Labial Frenum Research Articles

Comparison of pain and healing period after frenectomy using diode laser and Er:YAG laser: a randomized controlled trial.

The frenum is a mucous membrane fold that attaches the lip and the cheek to the alveolar mucosa, the gingiva, and the underlying periosteum. Frenectomy is the surgical removal of the whole frenum, including the area connected to the bones. The purpose of this study was to compare the healing period and postsurgical pain experienced by patients operated with diode and Er:YAG lasers. Twenty referred patients requiring excision of the abnormal upper labial frenum were included in the study. Patients were randomly assigned into two groups: diode group (810 nm, 2W, continuous emission, initiated tip) and Er:YAG group (2,940 nm, 2W, 200 mJ, 10 Hz). Both lasers were applied in contact mode. Postoperative pain was assessed using a numerical rating scale at 3 hours postoperatively and every day during the first postoperative week. The epithelialization process of the wound surface was evaluated using hydrogen peroxide solution applied to the wound on postoperative days 7, 14, 30, 60, and 90. The results showed the mean values of Pain Index after 3 hours (diode group 2.1 ± 2.0, Er:YAG group 2.6 ± 1.4), day 1 (diode group 1.1 ± 1.1, Er:YAG group 1.9 ± 1.4), and day 2 (diode group 0.0 ± 0.0, Er:YAG group 0.9 ± 1.1), with no significant difference after 3 to 7 days (P = 1.00). For the Healing Index there was a significant difference between the diode group and the Er:YAG group (7 days, P = .029; 14 days, P = .001), with no significant difference after 30/60/90 days (P = 1.00). The Er:YAG laser had better clinical results in healing wounds, whereas the diode laser resulted in better decreasing pain levels after frenectomy during the follow-up periods.

Association of Frenum Attachments with Age and Gender in a Sample of Iraqi People: A Cross-Sectional Study

Background: The labial frenum is a thin fold of oral mucosa that contains muscle fibers. It connects the lips to the tissues and bones around the upper and lower teeth. Objective: To assess the various types of labial frenal attachments in the upper and lower jaws, as well as their relationship with age and gender, in a sample of the Iraqi population. Methods: The study includes 1,939 subjects (978 males and 961 females) with an age range of 10 to 70 years. These individuals visited the Periodontics Department of Dentistry at Al-Rafidain University College in Baghdad, Iraq, from October 2021 to April 2023. The patients were categorized into age subgroups: 10–30 years, 31–50 years, and 51–70 years. Descriptive statistics estimate frequencies and percentages, and the Chi-square test compares the results. Results: The total number of labial frenum attachments, encompassing both upper and lower attachments, varies between males and females. There are 1397 gingival attachments (36.02%), 1793 mucosal attachments (46.24%), 567 papillary attachments (14.62%), and 121 papillary penetrating attachments (3.12%) in both sexes. In both sexes, there is a significant correlation between age and different upper and lower labial frenum attachment categories. Additionally, there is a significant correlation between gender and the upper and lower labial frenum attachment categories. Conclusions: In the maxilla, the gingival attachment was more prevalent, followed by the mucosal attachment. However, we detect the mucosa attachment in the mandible, followed by the gingiva attachment. There was a significant relationship between frenum attachment, age, and gender.

Assessment and Management of Maxillary Labial Frenum-A Scoping Review.

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. 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. 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. There is a need for more objective MLF diagnostic protocols and treatment guidelines, which could prevent unnecessary surgical interventions.

Evaluation of patient perception and intraoperative bleeding in labial frenectomy: A comparision of diode laser and conventional scalpel techniques

: High frenal attachments are abnormalities corrected by surgical procedure called frenectomies. The scalpel technique is associated with pain, bleeding and postoperative discomfort. To overcome these shortcomings, in the recent times, diode lasers are gaining popularity due to less bleeding, pain during the procedure, healing outcome, and need for analgesics: To compare the bleeding during the procedure and postoperative pain in patients requiring labial frenectomy using conventional scalpel and diode laser techniques. Twenty patients with high labial frenum attachment requiring frenectomy were included in this study. Patients were randomly divided into Group A: scalpel group and Group B: diode laser group. Pain assessment using VAS, severity of intraoperative bleeding and number of analgesics used were recorded: The analysis showed that VAS score for pain was significantly lower in the laser group as compared to the scalpel group Bleeding was mild in laser group, where as in scalpel group showed moderate or severe bleeding scores Post operative use of analgesics was more in scalpel group than laser group Laser was found to be an effective alternate to scalpel in performing frenectomy procedures, more importantly it showed less bleeding, less pain perception and more patient acceptance during the procedure.

Orodental malformations associated with human MSX1 sequence variants

BackgroundMSX1 sequence variants have been known to cause human tooth agenesis (TA) with or without orofacial clefts. However, their roles during the whole processes of tooth development are not fully understood. This study aimed to characterize a 4-membered family with TA carrying a novel MSX1 pathogenic variant and investigate the disease mechanism. MethodsThe authors conducted whole exome analysis to define the disease-causing sequence variant. They performed microcomputed tomography, morphometric analyses, transcriptome profiling, and molecular characterization to study the affected teeth and the gene variant. ResultsThe authors identified an MSX1 pathogenic variant, p.Glu232∗, in affected family members with TA and concomitant orodental anomalies, namely, prominent maxillary labial frenum, central incisor diastema, median maxillary anterior alveolar cleft, tooth fusion, mandibular molar dysmorphology, thin dentin layer, and slender dental roots. MSX1-defective teeth were not apparently microdontic but had thin dentin layers. The mandibular molars showed a homeotic transformation to maxillary counterparts. Genes involved in extracellular matrix organization and dentinogenesis, such as DMP1 and MMP20, were downregulated in dental pulp tissues of MSX1-defective teeth. The p.Glu232∗-truncated MSX1 properly localized to the nucleus but partially lost its transactivation ability. Analyzing reported cases indicated that truncation sequence variants within the homeobox domain of MSX1 caused a more severe TA phenotype than those outside of the homeobox domain, probably due to dominant negativity compared with haploinsufficiency. ConclusionsThis study provides in vivo evidence that MSX1 contributes to developmental processes of various orodental tissues in humans. Practical ImplicationsClinically, hypertrophic labial frenum, incisor diastema, and median maxillary anterior alveolar cleft might be considered diagnostic for MSX1-associated TA.

Labial ankyloglossia - a case report on fusion of frenums

Labial ankyloglossia is a rare condition where the lingual frenum is found to be continuous with the labial frenum. It is a rare condition that can have a significant impact on a patient’s quality of life. Early recognition and appropriate intervention can lead to substantial improvements in speech, oral hygiene, and overall well-being. This case report underscores the importance of considering labial ankyloglossia as a differential diagnosis in patients with lip-related issues and highlights the potential benefits of surgical correction in improving lip function and aesthetics.

Management of frenectomy anterior upper arch before orthodontic treatment

Abnormal labial frenum may affect gingival health and cause periodontal disease. Abnormalities of the frenum also cause diastema of central incisors and irritation of the periodontal tissues, interfering with the teeth cleaning process, movement of orthodontic tools, and the proper fit of the denture and affecting the aesthetics. This case report shows that frenectomy is an alternative treatment due to abnormal labial frenum, in this case, caused by central diastema on maxillary incisors teeth. A-19 years old female patient came with chief complaints of midline diastema that affect her smile. She wants to get orthodontic treatment after the frenectomy management. The frenum was clinically high and elongated to the palatal side. Scaling and root planing were done at the first appointment, continued with frenectomy using a conventional technique (classical frenectomy) a week after the control. The treatment result showed that the frenectomy attachment was repaired and can continue the orthodontic treatment.

Associations between maxillary labial frenum Morphology, Attachment, and Patient-Related clinical factors in Saudi Arabian Adults: Cross-sectional study

ObjectiveThis study investigated the prevalence of maxillary labial frenum morphologies and attachment types and their associations with various patient-related clinical variables in a population of Saudi Arabian adults. MethodsThis study comprehensively examined 100 participants of both genders to categorize frenum types and attachment sites. The following clinical variables were recorded: probing depth, clinical attachment loss, attached gingiva width, overjet, overbite, diastema width, central incisor condition, occlusion, previous orthodontic treatment, and the incidence of gummy smile. ResultsThe mean age was 32.6 years, and the average diastema width was 0.23 mm. The study found that the simple frenum type was the most common morphology (57 %), and gingival attachment was the most frequent attachment type (54 %). Simple frenum was significantly associated with class I occlusion (p = 0.018), and frenum with nichum was significantly associated with class II occlusion (p = 0.019). Females were more likely to exhibit simple frenum with nodule frenum than males (p = 0.042). Mucosal frenum attachment was significantly correlated with the absence of previous orthodontic treatment (p = 0.042). ConclusionThe study identified a relationship between the features of the maxillary labial frenum and occlusion as well as previous orthodontic treatment. Our findings suggest that understanding each patient’s unique frenum features can lead to more effective and personalized dental care, thus improving patient satisfaction.

Emanuel syndrome due to unusual pattern

BackgroundThe hallmarks of Emanuel syndrome are pre- and postnatal growth retardation, microcephaly, global developmental delay, ear anomalies, and in males, heart, kidney, and genital abnormalities.ResultsThis study describes the atypical features of Emanuel syndrome, a rare chromosomal disorder. The patient had several physical features that are common in Emanuel syndrome, such as microcephaly, hypotonia, and ear anomalies. However, he exhibited certain unusual characteristics, including the lack of a prominent forehead, epicanthic folds, and a downward slanting palpebral fissure. There was infratentorial brain involution with a minor infarction in the left cerebral hemisphere and cerebellar hypoplasia on the magnetic resonance imaging (MRI) scan of the brain. Additionally, the patient had bilateral mild hearing loss and an aberrant epileptogenic pattern on the electroencephalogram (EEG). Orodental examination showed a long philtrum, everted fissured thick lower lip, highly attached labial frenum, and prominent median palatine raphe. The karyotype revealed 45XY t(11;22)(p15.5;q11.22), which is different from the typical karyotype of Emanuel syndrome.ConclusionsThis case sheds light on the possibility of alternative genetic mechanisms, beyond chromosomal abnormalities, in patients presenting with multiple congenital anomalies and facial dysmorphism.

Axenfeld-Rieger syndrome – A report of a rare case and review

A typical case of Axenfeld-Rieger syndrome (ARS), a rare autosomal dominant condition manifesting with ocular, craniofacial, and dental abnormalities, is presented. The patient showed dental features such as oligodontia, microdontia, abnormally shaped teeth, hyperplastic maxillary labial frenum, and maxillary retrognathism. Early diagnosis of the syndrome from its dentofacial manifestations and a multidisciplinary approach is required for the management of patients with ARS.

Prevalence of Maxillary and Mandibular Frenal Attachment and Its Association with Age, Gender, and Oral Hygiene Status in Nepalese Population Seeking Dental Treatment.

Frenum attachments are folds of mucous membrane that connect the lips to the alveolar mucosa and underlying periosteum. Aberrant positioning of the maxillary and mandibular labial frenum can lead to various clinical issues, including mucogingival problems and midline diastema. The objective of this study was to assess the prevalence of maxillary and mandibular frenal attachments and their association with age, gender, and oral hygiene status in the Nepalese population seeking dental treatment. This descriptive cross-sectional study was conducted over a period of 6 months, from February 2023 to August 2023, among patients visiting the Department of Periodontology and Oral Implantology, aged 6 years and above, after obtaining official permission from the Institutional Review Committee (IRC-KUSMS Approval No. 8/23). The study collected data on morphological variations of frenal attachment and various periodontal parameters such as Oral Hygiene Index-Simplified (OHI-S), pocket depth, recession, and midline diastema in both arches. Descriptive statistics, including frequency and percentage, were used to analyze the data. The χ2-test was employed to determine the correlation between gender and types of frenulum attachment, while analysis of variance was used to assess the association of frenal attachments with oral hygiene status. Among 380 patients, the prevalence of frenal attachment was as follows: gingival 248 (65.30%), mucosal 71 (18.70%), papillary 42 (11.10%), and papillary penetrating 19 (5.00%) in the maxilla, and mucosal 225 (59.20%) and gingival 155 (40.78%) in mandible. Among the different morphological variations of frenal attachments, normal frenum was the most common, accounting for 231 cases (60.80%), followed by frenum with a nodule, with 101 cases (26.60%). The study found significant associations between frenal attachment and gender, as well as oral hygiene status. The prevalence of frenal attachments in this study was comparable to findings from previous research.

Mind the Gap Familial Maxillary Midline Diastema and High Labial Frenum Attachment

In day today life clinicians can come across various dental malocclusions in human beings. Maxillary midline diastema is one among those and when this condition occurs it causes aesthetic impairment requiring orthodontic treatment in order to close the existing ugly looking gap between two central incisors. However, before performing this treatment, it is essential to rule out the underlying etiologic factors as this clinical entity is caused by various causative factors. In the present article, occurrence of maxillary midline diastema and high labial frenum attachment both in mother and daughter indicating genetic relation associated with it is shown

A Novel Method of Mentoplasty with Intraoral Vertical Incision (Labial Frenum)

A Novel Method of Mentoplasty with Intraoral Vertical Incision (Labial Frenum)

Labial Frenum Incision to Extraction of Transmigrated Impacted Mandibular Canine

Labial Frenum Incision to Extraction of Transmigrated Impacted Mandibular Canine

The role of the maxillary labial frenectomy in closure of the midline diastema: A review and management recommendations

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

Prevalence and Variations of Maxillary Labial Frenal Attachment among the Patients in a Tertiary Health Care Center: An Analytical Cross-sectional Study

IntroductionA high frenal attachment can cause diastema, distend the gingival sulcus, increasing plaque accumulation, gingival recession, bone loss, poor lip mobility while smiling and speaking, along with speech and esthetic issues. The objective of this study was to assess the prevalence of maxillary labial frenum and its’ variations among patients visiting a tertiary care hospital.MethodsThis analytical cross-sectional study was conducted from July 2022 to March 2023 among 385 patients. The demographic details of the participants were recorded and the types of frenal attachment and its’ morphological variations were assessed using the classification by Mirko et al. and Sewerin. Pearson Chi-square test was used to determine the association between categorical variables where p-value ≤0.05 was considered statistically significant.ResultsThe most prevalent frenum was found to be gingival 237(61.56%) while the least common was papillary penetrating type 29(7.53%). Only 85(22.08%) frenum showed morphological variations where, commonest variation was frenum with nodule 51(13.25%) followed by frenum with appendix 27(7.01%). The gingival frenal attachment was found to be more among younger patients while papillary and papillary frenal attachment were seen lesser among older individuals.ConclusionsGingival type was the commonest frenal attachment followed by mucosal, papillary and then papillary penetrating frenum in all the age groups and both sexes. Around three-fourth of the participants showed no variations in frenal morphologies.

Rehabilitation of the patient with ceramic laminate veneers having midline diastema and rotated maxillary central incisors associated with highly attached maxillary labial frenum- A case report

IPS Emax is a lithium disilicate glass ceramic that has excellent translucency, longetivity, durability and strength for all restorations. It is a unique system that fulfills all of your patient demands for minimally invasive dentistry. It is a choice for single anterior/posterior crowns, as it truly mimics the light refraction and natural translucency necessary for outstanding esthetic appearance. Maxillary midline diastema with associated rotation of maxillary incisors presents a very challenging situation for dentist to meet the esthetic requirements. The presence of highly attached labial frenum in such patients adds to the complexity of the outcome of the treatment. Labial frenectomy done with the Laser presents a very quick and early satisfactory healing with no postoperative patient discomfort. Presenting a one such case report of rehabilitation of maxillary midline diastema with the IPS Emax ceramic laminate veneers.

Oral Frenum Composition and Clinical Implications in Bone Regeneration: A Review.

Successful bone augmentation relies on primary wound closure. The labial frenum is a soft tissue that connects the lip to the alveolar mucosa or gingiva. However, the frenum may exert biomechanical forces to the wound edge, causing wound instability. The aim of this study is to review the frenum composition and classifications and to understand the significance of the frenum in wound stability upon bone regeneration. Together with a manual search, an electronic search was conducted through three online databases on studies published until September 2022. A total of 300 articles were identified, and 9 studies were included in this review. Two of the included studies discovered that 35% to 37.5% of the labial frenum had muscle fibers. Other studies showed that the labial frenum was mainly composed of connective tissue with elastic fibers. There are two widely used classifications for the frenum based on its morphology and attachment position. No studies specifically evaluated the impact of the frenum on bone regeneration, but the frenum location intercorrelated with the amount of keratinized tissue, which could influence wound stability. A modified frenum classification for the edentulous ridge and a decision diagram to manage the frenum is proposed for research and evidence-based practice.

ASSESSMENT OF LABIAL FRENAL ATTACHMENT AND ITS ASSOCIATION WITH ORAL HYGIENE STATUS

Background: Maxillary labial frenum is a mucous membrane fold which shows variation in morphology, position. This anatomic structure presents with variety of orofacial problems leading to diastema, phonetic, periodontal, and orthodontic issues thus affecting growth and development. Hence it is mandatory to examine the frenal attachment during oral examination. With this the study was aimed to assess the prevalence of the various types of maxillary labial frenum attachment among the patients and its association with oral hygiene status. Methods: A total of 260 patients aged from 18 to 35years were clinically examined to evaluate the type of frenal attachment using Placek’s classification. Oral hygiene index (simplified) was recorded and data was analyzed statistically. The obtained data was statistically analyzed by using SPSS version 23.0 with descriptive and inferential statistics. Results: Most of the individuals 136 (52.3%) had gingival type of frenum followed by mucosal 92 (35.38%), papillary 21 (8.07%), and least with papillary penetrating 11(4.23%). There was statistically significance between frenum attachment and gender. The relationship of frenal attachment with oral hygiene status was found to be significant. Conclusions: In terms of maxillary labial frenum attachment type, gingival frenal type was the most predominant types among the study sample with a low incidence of papillary penetrating frenal attachment. The study showed strong association between type of frenal attachment and oral hygiene status.

Clinical and psychological impact of lip repositioning surgery in the management of excessive gingival display

BackgroundExcessive gingival display (EGD), also known as a gummy smile, is characterized by overexposure of the maxillary gingiva on smiling. EGD can cause embarrassment and reduce patient satisfaction. This study aimed to evaluate the clinical and psychological effects of lip repositioning surgery on the management of EGD. MethodologyThis experimental study enrolled 14 patients with EGD who had undergone a modified lip repositioning technique, which comprised moving two strips of mucosa bilaterally to the maxillary labial frenum and repositioning the new mucosal margin coronally. The extent of gingival display (GD), lip mobility (LM), total lip length (TLL), lip length (LL), and internal lip length (ILL) was measured at baseline and 6 months postoperatively. The pre-operative psychological assessment was conducted using the social appearance anxiety scale (SAAS) scores, whereas the postoperative assessment was conducted using SAAS and visual analog scale (VAS) scores at 1 week, 3 months, and 6 months postoperatively. ResultsAmong the clinical parameters, TLL increased by 2.0 ± 1.038, LL increased by 2.28 ± 0.99, ILL reduced by 2.78 ± 1.36, LM reduced by 3.21 ± 1.12, and GD reduced by 3.14 ± 0.77 at 6 months postoperatively. Among the psychological parameters, SAAS reduced by 31.42 ± 1.907 from the baseline to 6 months, whereas the VAS score reduced to 3.14 ± 0.27 at 6 months postoperatively. ConclusionA significant reduction in GD, which is largely dependent on strict case selection, pain, and social anxiety was observed in this study, indicating that lip repositioning surgery is effective in managing EGD.