Longitudinal changes of the insertion of the maxillary labial frenum in children and adolescents undergoing orthodontic treatment

Abstract

This study aimed to evaluate potential vertical changes in the position of the maxillary labial frenum (MLF) insertion in growing children and to compare these changes to the vertical growth of the dentoalveolar process and lower facial third. This retrospective longitudinal study investigated records of 33 healthy children. Dental casts, lateral cephalograms, and photographs were evaluated at pretreatment (T0), posttreatment (T1), and 3-5 years into retention (T2). To evaluate the vertical changes of MLF insertion in relation to the vertical growth of the dentoalveolar process, the palatal plane (PP) was used as a reference. These changes were also compared between different MLF typologies (ascribed as thin or fibrous). The distance from MLF to PP only slightly increased from T0 to T2 by 0.6 ± 0.5 mm (P<0.001), whereas the distance between the incisal edge and PP increased significantly from T0 to T2 by 2.6 ± 0.8 mm (P<0.001). A positive correlation was found (r= 0.94; P<0.001) between the changes from the incisal edge to the PP and the MLF to the incisal edge between T0 and T2. No correlation was found between the change from the incisal edge to the PP and MLF to PP between T0 and T2. Thin MLF types showed a larger increase in distance from their insertion to the incisal edge (2.6 ± 0.8 mm) than thick MLF types (1.8 ± 0.7; P<0.03). The MLF remains stable compared with the PP, whereas the maxillary incisal edge moves away from the PP, indicating increased vertical growth of the alveolar process. Dentists should be aware of those changes before performing interventions such as unnecessary frenectomies.