Morphology of maxillary labial frenum in primary, mixed, and permanent dentition of Indian children

Byline: Nandanahosur. Nagaveni, Kagathur. Umashankara

Background: Maxillary Labial frenum is a soft tissue structure that may exhibit the most diverse types. Objective: To estimate the incidence of different morphologic types of maxillary labial frenum in primary, mixed, and permanent dentitions of Indian children. Materials and Methods: A study was conducted involving 3000 Indian children. The 3000 children were divided into three groups (primary, mixed, and permanent dentition) according to the dentition of the patients with each group containing 1000 children. The maxillary labial frenum was examined and classified according to Sewerin's frenum typology using direct visual method. The data obtained was subjected to statistical analysis. Results: The most prevalent frenum types observed in all the threee groups (primary, mixed, and permanent dentition) were the simple frenum followed by persistent tectolabial frenum and frenum with nodule. The prevalence of simple frenum was found to be increased with age, while the persistent tectolabial frenum decreased proportionally. There was no statistically significant gender difference found with respect to the frenum morphology in all three groups. Conclusion: Simple frenum is the most prevalent morphologic type recorded in all the three groups studied, followed by persistent tectolabial frenum. The prevalence of simple frenum was found to increase with age, whereas the persistent tectolabial frenum decreased gradually. Dentists should give due importance for frenum assessment during oral examination of children to avoid misdiagnosis of normal variations as abnormal frenum.

Introduction

Maxillary labial frenum is one of the more interesting and often misunderstood soft tissue anatomic structure in the oral cavity. The frenum is also called superior labial frenum or frenulum labii superioris and provides stability and support for the upper lip. [sup][1],[2] In its composition, it consists of epithelium, collagen fibers, blood vessels and nerves, and sometimes few elements of minor salivary glands and isolated stratified muscle fibers. [sup][3] It has a wide and relatively deep origin or base on the inferior surface of the upper lip. It extends to the middle portion of the labial surface of the alveolar process, between the maxillary central incisors and here it is attached to the periosteum, the maxillary suture's connective tissue, and the alveolar process. [sup][1],[2],[3],[4]

Labial frenum is a dynamic and often changeable structure and is subject to variation in shape, size, and position during the different stages of growth and development. [sup][5],[6] During growth, it tends to decrease in size and lose clinical importance. [sup][7] In young children, the frenum is generally wide and thick, and during growth it becomes thin and small. [sup][8],[9]

Literature review reflects that maxillary labial frenum has diverse morphology and clinical implications. Sewerin [sup][10] has described eight types of normal variations of this frenum as simple, persistent tectolabial, simple with appendix, simple with nodule, double frenum, frenum with nichum, bifid frenum and frenum with two or more variations at the same time. Whereas, Placek in 1974 [sup][9] classified the maxillary frenum into types based on the attachment location. They are mucosal, gingival, papillary, and papillary penetrating. Among these, the last two...