Morphological variations of median maxillary labial frenum: A clinical study.

BACKGROUND: Median maxillary labial frenum (MMLF) appears as a fold of mucous membrane extending from the lining of the mucous membrane of the lips towards the crest of the alveolar ridge on the labial surface. MMLF can demonstrate certain variations in their shape, size and position, both among individuals and within the same individual at different ages. Many clinicians, not being aware of the normal variations of median maxillary labial frenum misinterpret them as pathological entities. OBJECTIVES: The objectives of the study were to determine the prevalence of morphologic variations of MMLF, to classify the morphological variations of MMLF on the basis of their location on the frenum and to compare the morphological variations of MMLF among different age groups and genders. MATERIALS AND METHODS: The study was conducted on 700 males and 700 females of age 5 to 74 yrs, chosen randomly. They were equally divided on the basis of age into 7 groups, each group having equal gender distribution. The morphological variations of MMLF were classified according to Sewerin's classification and the attachments on the freni were further sub-classified. RESULTS: The commonest type of frenum was found to be the simple type, whereas bifid frenum was not found at all. Statistically significant difference was found in proportion of types of frenum among the different age groups and also in proportion of types of frenum among the different sites of presence of frenal attachments. No statistically significant difference was found in proportion of types of frenum in male and female subjects. CONCLUSION: This study shows that MMLF presents with an array of morphological variations. These morphological variations may sometimes pose a complicating factor in maintaining oral hygiene, speech, mastication, esthetics, denture construction, etc. Hence, appropriate recognition of frenal variations and subsequent modification of treatment procedures are essential for a successful outcome of therapy.

Relación entre frenillos labiales y periodonto en una población peruana / Relationship between labial frenulum and periodontium in a Peruvian population

RESUMEN: Los frenillos aberrantes están incluidos dentro de las deformidades mucogingivales, y estas pueden alterar la función y la estética del periodonto de protección. Este estudio tuvo como objetivo evaluar la inserción de los frenillos labiales y establecer una relación con la pérdida papilar y recesión gingival a nivel de los dientes anterosuperiores y anteroinferiores. Materiales y métodos Estudio transversal que evaluó a 97 pacientes sistémicamente sanos en los cuales se evaluó el tipo de frenillo (TF), la altura del frenillo (AF), el tipo de recesión gingival y la pérdida papilar al nivel de los sectores anteriores maxilar y mandibular. Resultados El TF más prevalente fue el mucoso, con un 54,6% y 93,8% de prevalencia a nivel maxilar y de la mandíbula respectivamente; la AF promedio fue de 8,37mm ± 2,671mm para el frenillo labial maxilar y 8,33mm ± 1,657mm para el frenillo labial mandibular. No se encontraron relaciones entre el TF, la AF con la presencia y severidad de pérdida papilar y recesión gingival al nivel de los incisivos centrales (p>0,05). Conclusión El frenillo más común de la población estudiada fue el frenillo mucoso, no existiendo una relación directa entre su clasificación e inserción con la presencia de una recesión gingival o pérdida papilar.

ABSTRACT: Aberrant frenums are included within the mucogingival deformities, which can alter the function and aesthetic periodontal protection. This study aimed to evaluate the adherence of labial frenulum and establish a relationship with papillary loss and gingival recession of the anterior teeth in maxilla and in the jaw. Materials and methods A cross-sectional study was conducted on 97 systemically healthy patients in whom the type of frenulum (TF), the height of the frenulum (AF), the type of gingival recession, and papillary loss was evaluated in the upper maxillary and mandibular sectors. Results The most prevalent frenum was the mucosal. The prevalence of TF was 54.6% and 93.8% of maxilla and mandible, respectively. The mean AF was 8.37mm ± 2.671mm for the labial frenulum in maxillary, and 8.33mm ± 1.657mm for frenulum. No relationship was found between the TF, AF with the presence and severity of papillary loss and gingival recession (P>.05). Conclusion The most common frenulum of the study population was the mucosal frenulum. There was no direct relationship between the classification and adherence of the frenulum with the presence of gingival recession or papillary loss.

Diastema size and type of upper lip midline frenulum attachment.

BACKGROUND: Diastema is a space between teeth. The most often is maxillary midline diastema between upper central incisors. One of the main causes of diastema is enlarged upper lip frenulum attachment. The aim of the study was to assess frenulum attachment in patients with diastema and investigate if type of upper lip frenulum attachment has an impact on the width of diastema. MATERIALS AND METHODS: Upper lip frenulum attachment was assessed clinically in two groups of adult patients: study group with diastema and control group without diastema. Moreover the width of diastema was measured on plaster models of dentition. The results were statistically analysed. RESULTS: In study material the most often was diastema in range more than 2 mm. There were statistically significant differences between study and control group in upper lip frenulum attachment (p < 0.05). Normal frenulum attachment (mucosal or gingival) was typical for group without diastema, but enlarged frenulum (papillary or papilla penetrating) was characteristic for diastema group. Type of frenulum had significant (p < 0.05) impact to the width of diastema. Small diastema (≤ 2 mm) more often coexisted with normal frenulum. Oversized frenulum was observed in the big diastema (> 2 mm). CONCLUSIONS: Patients with diastema have more often oversized upper lip frenulum attachment then patients without diastema. The most often type of frenulum in patients with diastema is papillary and papilla penetrating type. Type of upper lip frenulum attachment has an impact to the size of diastema.

Análisis morfométrico del frenillo labial superior durante el crecimiento y desarrollo del niño en edades 0 a 12 años / Análise morfométrica do freio labial superior durante o crescimento e desenvolvimento crianças em idades de 0 a 12 anos / Morphometric analysis of the upper lip frenulum during growth and development of the child aged 0 to 12 years

Objetivo: Establecer un análisis morfométrico del frenillo labial superior durante el crecimiento y desarrollo del niño en edades de 0 a 12 años en el Municipio Naguanagua periodo Marzo-Septiembre 2016. Materiales y Métodos: investigación de tipo descriptivo con un diseño de campo. Teniendo como objeto una población de 650 niños tomando como Muestra 260 sujetos, distribuidos de manera porcentual en, 31% Primera Infancia 23% Segunda Infancia y 46% Tercera Infancia. Se obtuvieron fotografías del frenillo, tomando 10 "landmark" (puntos de referencia) para la conformación de la estructura, siendo procesadas para su análisis con los Software, TpsDig2, Past, IMP7 y Morphoj. Resultados: la zona que presento mayor superposición en todos los grupos fue la de inserción gingival, mientras que la inserción labial presento mayor variación, en cuanto a 1 Residente del Postgrado de Odontopediatría, Universidad de Carabobo. 2 Odontopediatra UC. Docente del Postgrado de Odontopediatría U.C. y docente de Pregrado facultad de Odontología U.C. 3 PhD, en Entomología, Docente de la Universidad de Ikiam Ecuador. la deformación de la estructura en todas las etapas hubo desarrollo en sentido horizontal en la inserción labial. La medida promedio del frenillo labial superior se estableció entre 11 a 13mm, ±1-2mm de desviación. La inserción gingival a la papila interincisal se presentó una medida promedio 1 a 3 mm. ±1 mm. Conclusiones: el frenillo labial superior al nacer es fisiológicamente tectolabial, presentara un desarrollo de 1 a 2mm durante el 1er año de vida en su zona de inserción gingival exclusivamente, manteniéndose estable sin reposicionarse ni modificarse en longitud hasta la adolescencia, por lo que al realizar el análisis Morfométrico del frenillo labial superior en todos tipos de dentición dicha estructura presento similitudes indicándonos su estabilidad en las diferentes edades del infante.

Objetivo: Estabelecer uma análise morfométrica do freio labial superior durante o crescimento e desenvolvimento de crianças de idades 0 a 12 anos no município Naguanagua período Marzo-Septiembre 2016. Materiais e Métodos: Pesquisa de tipo descritivo com um projeto de campo. Tendo como objeto uma populaçã o de 650 crianças e tomando como amostra 260 sujeitos, distribuídos de forma percentual em, 31% Primeira Infância 23% Segunda Infância e 46% Terceira Infância. Se obtiveram as fotografias do freio, tomando 10 pontos de referência para a conformação da estrutura, as quais foram processadas para seu análise com os software, TpsDig2, Past, IMP7 e Morphoj. Resultados: a zona que preside o superposição do maior em todos os grupos foi a inserção gingival, enquanto que a inserção labial apresentou a maiori variação, forma da deformação da estrutura em todas as etapas desenvolvimento ocorreu no sentido horizontal na inserção labial. A medida médioa freio labial superior foi 11 a 13mm, ± 1-2mm de desvio. A inserção gengival à la papila interincisal se mostrou uma medida média 1 a 3 mm. ± 1 mm. Conclusões: o freio labial superior , ao nascer, é fisiologicamente teto-labial, apresenta um desenvolvimento de 1 a 2mm durante o primeiro ano de vida em sua zona de inserção gengival exclusivamente, mantendo-se estável sem reposicionar nem modificando em comprimento até a adolescência. Por isso que realizar analise morfométrica do frenillo labial superior em todos os tipos de dentição nos mostra semelhanças nos indicando sua estabilidade nas diferentes idades da criança.

Objective: To establish a morphometric analysis of the upper lip frenulum during the growth and development of the child aged 0 to 12 years in the Naguanagua Municipality period March-September 2016. Materials and Methods: A descriptive research with a field design was performed. The target population was 650 children, the sample taken was 260 subjects, distributed in 31% First Infancy 23% Second Infancy and 46% Third Infancy. Photographs of the bridle were taken, taking 10 landmarks for the structure conformation, being processed for analysis with the Software, TpsDig2, Past, IMP7 and Morphoj. Results: the area that presented greater overlap in all groups was that of gingival insertion, while the labial insertion presented greater variation, in terms of the deformation of the structure in all the stages there was development in horizontal sense in the labial insertion. The mean upper lip frenulum measurement was established between 11 to 13mm, ± 1-2mm of deviation. The gingival insertion to the interincisal papilla presented an average measure of 1 to 3 mm. ± 1 mm. Conclusions: the upper labial frenulum at birth is physiologicallyw tectolabial, presenting a development of 1 to 2 mm during the first year of life in its area of gingival insertion exclusively, remaining stable without repositioning or modification in length until adolescence, The morphometric analysis of the upper lip frenulum in all types of dentition said structure showed similarities indicating its stability in the different ages of the infant.

Avaliação dos padrões de morfologia e inserção dos freios labiais em pacientes da clínica-escola de odontologia do Centro Universitário de João Pessoa - PB / Patterns evaluation of the labial frenum's morphology and insertion on patients that attended the clinic school of dentistry of the University Center of João Pessoa - PB

Introdução: A investigação dos padrões estruturais dos freios labiais é importante para o estabelecimento da frequência com que ocorrem as variações, sejam estas de normalidade ou prejudiciais à função. Objetivo: Avaliar os padrões de morfologia e inserção dos freios labiais de pacientes atendidos na Clínica-Escola de Odontologia do Centro Universitário de João Pessoa-PB. Material e método: Avaliaram-se 385 pacientes atendidos no período de agosto de 2012 a abril de 2013, de ambos os sexos. Os dados foram analisados no software IBM SPSS (20.0). Resultado: A morfologia de prevalência foi do tipo simples tanto para o freio labial superior (82,6%) quanto para o inferior (100,0%). A inserção de maior prevalência foi a "mucosa alveolar", tanto nos superiores (75,8%) quanto nos inferiores (99,0%). Não houve diferença entre os sexos masculino e feminino para morfologia e inserção superiores (p=0,673 e p=0,582, respectivamente), bem como para a inserção inferior (p=0,599). Note-se que o mesmo ocorreu para as diferentes cores de pele - leucoderma, melanoderma e faioderma, com p=0,343; p=0,269; p=0,134, respectivamente. Verificou-se diferença (p=0,011) entre as médias de idade para as variantes de inserção do freio labial superior. Conclusão: A morfologia predominante tanto para freios labiais superiores quanto para inferiores é o tipo simples, havendo maior número de variantes morfológicas para os superiores. A inserção do tipo mucosa alveolar é a de maior ocorrência tanto para freios superiores quanto inferiores. Não há relação entre os padrões de morfologia e inserção com o sexo e a cor da pele, mas observa-se relação entre o padrão de inserção dos freios labiais superiores e a idade dos indivíduos.

Introduction: The investigation of the structural patterns of labial frenum is important to establish the frequency with which variation occur, whether normal or harmful to the function. Objective: To evaluate the patterns of morphology and insertion of labial frenum of patients attended at the clinical School of Dentistry of the University Center of João Pessoa-PB. Material and method: It was evaluated 385 patients of both genders that attended the clinic between august 2012 and april 2013. The data was analyzed using SPSS (20.0) software. Result: The most prevalent morphology was single for both the upper labial frenum (82.6%) and for the lower (100.0%). The insertion most prevalent is the "alveolar mucosa", both in the upper (75.8%) and the lower (99.0%). There was no difference between males and females for morphology and superior insertion (p= 0.673; p=0.582, respectively), as well as to the lower insertion (p=0.599), and so on for the different skin colors (leucoderma, melanoderma e faioderma) (p=0.343; p=0.269; p=0.134, respectively). There was statistical difference (p=0.011) between the mean age for insertion variants of the upper labial frenum. Conclusion: The most common morphology for both upper labial frenum and for lower is simple, with a higher number of morphological variants to superiors; while the insertion of the alveolar mucosa is most common for both upper and lower frenum; there is no relationship between the morphology and patterns of insertion regarding gender and skin color, but there is relation between the pattern of insertion of the upper labial frenum and age.

A novel design solution to the fraenal notch of maxillary dentures.

This study investigates a novel design feature for the fraenal notch of maxillary dentures, using computational and experimental methods, and shows that its use could significantly increase the longevity of the prosthesis. A two-step process can be used to create the design feature with current denture base materials, but would be highly dependent on the individual skill of the dental technician. Therefore, an alternative form of manufacture, multi-material additive layer manufacture (or '3D printing'), has been proposed as a future method for the direct production of complete dentures with multi-material design features.

Prevalence and variations of the median maxillary labial frenum in children, adolescents, and adults in a diverse population.

The median maxillary labial frenum (MMLF) is a normal anatomic structure with inherent morphologic variations. This study sought to evaluate the prevalence of those variations in a diverse ethnic population and to educate practitioners about the prevalence of MMLF variations to prevent unnecessary biopsies. This study included adult, adolescent, and child patients at the Louisiana State University Health Science Center School of Dentistry. Among the 284 subjects examined, frenum normale was the most common frenum classification, followed by frenum with nodule and frenum with appendix. Most nodules were found in the intermediate third of the MMLF, while appendices were mainly found in the labial third. The prevalence of an appendix was significantly higher (P < 0.001) in Caucasians compared to African-Americans. The prevalence of nodules was marginally higher (P = 0.096) in Caucasians than in African-Americans. No other statistically significant differences were found with regard to ethnicity. Additionally, nodules and appendices on the MMLF were identified in all age groups, and may become more common with increasing age. The authors determined that variations of the MMLF are inherent and do not represent a pathologic condition, nor do they require biopsy for diagnostic purposes.

Maxillary labial frenum attachment in children.

BACKGROUND: The distribution of the attachment of the maxillary labial frenum in the children of different ethnic backgrounds has not been studied extensively. AIM: The purpose of this cross-sectional study was to examine the prevalence of the various types of maxillary labial frenum attachment in the children of different ethnic backgrounds. DESIGN: Children (aged 1-18) attending a public health clinic in Lavrion, Greece, were clinically examined for maxillary frenum attachment location. Demographic information was recorded. Parents provided written informed consent. RESULTS: The examined children were 226, with mean (± standard deviation) age of 8.5 ± 3.0 years. They were of Greek (51%), Albanian (20%), Turkish (12%), and Afghan (11%) descent. The prevalence of the maxillary labial frenum attachment was mucosal (10.2%), gingival (41.6%), papillary (22.1%), and papillary penetrating (26.1%). Frenum attachment differed significantly by age (P = 0.001). The age of children with mucosal- or gingival-type frenum was significantly greater than the age of children with papillary penetrating-type frenum. Frenum attachment did not differ by gender or ethnic background (P ≥ 0.20). CONCLUSIONS: The results of this study suggest that, in children, ethnic background and gender are not associated with maxillary labial frenum attachment type, whereas age is strongly associated.

Vantagens e limitações da técnica de frenulectomia à laser Er: Yag / Advantages and limitations of the technique of frenulectomy to laser Er: Yag

Os frênulos labiais são inserções de tecido conjuntivo fibroso e têm como função limitar os movimentos do lábio, promovendo sua estabilização e impedindo a excessiva exposição da mucosa gengival na área de sua inserção. Entretanto, os frênulos podem exercer funções adversas, sendo indicada sua remoção cirúrgica por motivos periodontais, ortodônticos, protéticos e estéticos. Este trabalho tem como objetivo discutir a frenulectomia com uso do laser Er: Yag, comparando suas vantagens e limitações em relação às técnicas de frenulectomias convencionais.

The labial frenulum are insertions of fibrous conjunctive tissue and have function of a labial frenulum is to limit movements of the lip, promoting stabilization and to impede the excessive exhibition of the gingival mucosa in the area attachment. However, the frenulum can exercise adverse functions, being indicated its surgical removal by periodontal, orthodontics, prosthetic and aesthetic reasons. This paper aim objective to discuss the frenulectomy with use of the laser Er:Yag, comparing its advantages and limitations in relation to the conventional frenulectomy techniques.

Frênulo labial superior e inferior: estudo clínico quanto a morfologia e local de inserçäo e sua influência na higiene bucal / Superior and inferior labial frenulum: clinical study of morphology, position of attachment, and influence on oral hygiene

Foi realizada uma pesquisa visando a valiaçäo morfológica e o local de inserçäo dos frênulos labiais superiores e inferiores. A amostra foi constituída de 100 pacientes em condiçöes sócio-econômicas semelhantes, tendo-se observado que o frênulo labial simples foi o mais prevalente, inserindo o superior na gengiva inserida e o inferior, na mucosa alveolar. A distância média da inserçäo, em relaçäo à borda gengival livre, foi de 4,4 mm para o superior e de 5,6 mm para o inferior. Foi possível, nessas áreas, manter o controle clínico da placa bacteriana

Estudo da morfologia do freio labial superior em escolares de Säo José dos Campos / Study of the morphology of the upper labial frenum in students of the Säo José dos Campos city

O objetivo desta pesquisa foi estudar a variaçäo da morfologia do freio labial superior, em relaçäo à raça e ao sexo. A amostra foi constituída por 702 pacientes, escolares de Säo José dos Campos, na faixa etária de 7 a 10 anos, dos quais 303 säo do sexo masculino e 399 do feminino. Desses, 626 eram da raça branca e 76, da negra. Os resultados obtidos, segundo a metodologia aplicada, permitiram concluir que o freio tipo A foi o mais prevalente, tanto para o sexo masculino (66,34 por cento), como para o feminino (73,18 por cento); seguido pelo freio tipo D (21,78 por cento para o sexo masculino e 17,79 por cento para o feminino). O mesmo ocorreu em relaçäo à raça, em que encontramos uma prevalência de 69,00 por cento para o freio tipo A na raça branca e 80,26 por cento na raça negra, seguido pelo freio tipo D (20,45 por cento para a raça branca e 11,84 por cento para a raça negra). A aplicaçäo do teste x² demonstrou haver uma diferença estatisticamente significante (x² = 5,152) para o freio com apêndice, tipo C, em relaçäo ao sexo. Com relaçäo à raça, näo ocorreram diferenças estatisticamente significantes na freqüência dos vários tipos morfológicos do freio labial superior

Frenectomia / Frenectomy

Os autores fazem uma revisão de literatura, enfocando os aspectos anatômicos e funcionais do freio e a possível interferência deste na saúde periodontal

A importância do freio labial nas estruturas periodontais / The importance of labial frenum in the periodontal structures

Foi analisada na literatura a importância do freio labial nas estruturas periodontais, bem como as discordâncias que ocorrem entre os autores

The superior labial frenum: a histologic observation.

Superior labial frena obtained from cadavers or frenectomies were examined histologically. The frena were covered by stratified squamous nonkeratotic, orthokeratotic, or parakeratotic epithelia, depending upon the gingival extent of the frenum. In addition to the normal components of dense, irregular, collagenous connective tissue, almost all frena contained myelinated nerve fiber bundles and small vascular channels. Additionally, 35% of the frena examined contained a few small skeletal muscle fibers.

Histologic survey of the frena of the oral cavity.

The literature shows an apparent lack of agreement concerning the histologic morphology of the frena of the oral cavity, particularly relating to the presence or absence of skeletal or striated muscle. The purpose of this study was to do a histologic retrospective analysis of 40 oral frenal biopsy specimens. The results of the study showed that approximately 37.5% of the frena investigated contained skeletal or striated muscle.

The frenulum labii inferioris laterale.

A lateral counterpart to the frenulum of the lower lip, located between the dens caninus and the area of the angle of the mouth is reviewed. Anatomical considerations are discussed and the term frenulum labii inferioris laterale is suggested.