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.
The influence of the maxillary labial frenum in relation to the midline diastema has been a proven fact to clinicians for many years. A pilot study was carried out to investigate the relationship between a low maxillary labial frenum attachment and skeletal malocclusions (class I, II, and III). Astonishingly, it was observed that the class III malocclusion had a statistically high number of cases with low frenum attachments. The objective of the study was to understand the underlying skeletal class III dysplasia in these cases. A comparative cross-sectional study was performed on 300 consecutive subjects between 13-30-years of age. Based on the cephalometric parameters the participants were categorized into 98 skeletal class I, 102 class II, and 100 class III subjects. Variations in the frenum attachment were clinically evaluated using Placek classification. The insertion level and width of the frenum were also measured by using a caliper and the data were statistically analyzed for determining the association between the frenum attachment and skeletal malocclusion. The prevalence of low frenum attachment in class III subjects was found to be 64%. Also, the mean attachment level of the frenum was significantly closer to the gingival margin in skeletal class III subjects compared with that of the other groups (p<0.01). The study identified that the subjects with a low frenum attachment had a tendency towards a retruded maxilla in terms of linear dimension. Therefore the present study supports the hypotheses that the skeletal Class III malocclusion may be associated with low frenum attachment.
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