Citation Information :
Jain A, Tailor B, Jaiswal V, Bane P. Morphology of Maxillary Frenum and Correlation to Diastema in Children with Primary, Mixed, and Permanent Dentition. J South Asian Assoc Pediatr Dent 2024; 7 (1):5-10.
Context: The labial frenum is subject to change with growing age and physical development. It is thought to be a contributing factor to maxillary diastema.
Aims: The study aims to check the frenal morphology and midline diastema at different stages of dentition.
Materials and methods: Clinical examination of frenum and midline diastema of 515 children with different stages of dentition was carried out. Sewerin's typology and Placek et al.'s classification for attachment level were used.
Results: Association was found significant for both spacing (p = 0.001) and midline diastema (p = 0.018). Morphology of frenum, which was prevalent for all three types of dentition, was simple frenum and mucosal type of attachment in primary (47.1%) and permanent (37.6%), whereas it was gingival in mixed dentition (44.3%). The association between dentition and morphology and frenum attachment was found to be significant (p = 0.024 and 0.001, respectively). Crosstabulation for midline diastema with morphology and frenum attachment was found to be highly significant (p = 0.001).
Conclusion: As the type of frenal attachment differs depending on the type of dentition, it is crucial to comprehend the relationship between a child's age, the type of frenal attachment, and the morphology in order to prevent misdiagnosis and inconsequential treatment.
Dasgupta P, Kamath G, Hs S, et al. Morphological variations of median maxillary labial frenum: a clinical study. J Stomatol Oral Maxillofac Surg 2017;118(6):337–341. DOI: 10.1016/j.jormas.2017.06.018
Gkantidis N, Kolokitha OE, Topouzelis N. Management of maxillary midline diastema with emphasis on etiology. J Clin Pediatr Dent 2008;32(4):265–272. DOI: 10.17796/jcpd.32.4.j087t33221771387
Breslin WW. Excision of the abnormal frenum. J Can Dent Assoc 1949;15(1):20. PMID: 18109035.
Fischer TJ, Psaltis GL. The diastema and the abnormal frenum. ASDC J Dent Child 1981;48(4):264–268. PMID: 6944323.
Christabel SL, Gurunathan D. Prevalence of type of frenal attachment and morphology of frenum in children, Chennai, Tamil Nadu. World J Dent 2015;6(4):203–207. DOI: 10.5005/jp-journals-10015-1343
Dewel BF. The normal and the abnormal labial frenum; clinical differentiation. J Am Dent Assoc 1946;33(5):318–329. DOI: 10.14219/jada.archive.1946.0261
Edwards JG. The diastema, the frenum, the frenectomy: a clinical study. Am J Orthod 1977;71(5):489–508. DOI: 10.1016/0002-9416(77)90001-x
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(3):304–308. DOI: 10.1177/0890334410362520
Huang WJ, Creath CJ. The midline diastema: a review of its etiology and treatment. Pediatr Dent 1995;17(3):171–179. PMID: 7617490.
Curran M. Superior labial frenotomy. J Am Dent Assoc 1950;41(4):419–422. DOI: 10.14219/jada.archive.1950.0198
Noyes HJ. The anatomy of the frenum labia in newborn infants. Angle Orthod 1935;1:3–8.
Sewerin I. Prevalence of variations and anomalies of the upper labial frenum. Acta Odontol Scand 1971;29(4):487–496. DOI: 10.3109/00016357109026535
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(12):891–894. DOI: 10.1902/jop.1974.45.12.891
Tadros S, Ben-Dov T, Catháin ÉÓ, et al. Association between superior labial frenum and maxillary midline diastema - a systematic review. Int J Pediatr Otorhinolaryngol 2022;156:111063. DOI: 10.1016/j.ijporl.2022.111063
Yamane T. Statistics: An Introductory Analysis, 2nd edition. New York: Harper and Row; 1967.
Díaz-Pizán ME, Lagravère MO, Villena R. Midline diastema and frenum morphology in the primary dentition. J Dent Child (Chic) 2006;73(1):11–14. PMID: 16734307.
Ray S, Golden WC, Walsh J. Anatomic distribution of the morphologic variation of the upper lip frenulum among healthy newborns. JAMA Otolaryngology Head Neck Surg 2019;145(10):931–938. DOI: 10.1001/jamaoto.2019.2302
Rajagopalan RE, Padmaprabha BP. An insight into the role of the maxillary labial frenum in the growth of the maxilla: a systematic review. J Indian Orthod Soc 2019;53(4):232–243. DOI: 10.1177/0301574219877728
Upadhyay S, Ghimire N. Attachment of maxillary labial frenum in Nepalese children. Orthod J Nepal 2012;2(1):38–31. DOI: 10.3126/ojn.v2i1.9291
Popovich F, Thompson GW, Main PA. The maxillary interincisal diastema and its relationship to the superior labial frenum and intermaxillary suture. Angle Orthod 1977;47(4):265–271. DOI: 10.1043/0003-3219(1977)047<0265:TMIDAI>2.0.CO;2
Boutsi EA, Tatakis DN. Maxillary labial frenum attachment in children. Int J Paediatr Dent 2011;21(4):284–288. DOI: 10.1111/j.1365-263X.2011.01121.x
Manjunath N, George AM, Neethi M, et al. The frenum and the diastema: a clinical observational study. Int J Innov Sci 2018;3(9):560–566. https://ijisrt.com/the-frenum-and-the-diastema-a-clinical-observational-study
Sękowska A, Chałas R. Diastema size and type of upper lip midline frenulum attachment. Folia Morphol (Warsz) 2017;76(3):501–505. DOI: 10.5603/FM.a2016.0079
Ceremello PJ. The superior labial frenum and the midline diastema and their relation to growth and development of the oral structures. Am J Orthod 1953;39(2):120–139. DOI: 10.1016/0002-9416(53)90016-5
Pandiyan NJ, Hedge A. Clinical assessment of frenum morphology and attachment in Malaysian children. Pesquisa Bras Odontopediatria Clín Integr 2018;18(1):1-9. DOI: 10.4034/pboci.2018.181.20.
Joshi U, Pradhan M, Lawaju N, et al. Variations in maxillary frenal morphology in a sample of Newari Children of Bhaktapur. J Nep Soc Periodontol Oral Implantol 2021;5(1):34–38. DOI: 10.3126/jnspoi.v5i1.38181
Thosar N, Murarka P, Baliga S, et al. Assessment of maxillary labial frenum morphology in primary, mixed, and permanent dentitions in Wardha district. Eur J Gen Dent 2017;6(1):14–17. DOI: 10.4103/2278-9626.198601
Nagaveni NB, Umashankara KV. Morphology of maxillary labial frenum in primary, mixed, and permanent dentition of Indian children. J Cranio Maxillofac Surg 2014;3:5–10. DOI: 10.4103/2278-9588.130430
Biradar SM, Patil AY, Kotnoor SS, et al. Assessment of diverse frenal morphology in primary, mixed, and permanent dentition: a prevalence study. J Contemp Dent Pract 2020;21(5):562–567. PMID: 32690841.
Vierci VR, Marin AP, Gini AM, et al. Malocclusions, gingivitis, upper labial frenum and diastemas in students of Itá (Paraguay). Rev Odontol Circ Odontol Parag 1974;20:79–87. PMID: 4535777.
dos Santos VI, Korytnicki D, Ando T, et al. Prevalence of different types of upper labial frenum in the deciduous dentition. Rev Fac Odontol Sao Paulo 1985;23(2):129–135. PMID: 3880305.
Kaimenyi JT. Occurrence of midline diastema and frenum attachments amongst school children in Nairobi, Kenya. Indian J Dent Res 1998;9(2):67–71. PMID: 10530193.
Lindsey D. The upper mid-line space and its relation to the labial fraenum in children and in adults. A statistical evaluation. Br Dent J 1977;143(10):327–332. DOI: 10.1038/sj.bdj.4804003
Bergese F. Research on the development of the labial frenum in children of age 9-12. Minerva Stomatol 1966;15(10):672–676. PMID: 5225222.
Nadar S. Maxillary labial frenum attachment in children of different age groups. Int J Curr Res 2017;9(5):50367–50369. https://www.journalcra.com/sites/default/files/issue-pdf/20873.pdf
Zakirulla M, Alshahrani NA, Alqarni LS, et al. Maxillary midline frenum morphology and its variations in Saudi Children. J Res Med Dent Sci 2021,9(1):174–178.