Journal of Indian Society of Periodontology
Journal of Indian Society of Periodontology
Home | About JISP | Search | Accepted articles | Online Early | Current Issue | Archives | Instructions | SubmissionSubscribeLogin 
Users Online: 566  Home Print this page Email this page Small font size Default font size Increase font sizeWide layoutNarrow layoutFull screen layout

   Table of Contents    
Year : 2018  |  Volume : 22  |  Issue : 3  |  Page : 257-262  

Prevalence of variations in morphology and attachment of maxillary labial frenum in various skeletal patterns - A cross-sectional study

1 Department of Public Health Dentistry, Royal Dental College, Palakkad, Kerala, India
2 Department of Orthodontics and Dentofacial Orthopedics, Royal Dental College, Palakkad, Kerala, India
3 Department of Periodontology, Royal Dental College, Palakkad, Kerala, India

Date of Submission07-Nov-2017
Date of Acceptance22-Mar-2018
Date of Web Publication8-Jun-2018

Correspondence Address:
Dr. Elayadath Rajagopalan Rajani
Kodamana house, Kadangode Post, Erumapetty via, Thrissur - 680584, Kerala
Login to access the Email id

Source of Support: None, Conflict of Interest: None

DOI: 10.4103/jisp.jisp_294_17

Rights and Permissions

Background: Maxillary labial frenum is a dynamic structure with a diverse morphology. Although an abnormal labial frenum is associated with syndromic and nonsyndromic conditions, it is often been neglected during the routine intraoral examination. The significance of various types of frenum (normal to abnormal), based on the attachment site and morphology in different skeletal patterns, has not been studied yet. Materials and Methods: A cross-sectional study was conducted in a clinical setting on 150 participants (50 each in Class I, Class II, and Class III skeletal pattern) within the age group of 13–30 years. Frenum was examined by direct visual method and intraoral photographs were taken for all the participants. Results: Chi-square and Fisher's exact tests were used. No gender-wise differences were found among the various frenum typologies. Mucosal type was the most prevalent in Class I and II and gingival type in Class III. Simple frenum was the common type in all the three groups. However, abnormal frenum categories based on its location and morphology were more in class III and found to be statistically significant. Papillary and papillary penetrating types are significantly associated with skeletal class III pattern and midline diastema (P < 0.05). Conclusion: The prevalence of papillary and papillary penetrating types of frenum are significantly more in Class III skeletal pattern. A labial frenum that is attached close to the gingival margin could be an etiological factor in midline diastema, mucogingival problems, and affect the growth of the alveolar process. Hence, an early diagnosis of abnormal frenum prevents the emergence of periodontal as well as orthodontic problems.

Keywords: Bifid, maxillary labial frenum, midline diastema, papillary penetrating, trifid frenum

How to cite this article:
Rajani ER, Biswas PP, Emmatty R. Prevalence of variations in morphology and attachment of maxillary labial frenum in various skeletal patterns - A cross-sectional study. J Indian Soc Periodontol 2018;22:257-62

How to cite this URL:
Rajani ER, Biswas PP, Emmatty R. Prevalence of variations in morphology and attachment of maxillary labial frenum in various skeletal patterns - A cross-sectional study. J Indian Soc Periodontol [serial online] 2018 [cited 2022 Aug 13];22:257-62. Available from:

   Introduction Top

The maxillary labial frenum, also called as frenulum labii superioris, is a mucous membrane fold that connects the upper lip to the alveolar mucosa, gingiva, and the underlying periosteum.[1] Histologically, it is made of loose connective tissue fibers, abundance of elastic fibers, and mucous glands in the subcutaneous tissue on either side of the central artery and vein.[2] Few striated muscle fibers also arise from the muscle bundles of the lip on either side of the midline.[3],[4],[5] It is a dynamic structure with much of physiological importance [6] and exhibits a diverse array of variations. The primary function of the labial frenum is to support or provide stability to the upper lip and to keep the lip in harmony with the growing bones of the maxilla. Thus, it contributes to the regulation of the facial growth.[6],[7],[8],[9],[10],[11] A frenum that is attached too close to the gingival margin can cause diastema, gingival recession, bone loss due to the muscle pull, poor lip mobility, especially during smiling and speaking.[8],[9],[10],[11],[12],[13]

The maxillary labial frenum has fibrous tissue running in an anteroposterior direction and merges with the submucosal fibers of the upper lip.[13],[14] It also encloses the septopremaxillary ligament [6] serves as a means of transmitting the septal growth force to the premaxilla. It also encompasses few striated fibers of the nasolabial muscles.[15],[16] Delaire had explained anatomic and neurophysiologic correlations existing between the labial frenum, septopremaxillary ligament, and interincisal suture which are important determinants of vertical and anteroposterior relationship of mandible and nasomaxillary complex. He further stated that inadequate muscular reconstruction and mutilation of the labial frenum could result in growth abnormalities.[17]

Based on its attachment site, Mirko et al.[18] has classified into four types [Figure 1] and Sewerin [19] has classified into eight different types based on its variations in the morphology [Figure 2]. There is a scarcity of literature which documents the variations in the diverse morphology of the maxillary labial frenum.[20],[21] Newer morphological variants are also reported in the literature.[20]
Figure 1: Frenum types based on attachment site. (a) Mucosal frenal attachment; (b) Gingival frenal attachment; (c) Papillary frenal attachment; (d) Papillary penetrating frenal attachment

Click here to view
Figure 2: Frenum types based on morphology. (a) Simple frenum; (b) Simple frenum with appendix. (c) Simple frenum with nodule; (d) Frenum with nichae; (e) Bifid frenum; (f) Double frenum with appendix; (g) Persistent tectolabial band; (h) Trifid frenum; (i) Trifid frenum with nodule

Click here to view

A thick, wide maxillary labial frenum attached close to the gingival margin is often considered as a contributing factor for midline diastema [12],[22],[23],[24],[25] and delayed growth of premaxilla.[25],[26],[27] It is considered normal during the early developmental stage.[11],[13],[28] The attachment of the frenum thins out and relocates to a more apical position as the alveolar process enlarges and maxillary anterior teeth erupt.[9],[22],[24],[25],[29] Thus, the papillary and papillary penetrating type are said to be pathogenic if it exists beyond the mixed dentition.[13] The mucosal and gingival types of frenal attachment are more common in permanent dentition.[13],[22],[30] Midline diastema is the most common esthetic problem, and its prevalence ranges from 1.6% to 25.4%.[22] The aim of the study is to assess the most prevalent type of maxillary labial frenum based on its attachment site and morphology in Class I, Class II, Class III skeletal participants and its association with midline diastema.

   Materials and Methods Top

A cross-sectional study was conducted in 150 adults consisting of both males and females with an age ranging from 13 to 30 years who were undergoing orthodontic treatment in our institution. The study protocol was approved by the Institutional Ethics Committee and a written informed consent was obtained from the study participants. The participants who had any congenital/developmental defects, trauma/injuries in the premaxillary region, history of prior orthognathic/frenal surgeries, and under any medication known to affect the gingiva were excluded from the study.

Demographic details such as age and gender were recorded. The study participants were categorized into Class I, Class II, and Class III skeletal pattern (50 individuals in each of the three groups) based on the cephalometric variables. ANB, Wits Appraisal, and Beta angle were used to assess the skeletal pattern [31],[32],[33] using the standardized digital lateral cephalogram which is then digitized using Dolphin software system [Figure 3]. These mean values of the variables are shown in [Table 1].
Figure 3: Cephalometric landmarks, angular, and linear measurements used in the study. (a) ANB (°) – The relative position of jaws to each other. Uses the skeletal landmarks point A, point B, and Nasion (N); Wits Appraisal (mm) – Measures the degree of anteroposterior jaw dysplasia on a lateral cephalometric head film. The points of contact of the perpendiculars onto the occlusal plane from the point A and point B are used. (b) Beta angle (°) – The type of skeletal dysplasia in the sagittal dimension. Uses three skeletal landmarks such as point A, point B, and the apparent axis of the condyle

Click here to view
Table 1: Mean values of cephalometric variables

Click here to view

Clinical examination of the frenum was conducted in the dental chair under adequate light by a single examiner. Attachment site of the frenum and its morphology were examined under direct visual method, by upward distension of the upper lip following which intraoral photographs were taken for all the study participants. The midline diastema is recorded when the space between the maxillary central incisors are more than 1 mm.

The reliability of the measurements was determined on 20 randomly selected adults who were examined at intervals of 14 days. Testing for the method error of all measurements was done with Dahlberg's formula [√∑d2/2n] where d is the difference between two measurements pair and n is the number of subjects.

   Results Top

Data were analyzed using IBM SPSS Statistics Base 24.0, SPSS South Asia Private Limited, Bangalore, India. Chi-square and Fisher's exact tests were performed to evaluate the difference in the prevalence of frenum typology in three groups and also to compare the association between the type of frenum and midline diastema. P < 0.05 was considered to be statistically significant.

The mean age of the individuals and gender distribution in Class I, Class II, and Class III skeletal pattern are shown in [Table 2]. No statistical significant difference was observed in males and females for different types of frenum based on the attachment site and morphology [Table 3]a and [Table 3]b.
Table 2: Mean age and gender distribution in each group

Click here to view

Click here to view

[Table 4] shows the overall comparison of maxillary labial frenum attachment site in all three groups. Out of 150 study participants, mucosal type (42%) was most prevalent followed by gingival (34%), papillary (20%), and papillary penetrating type (4%). There is a statistical significant difference between the proportion of the mucosal type which is the most prevalent in Class I (60%) and Class II (54%) than Class III (12%). The cumulative percentage of papillary and papillary penetrating type of attachment is more in Class III (44%) which is statistically significant (P = 0.001) than that of the other two groups.
Table 4: Overall comparison of frenum types based on attachment site in three groups

Click here to view

[Table 5] shows the overall prevalence of frenum in the three groups based on morphological variations. Simple frenum (45.33%) was the most prevalent in all three groups, followed by bifid frenum (19.33%). Trifid frenum was found to be 8% in the present study. Abnormal frenum morphology categories [persistent tectolabial, bifid, trifid, and double frenum] were more in Class III (50%) than in Class I (25%) and II (24%) which was statistically significant (P = 0.013).
Table 5: Overall comparison of frenum types based on morphology in three groups

Click here to view

Forty-six percent had a frenum which was thick and wide. Wide frenum was more in class III skeletal pattern (70%) than that of class I (32%) and class II (36%) skeletal pattern. There was a statistically significant difference (P = 0.001) in the proportion of wider frenum in three groups [Figure 4].
Figure 4: Wide frenum in Class I, Class II, and Class III skeletal pattern

Click here to view

There is no statistically significant difference in the presence of midline diastema in the three groups [Table 6]a. The association of diastema with normal and abnormal frenum typologies is tabulated in [Table 6]b and [Table 6]c. 29.3% of the total study participants had diastema. The papillary and papillary penetrating types of frenum were significantly associated with the diastema (P = 0.007).

Click here to view

   Discussion Top

The prevalence of different types of maxillary labial frenum in primary, mixed, and permanent dentition and its significance in gingival recession and periodontal pocket formation in the maxillary anterior teeth and midline diastema had been studied extensively.[5],[13],[14],[20],[29],[21],[30],[34],[35],[36] Since the frenum is in passive relation with the growth of the alveolar process,[13] an attempt is made to study the prevalence of frenum in various skeletal patterns based on the attachment site and the morphology of frenum.

The primary role of the frenum is to provide stability to the upper lip and to maintain a balance between the growing bones.[8] The pull on the septopremaxillary ligament which is enclosed in the frenum induces alveolar basal bone development and translative growth of entire maxilla.[34] Pushing of the nasal septal cartilage is transmitted to the anterior nasal spine by the septopremaxillary ligament and the nasolabial muscles.[15] Henceforth, the displacement of the maxilla downward and forward occurs by the direct thrust of the septal cartilage, biomechanical forces exerted by the forward traction of the nasolabial muscles, and the induction mechanism emanating from the septopremaxillary ligament and maxillary labial frenum resulting in forward traction of premaxilla.[16]

When the frenum is in close proximity to the gingival margin, it limits the movement of these structures, particularly the anterior portion of the maxilla.[5],[26] An adequate zone of attached gingiva is essential for maintaining the gingival health.[37],[38] Hence, a frenum which is inordinately large and wide with no apparent zone of attached gingiva in the permanent dentition and/or when the interdental papilla shifts when the frenum is extended, is said to be pathogenic.[22],[23],[39] It interferes with plaque control measures and leads to gingival recession and periodontal pocket.[8],[9],[18] The frenal attachment is considered normal when it is attached apically away from the gingival margin, usually at the mucogingival junction [5] and does not exert pull on the attached or marginal gingiva (pull syndrome).[18],[20]

The maxillary labial frenum is a posteruptive remnant of tectolabial bands connecting the tubercle of the upper lip to the palatine papilla.[12] The developing alveolar process causes severance of this band into labial and palatal portion which forms the maxillary labial frenum and the palatine papilla, respectively.[24],[25] The present study comprises of the only adult population which shows that papillary (20%) and papillary penetrating (4%) types are least common which is concomitant with the previous studies.[5],[14],[18],[29],[35],[36],[40] However, a study conducted by Christabel SL reported that there were no papillary and papillary penetrating type of frenum in permanent dentition.[13]

Any interference in the relocation of the continuous band of connective tissue of the frenum during the growth of the alveolar process can cause midline diastema and also affects the growth of anterior part of the maxilla. In such cases, frenum retains its primitive state, a sort of maturational arrest.[41] Thus, papillary and papillary penetrating type are said to be pathological in the permanent dentition, and interestingly, those types were more common in Class III (44%) compared to that of Class I (14%) and Class II (14%) skeletal patterns with a high statistical significant difference.

No statistically significant difference in gender-based comparison was noted in all the three groups based on attachment site and morphology which were consistent with the similar studies in the literature.[14],[35] However, Sewerin reported higher frequency of variations among males.[19] Few studies also document significant difference among females.[37]

Based on the morphological variation, simple frenum (45.33%) is the most prevalent type reported followed by frenum with nodules (12%) and appendix (6%) which are similar with that of the previous studies reported.[5],[13],[14],[19],[20],[21],[37],[42] Nodules and appendix found commonly in the simple frenum is a normal variant with no pathological potential, frequently seen with increase in age.[14],[41] Frenum with nichum and bifid frenum were 2.67%, 19.33%, respectively, in the present study which was concomitant with the results of Sagar et al.[43] However, it was found to be <1% in a study conducted by Kakodkar et al. in permanent dentition.[42] As most of the prior studies were done in children of different age groups, and in diverse population, direct comparison with other study should be done cautiously.

Persistent tectolabial frenum, bifid frenum, double frenum, and wide frenum which are considered abnormal,[5],[40] showed a statistical significant difference among the three groups. The overall prevalence of trifid frenum, a newer variant, was 8% which was only 0.58% by Mohan et al.[20] These variations can be attributed to racial or ethnic differences which are inherent with the frenum morphology.[10],[14] Wide frenum was found to be 32%, 36%, and 70% in Class I, Class II, and Class III skeletal patterns, respectively, which was highly significant.

The development of abnormal frenum is an important diagnostic feature of several syndromic conditions such as Ehlers–Danlos syndrome, infantile hypertrophic pyloric stenosis, holoprosencephaly, Ellis–van Creveld Syndrome (EVCS), and oro-facial-digital syndrome.[11],[35],[44],[45] Two potentially fatal conditions associated with hyperplastic frenum are EVCS and hypoplastic left heart syndrome.[10],[11] The most striking feature of EVCS is the concave facial profile with midfacial retrusion resulting in a Class III skeletal pattern.[45]

Maxillary midline diastema is one of the most common malocclusion.[22] An aberrant maxillary labial frenum is considered one of the major etiological factor for diastema if other associated dental conditions persist.[22],[23],[24],[25],[46] The fibroelastic band of the frenum crosses the alveolus and inserts into the incisive papilla and hinders the approximation of the maxillary central incisors.

Studies relating the midline diastema with various morphological variations of frenum in different skeletal patterns are scarce. Diastema is significantly associated with papillary and papillary penetrating type of frenum,[22],[37],[46] whereas no significant association was noted with the variation in the morphology of frenum which was similar to the prior study.[43] However, diastema can also occur even without an abnormal frenum and vice versa.[24] The width of the diastema is inversely correlated with the presence of an abnormal maxillary labial frenum.[46],[47]

An attractive balanced smile and confident speech are the most valuable assets for the proper psychosocial development of an individual. A frenum that is close to the gingival margin intervenes the pronunciation of certain words as well as a good smile.[10] This study also reveals that the papillary and papillary penetrating types of frenum are commonly noticed in Class III skeletal pattern. Hence, an early diagnosis and prompt treatment of the aberrant frenum will intercept the developing skeletal Class III malocclusion and other mucogingival problems.

The limitation of the study is its smaller sample size. Hence, a similar study with larger samples involving siblings/twins should be conducted to evaluate the genetic and racial variations in the morphology and attachment site of the labial frenum.

   Conclusion Top

The prevalence of papillary and papillary penetrating type of frenum are significantly more in Class III skeletal pattern which calls for an interdisciplinary attention. A labial frenum that is attached close to the gingival margin interferes with normal oral hygiene maintenance and mucogingival problems and can affect the growth of the maxillary alveolar process. Thus, the present study attempts to add insight into the importance of prompt early diagnosis of abnormal frenum in preventing the emergence of periodontal as well as orthodontic problems.

Financial support and sponsorship


Conflicts of interest

There are no conflicts of interest.

   References Top

Kotlow L. Diagnosis and treatment of ankyloglossia and tied maxillary fraenum in infants using Er:YAG and 1064 diode lasers. Eur Arch Paediatr Dent 2011;12:106-12.  Back to cited text no. 1
Noyes HJ. The anatomy of frenum labia in newborn infants. Angle Orthod 1935;5:3-8.  Back to cited text no. 2
Ross RO, Brown FH, Houston GD. Histologic survey of the frena of the oral cavity. Quintessence Int 1990;21:233-7.  Back to cited text no. 3
Gartner LP, Schein D. The superior labial frenum: A histologic observation. Quintessence Int 1991;22:443-5.  Back to cited text no. 4
Bervian J, Cazarotto F, Perussolo B, Patussi EG, Pavinatto LC. Description of the upper labial frenulum characteristics in preschool children of Passo Fundo, Brazil. Braz Res Pediatr Dent Integr Clin 2016;16:351-7.  Back to cited text no. 5
Hall BK, Precious DS. Cleft lip, nose, and palate: The nasal septum as the pacemaker for midfacial growth. Oral Surg Oral Med Oral Pathol Oral Radiol 2013;115:442-7.  Back to cited text no. 6
Srinivasan B, Chitharanjan AB. Skeletal and dental characteristics in subjects with ankyloglossia. Prog Orthod 2013;14:44.  Back to cited text no. 7
Northcutt ME. The lingual frenum. J Clin Orthod 2009;43:557-65.  Back to cited text no. 8
Kashyap RS, Zareena, Hegde S, Kumar AM. Management of aberrant frenum: A case report. IOSR J Dent Med Sci 2015;14:10-3.  Back to cited text no. 9
Jathar P, Panse A, Metha D, Kulkarni A. Acute speech impediment due to abnormal labial frenum in a 5 year old girl: A case report. J Dent Allied Sci 2012;1:76-8.  Back to cited text no. 10
  [Full text]  
Priyanka M, Sruthi R, Ramakrishnan T, Emmadi P, Ambalavanan N. An overview of frenal attachments. J Indian Soc Periodontol 2013;17:12-5.  Back to cited text no. 11
[PUBMED]  [Full text]  
Devishree, Gujjari SK, Shubhashini PV. Frenectomy: A review with the reports of surgical techniques. J Clin Diagn Res 2012;6:1587-92.  Back to cited text no. 12
Christabel SL, Gurunathan D. Prevalence of type of frenal attachment and morphology of frenum in children, Chennai, Tamil Nadu. World J Dent 2015;6:203-7.  Back to cited text no. 13
Townsend JA, Brannon RB, Cheramie T, Hagan J. Prevalence and variations of the median maxillary labial frenum in children, adolescents, and adults in a diverse population. Gen Dent 2013;61:57-60.  Back to cited text no. 14
Precious D, Delaire J. Balanced facial growth: A schematic interpretation. Oral Surg Oral Med Oral Pathol 1987;63:637-44.  Back to cited text no. 15
Standerwick RG, Roberts WE. The aponeurotic tension model of craniofacial growth in man. Open Dent J 2009;3:100-13.  Back to cited text no. 16
Delaire J. The potential role of facial muscles in monitoring maxillary growth and morphogenesis. In: Carlson DS, McNamara JA, editors. Muscle Adaptation in the Craniofacial Region. Monograph no. 8. Craniofacial Growth Series. Ann Arbor, (MI): The University of Michigan; 1978. p. 157-80.  Back to cited text no. 17
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;45:891-4.  Back to cited text no. 18
Sewerin I. Prevalence of variations and anomalies of the upper labial frenum. Acta Odontol Scand 1971;29:487-96.  Back to cited text no. 19
Mohan R, Soni PK, Krishna MK, Gundappa M. Proposed classification of median maxillary labial frenum based on morphology. Dent Hypothesis 2014;5:16-20.  Back to cited text no. 20
Thosar N, Murarka P, Baliga S, Rathi N. Assessment of maxillary labial frenum morphology in primary, mixed and permanent dentitions in Wardha district. Eur J Gen Dent 2017;6:14-7.  Back to cited text no. 21
  [Full text]  
Abraham R, Kamath G. Midline diastema and its aetiology – A review. Dent Update 2014;41:457-60, 462-4.  Back to cited text no. 22
Gkantidis N, Kolokitha OE, Topouzelis N. Management of maxillary midline diastema with emphasis on etiology. J Clin Pediatr Dent 2008;32:265-72.  Back to cited text no. 23
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;39:120-39.  Back to cited text no. 24
Edwards JG. The diastema, the frenum, the frenectomy: A clinical study. Am J Orthod 1977;71:489-508.  Back to cited text no. 25
Kotlow LA. Oral diagnosis of abnormal frenal attachments in neonates and infants: evaluation and treatment of the maxillary and lingual frenum using the Erbium: YAG Laser. J Pediatr Dent Care 2004;10:11-4.  Back to cited text no. 26
Krusteva S, Dimitrova M, Daskalov H, Krusteva S. Correcting labial thick and high attached frenum (clinical observation). J IMAB 2012;18:263-5.  Back to cited text no. 27
Lawande SA, Lawande GS. Surgical management of aberrant labial frenum for controlling gingival tissue damage: A case series. Int J Biomed Res 2013;4:574-8.  Back to cited text no. 28
Popovich F, Thompson GW, Main PA. The maxillary interincisal diastema and its relationship to the superior labial frenum and intermaxillary suture. Angle Orthod 1977;47:265-71.  Back to cited text no. 29
Boutsi EA, Tatakis DN. Maxillary labial frenum attachment in children. Int J Paediatr Dent 2011;21:284-8.  Back to cited text no. 30
Steiner CC. Cephalometrics for you and me. Am J Orthod 1953;39:729-55.  Back to cited text no. 31
Jacobson A. The “Wits” appraisal of jaw disharmony. Am J Orthod 1975;67:125-38.  Back to cited text no. 32
Baik CY, Ververidou M. A new approach of assessing sagittal discrepancies: The beta angle. Am J Orthod Dentofacial Orthop 2004;126:100-5.  Back to cited text no. 33
Frankel R, Frankel C. Orofacial Orthopedics with the Function Regulator. Basel: Karger Publications; 1989.  Back to cited text no. 34
Nadar S. Maxillary labial frenum attachment in children of different age groups. Int J Curr Res 2017;9:50367-9.  Back to cited text no. 35
Upadhyay S, Upadaya NG. Attachment of maxillary labial frenum in Nepalese children. Orthod J Nepal 2012;2:28-31.  Back to cited text no. 36
Jindal V, Kaur R, Goel A, Mahajan A, Mahajan N, Mahajan A, et al. Variations in the frenal morphology in the diverse population: A clinical study. J Indian Soc Periodontol 2016;20:320-3.  Back to cited text no. 37
[PUBMED]  [Full text]  
Malathi K, Singh A, Prem Blaisie RM, Dhanesh S. Attached gingiva: A review. Int J Sci Res Rev 2013;3:188-98.  Back to cited text no. 38
Miller PD Jr. The frenectomy combined with a laterally positioned pedicle graft. Functional and esthetic considerations. J Periodontol 1985;56:102-6.  Back to cited text no. 39
Ruli LP, Duarte CA, Milanezi LA, Perri SH. Superior and inferior labial frenum: Clinical study of morphology, position of attachment and influence on oral hygiene. Rev Odontol Univ Sao Paulo 1997;11:195-205.  Back to cited text no. 40
Lovell MA, McDaniel NL. Association of hypertrophic maxillary frenulum with hypoplastic left heart syndrome. J Pediatr 1995;127:749-50.  Back to cited text no. 41
Kakodkar PV, Patel TN, Patel SV, Patel SH. Clinical assessment of diverse frenum morphology in permanent dentition. Internet J Dent Sci 2008;7:1-8.  Back to cited text no. 42
Sagar S, Heraldsherlin J, Moses S. Morphological variation of abnormal maxillary labial frenum in South Indian population. Int J Pharm Sci Res 2016;7:2142-6.  Back to cited text no. 43
Mintz SM, Siegel MA, Seider PJ. An overview of oral frena and their association with multiple syndromic and nonsyndromic conditions. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2005;99:321-4.  Back to cited text no. 44
Susami T, Kuroda T, Yoshimasu H, Suzuki R. Ellis-van creveld syndrome: Craniofacial morphology and multidisciplinary treatment. Cleft Palate Craniofac J 1999;36:345-52.  Back to cited text no. 45
Díaz-Pizán ME, Lagravère MO, Villena R. Midline diastema and frenum morphology in the primary dentition. J Dent Child (Chic) 2006;73:11-4.  Back to cited text no. 46
Shashua D, Artun J. Relapse after orthodontic correction of maxillary median diastema: A follow-up evaluation of consecutive cases. Angle Orthod 1999;69:257-63.  Back to cited text no. 47


  [Figure 1], [Figure 2], [Figure 3], [Figure 4]

  [Table 1], [Table 2], [Table 3], [Table 4], [Table 5], [Table 6]

This article has been cited by
1 Comparative frenectomy with conventional scalpel and dual-waved laser in labial frenulum
Ling Xie, Ping Wang, Yue Ding, Liang Zhang
World Journal of Pediatric Surgery. 2022; 5(1): e000363
[Pubmed] | [DOI]
2 Evaluation of Median Maxillary Labial Frenum Type and Morphology in Different Age Groups
Gülser KILINÇ, Müjdet ÇETIN, Zafer Berk KÖSE, Ümran ERTUNÇ, Alp Abidin ATESÇI
Journal of Basic and Clinical Health Sciences. 2021;
[Pubmed] | [DOI]
3 Diode versus CO2 Laser Therapy in the Treatment of High Labial Frenulum Attachment: A Pilot Randomized, Double-Blinded Clinical Trial
Gian Luca Sfasciotti, Francesca Zara, Iole Vozza, Veronica Carocci, Gaetano Ierardo, Antonella Polimeni
International Journal of Environmental Research and Public Health. 2020; 17(21): 7708
[Pubmed] | [DOI]
4 Studying Maxillary Labial Frenulum Types and Their Effect on Median Diastema in 3–6-year-old Children in Tehran Kindergartens
Bahman Seraj, Mahdi Shahrabi, Samaneh Masoumi, Razieh Jabbarian, Amir A Manesh, Maryam B Fini
World Journal of Dentistry. 2019; 10(2): 93
[Pubmed] | [DOI]


    Similar in PUBMED
   Search Pubmed for
   Search in Google Scholar for
 Related articles
    Access Statistics
    Email Alert *
    Add to My List *
* Registration required (free)  

  In this article
    Materials and Me...
    Article Figures
    Article Tables

 Article Access Statistics
    PDF Downloaded532    
    Comments [Add]    
    Cited by others 4    

Recommend this journal