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. 2018 May-Jun;22(3):257-262.
doi: 10.4103/jisp.jisp_294_17.

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

Elayadath Rajagopalan Rajani  1 , Palakunnu Padmaprabha Biswas  2 , Rishi Emmatty  3
Affiliations

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

Elayadath Rajagopalan Rajani et al. J Indian Soc Periodontol. 2018 May-Jun.

Abstract

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.

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Conflict of interest statement

There are no conflicts of interest.

Figures

Figure 1
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
Figure 2
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
Figure 3
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
Figure 4
Figure 4
Wide frenum in Class I, Class II, and Class III skeletal pattern
See this image and copyright information in PMC

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