002; 23:424-428
Kotlow LA. The influence of the maxillary frenum on the development and pattern of dental caries on anterior teeth in breastfeeding infants: prevention, diagnosis, and treatment. J Hum Lact. 2010; 26:304-308 https://doi.org/10.1177/0890334410362520
The Aberrant Frenum. Dr. PD Miller the father of periodontal plastic surgery. 2006; 29-34
Fowler EB, Breault LG. Early creeping attachment after frenectomy: a case report. Gen Dent. 2000; 48:591-593
Huang WJ, Creath CJ. The midline diastema: a review of its etiology and treatment. Pediatr Dent. 1995; 17:171-179
Nuvvula S, Ega S, Mallineni SK Etiological factors of the midline diastema in children: a systematic review. Int J Gen Med. 2021; 14:2397-2405 https://doi.org/10.2147/IJGM.S297462
Hussain U, Ayub A, Farhan M. Etiology and treatment of midline diastema: a review of literature. Pakistan Orthodontic Journal. 2013; 5:27-33
Angle E. Treatment of malocclusion of the teeth, 7th edn. Philadelphia, PA, USA: SS White Dental Mfg. Co; 1907
Jonathan PT, Thakur H, Galhotra A Maxillary labial frenum morphology and midline diastema among 3 to 12-year-old schoolgoing children in Sri Ganganagar city: a cross-sectional study. J Indian Soc Pedod Prev Dent. 2018; 36:234-239 https://doi.org/10.4103/JISPPD.JISPPD_51_18
Sękowska A, Chałas R. Diastema size and type of upper lip midline frenulum attachment. Folia Morphol (Warsz). 2017; 76:501-505 https://doi.org/10.5603/FM.a2016.0079
Attia Y. Midline diastemas: closure and stability. Angle Orthod. 1993; 63:209-212
Luqman M, Sadatullah S, Saleem M The prevalence and etiology of maxillary midline diastema in a Saudi population in Aseer region of Saudi Arabia. International Journal of Clinical Dental Science. 2012; 2:(3)
Kumar S, Gandhi S, Valiathan A. Perception of smile esthetics among Indian dental professionals and laypersons. Indian J Dent Res. 2012; 23 https://doi.org/10.4103/0970-9290.100456
Sicher H. Oral Anatomy, 2nd edn. St Louis, MO, USA: CV Mosby; 1952
Tait C. The median frenum of the upper lip and its influence on the spacing of the upper central incisor teeth. Dent Cosmos. 1934; 76:991-992
Honores M. Stability of diastemas closure after orthodontic treatment. In: Aslan BI, Uzuner FD (eds). London: IntechOpen; 2019
Dibart S, Karima M. Labial frenectomy alone or in combination with a free gingival autograft.Germany: Blackwell Munksgaard; 2017
Devishree Gujjari SK, Shubhashini PV. Frenectomy: a review with the reports of surgical techniques. J Clin Diagn Res. 2012; 6:1587-1592 https://doi.org/10.7860/JCDR/2012/4089.2572
Kotha M, Rekha B, Ramachandra V. Evaluation of healing following labial frenectomy: a comparison of scalpel, electrosurgery and diode laser techniques. Int J Sci Res. 2019; 6:63-66
Shang J, Han M, Sun J Comparative study on the treatment of ankyloglossia by using Er:YAG laser or traditional scalpel. J Craniofac Surg. 2021; 32:e792-e795 https://doi.org/10.1097/SCS.0000000000007788
Sarmadi R, Gabre P, Thor A. Evaluation of upper labial frenectomy: a randomized, controlled comparative study of conventional scalpel technique and Er:YAG laser technique. Clin Exp Dent Res. 2021; 7:522-530 https://doi.org/10.1002/cre2.374
Al-Najjim A, Sen P. Are upper labial frenectomies in children aged 11 and under appropriate? Is it time to change practice and agree guidelines?. FDJ. 2014; 5:14-17
Bergström K, Jensen R, Mårtensson B. The effect of superior labial frenectomy in cases with midline diastema. Am J Orthod. 1973; 63:633-638 https://doi.org/10.1016/0002-9416(73)90188-7
Douglas P, Cameron A, Cichero J Australian Collaboration for Infant Oral Research (ACIOR) position statement 1: upper lip-tie, buccal ties, and the role of frenotomy in infants. Australasian Dental Practice. 2018:144-146
Koora K, Muthu MS, Rathna PV. Spontaneous closure of midline diastema following frenectomy. J Indian Soc Pedod Prev Dent. 2007; 25:23-26 https://doi.org/10.4103/0970-4388.31985
James GA. Clinical implications of a follow-up study after fraenectomy. Dent Pract Dent Rec. 1967; 17:299-305
Miller PD The frenectomy combined with a laterally positioned pedicle graft. Functional and esthetic considerations. J Periodontol. 1985; 56:102-106 https://doi.org/10.1902/jop.1985.56.2.102
Suter VG, Heinzmann AE, Grossen J Does the maxillary midline diastema close after frenectomy?. Quintessence Int. 2014; 45:57-66 https://doi.org/10.3290/j.qi.a30772
Wheeler B, Carrico CK, Shroff B Management of the maxillary diastema by various dental specialties. J Oral Maxillofac Surg. 2018; 76:709-715 https://doi.org/10.1016/j.joms.2017.11.024
Tadros S, Ben-Dov T, Catháin ÉÓ Association between superior labial frenum and maxillary midline diastema – a systematic review. Int J Pediatr Otorhinolaryngol. 2022; 156 https://doi.org/10.1016/j.ijporl.2022.111063
Morais JF, Freitas MR, Freitas KM Postretention stability after orthodontic closure of maxillary interincisor diastemas. J Appl Oral Sci. 2014; 22:409-415 https://doi.org/10.1590/1678-775720130472
Sullivan TC, Turpin DL, Artun J. A postretention study of patients presenting with a maxillary median diastema. Angle Orthod. 1996; 66:131-138
Shashua D, Artun J. Relapse after orthodontic correction of maxillary median diastema: a follow-up evaluation of consecutive cases. Angle Orthod. 1999; 69:257-263
The role of the maxillary labial frenectomy in closure of the midline diastema: A review and management recommendations Michaela DeSeta Janelle Nurse Paul Ashley Joseph Noar Susan Parekh Dental Update 2024 50:11, 707-709.
Authors
MichaelaDeSeta
BSc, BDS, MFDS RCPS(Glas)
Specialty Registrar in Paediatric Dentistry, Royal National ENT and Eastman Dental Hospitals and King's College Hospital NHS Foundation Trust, London
A maxillary midline diastema is often seen in childhood as part of physiological development, but those persisting after the establishment of the permanent dentition may be a functional and aesthetic concern for which patients seek treatment. The association between an enlarged maxillary labial frenum and a maxillary midline diastema is commonly reported in the literature. However, the aetiologic role of an enlarged frenum is likely to represent only a proportion of diastema cases, and many diastemas exist without the presence of an abnormal frenum. This article provides an overview of the maxillary labial frenectomy and its role in closure of the midline diastema, providing management recommendations for practitioners.
CPD/Clinical Relevance: The association between an enlarged maxillary labial frenum and a midline diastema and the management options is useful clinical information
Article
The maxillary labial frenum (MLF) is a dynamic structure, connecting the central portion of the upper lip to the mucosa of the maxillary alveolar process.1 It is a normal, albeit variable, structure that provides stability for the upper lip.1 Being larger in early childhood, the MLF generally diminishes in size and moves to a more coronal position following eruption of the permanent incisors and growth of the alveolar process.2
Labial frenal attachments can be classified clinically by their anatomical insertion level as detailed in Table 1,3 with clinical photographs demonstrating these attachments in Figure 1. Mucosal and gingival frenal attachments are the most commonly seen types,4,5 and are often considered ‘normal’ variations, with papillary and papillary penetrating types seen as enlarged or ‘abnormal’ variations and potentially pathological.6 There are no microscopic differences seen between an aberrant MLF and a frenum of more normal configuration and position.7
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