Clinical Assessment of Diverse Frenum Morphology in Permanent Dentition

Clinical assessment of diverse frenum
morphology in Permanent dentition.

Pradnya V Kakodkar BDS, MDS Reader, Department of Preventive and Community Dentistry,
Dr.D.Y.Patil Dental College and Hospital Pimpri, Pune
Teja N Patel BDS Dental surgeon, Department of Preventive and Community Dentistry,
Shimul V Patel BDS Dental Surgeon, Department of Preventive and Community Dentistry,
Sapan H Patel BDS Dental surgeon, Department of Preventive and Community Dentistry,
Citation: P.V. Kakodkar, T.N. Patel, S.V. Patel, S.H. Patel: Clinical assessment of diverse
frenum morphology in Permanent dentition.. The Internet Journal of Dental Science. 2009
Volume 7 Number 2. DOI: 10.5580/417
Keywords: Superior Labial frenum, frenum morphology, abnormal frenum, Persistent
tectolabial frenum and permanent dentition
Abstract
Aim: To determine the different frenum morphology in permanent dentition.Material and
Method : The study was undertaken for 2 months . The frenum morphology was assessed
according to Modified Sewerins typology using the direct visual method under natural light and
was conducted by three investigators among 1206 school going children ( 637 males and 569
females) between 12 to 17 years of age from six schools in Pune city, Maharashtra. Descriptive
statistics were determined based on the collected data. Chi-square test was used to analyze the
sex-wise difference with respect to the frenum morphology at 5% level of significance.Results:
Superior labial frenum has diverse morphology. The most prevalent frenum observed was the
simple frenum(70.6%) followed by simple with nodule (17.6%) and Persistent
techtolabial(6.6%). There was no statistically significant sex-wise difference with respect to the
frenum morphology.
Introduction
Superior labial frenum is a membranous fold of mucous membrane which provides stability and
support for the upper lip. It is also called as Maxillary frenum or frenulum labii superioris. It
extends from the interior surface of the upper lip to the middle portion of the buccal surface of
the alveolar process between the central incisors. It is attached to the periosteums external
layer , the maxillary sutures connective tissue and the alveolar process 1 .
Most often, during the oral examination of the patient the dentist gives very little importance for
frenum examination , for assessing its morpholology and attachment. However it has been seen
that abnormal frenum can be an indicator of a syndrome 2 . An abnormal frenum attachment can
lead to frenal pull which may result in distension of gingival sulcus which in turn encourages
plaque accumulation and increases the severity of periodontal pockets 3 ; it may also prejudice
the denture fit or retention 3 ; it can serve as an etiology for midline diastema 34 ; can cause
recession 5 ; can interfere with effective toothbrushing leading to patients inability to remove
plaque 6 . A torn labial frenum can be a indicator of child abuse 7 . Biber JT 8 in his review
article has documented various complication resulting from oral piercings. Of the different
piercing sites in the mouth, maxillary labial frenum piercing 8 is also popular and can result in
complications 9 .
Literature review reveals that superior labial frenum has diverse morphology. However, only one
study by Diaz-Pizan et al 1 could be retrived which was conducted among the deciduous
dentition. Hence the aim of this present study was to determine the different morphology of
superior labial frenum in permanent dentition
Material and Methods

The study was undertaken for 2 months (20 th November 06 - 20 th December 2006) in six
schools which were the selected schools for the dental screening camp organized by the
Community Department, Dr.D.Y.Patil Dental College and Hospital, Pimpri, Pune. Prior
permission from the school authorities, parents and approval of the Institutional Ethics
committee to conduct the study was obtained. All the children present in the school, on the day
of the screening camp and willing to participate in the study constituted the study sample. The
clinical examination was conducted by 3 investigators ( SP, SP and TP, authors of the study) with
the help of an dental assistant . The direct visual method under natural light was used and
consisted of lifting the upper lip with the index finger and thumb of both hands. The morphology
of the superior labial frenum was classified according to Modified Sewerins typology 1 .
Statistical Analysis: Descriptive statistics ( frequency , percentage and proportion) were
determined by using Microsoft Excel-2003 on the data collected .Chi-square test was used to
analyze the sex-wise difference with respect to the frenum morphology at 5% level of
significance.
Results
The study sample consisted of 1206 school going children ( 637 males and 569 females) between
12 to 17 years of age from Pune city. The results of the study are summarized in Table 1.
Table 1. Sex-wise distribution of frenum morphology according to Modified Sewerins typology.

Table 1 illustrates the frequency and percentage of males and females with respect to the
different frenum morphology. The most prevalent frenum type was simple frenum followed by
simple with nodule and then Persistent Tectolabial. There was one subject with absent frenum,
double frenum and none with two or more frenum variations. There was no statistically
significant sex-wise difference with respect to the frenum morphology.
Fig 1-9 shows the different types of frenum morphology.
Fig 1. Simple frenum
Fig 2. Simple frenum with appendix
Fig 3. Simple frenum with nichum and a lateral labial frenum
Fig 4. Simple frenum with nodule
Fig 5. Simple frenum with nodule and a lateral labial frenum
Fig 6. Bifid labial frenum
Fig 7. Persistent Tectolabial frenum
Figure 8.- Double frenum
Figure 9- . Absence of labial frenum
Discussion
A modified Sewerins typology of frenum was employed since the majority of the studies viewed
this classification as practical, useful and easy to use 1 .
Only one study, carried out by Diaz-Pizan ME et al 1 could be retrieved from the literature for
comparison. The study design was similar but only differed with respect to the age of the sample
which was 0-6 years (deciduous dentition) as against permanent dentition in our study. Table 2
illustrates the comparison of results of the present study with that of the study by Diaz-Pizan ME
et al 1 .
Table 2. Comparison of the results of the present study with that of the study by Diaz-Pizan ME
et al 1
Overall the results were similar, with the most prevalent morphology been simple frenum. But
variation was noted with the persistent tectolabial frenum which was 25% as against 6.6% in our
study. This difference can be attributed to the difference in the age of the sample in the two
studies ( Deciduous dentition versus Permanent dentition). In younger children during the first
few years of age the prevalence of tectolabial frenum is high, but as the age advances (permanent
dentition) there is vertical growth of the alveolar ridges which allows the gingival insertion to
change position further away from the alveolar ridge. The gingival insertion increases and the
labial frenum decrease in size. Due to the primary dentition development and intra alveolar
eruption of the permanent maxillary incisors, there is a apical migration of the frenum insertion 1
. Hence, there is a high proportion of the persistent tectolabial frenum in the deciduous dentition
to evolve to normal during the permanent dentition.
The simple frenum with appendix, nichum, bifid type, double, with two or more variation and
the absent frenum are rarely found with less than 1% in the population. However the absent
frenum is associated with Holoprosencephaly 21011 . The bifid frenum is associated with W
Syndrome 2 .
Conclusion
This paper throws light on the fact that, although, superior labial frenum is a small anatomical
landmark in the oral cavity, it is found to have diverse morphology. The dentist needs to give due
importance for frenum assessment during oral examination.
Acknowledgement
The authors wish to thank the school authorities , parents and the school children for having cooperated in the study.
References
1. Diaz- Pizan ME ,Lagravere MO, Villena R .Midline diastema and frenum morphology in
primary dentition. J Dent Child(Chic)2006; 73 (1):11-14
2. Mintz SM, Siegel MA, Seider PJ. An overview of oral frena and their association with
multiple syndromes and nonsyndromic conditions. Oral Surgery Oral Medicine Oral Pathology
Oral Radiology Endodontics 2005; 99(3) : 321-24
3. Kaimenyi JT. Occurrence of midline diastema and frenum attachments amongst school
children in Nairobi, Kenya. Ind J Dent Res .1998 Apr-Jun;9(2) :67-71
4. Popovich F ,Thompson GW ,Main PA .The maxillary interincisal diastema and its relationship
to the superior labial frenum and intermaxilary suture .Angle Orthod 1977 ;47:265-71
5. Pushpavathi N ,Nayak RP . the effect of mouth breathing upper lip coverage , lip seal and
frenal attachment on the gingivae of 11-14 year old Indian school children . J Indian Soc Pedod
Prev Dent 1997 Sep; 15(3): 100-3.
6. Addy M, D ummer PM ,Hunter ML,Kingdon A, Shaw WC. A study of the association of
frenal attachment .lip coverage and vestibular depth with plaque and gingivitis. J Periodontal
1987 Nov; 58 (11): 752-57.
7. Macintyre DR ,Jones GM, Pinckney RC .The role of dental practitioner in the management of
non accidental injury to children.Br Dent J 1986;1616 ;3:108-110.
8. Biber JT. Oral piercing ; The Hole story .Northwest Dent 2003 Jan Feb ; 82(1);13-17.
9. Folz BJ, Lippert BM,Kuelkens C and Werner JA. Jewellery induced diseases of the head and
neck .Ann Plast Surg 2002 ; 49 (3):264-71.
10. Martin RA, Jones KL. Absence of the superior labial frenulum in holoprosencephaly : a new
diagnostic sign .J Pediatr 1998 Jul ; 133 (1): 151 -53.
11. Thakur S, Singh R, Pradhan M, Phadke SR. Spectrum of holoprosencephaly . Indian J Pediatr
2004 ; 71 (7): 593-97.

Clinical Assessment of Diverse Frenum Morphology in Permanent Dentition

Uploaded by

Copyright:

Available Formats

Clinical Assessment of Diverse Frenum Morphology in Permanent Dentition

Uploaded by

Document Information

Original Description:

Copyright

Available Formats

Share this document

Share or Embed Document

Sharing Options

Did you find this document useful?

Is this content inappropriate?

Copyright:

Available Formats

Clinical Assessment of Diverse Frenum Morphology in Permanent Dentition

Uploaded by

Copyright:

Available Formats

Clinical assessment of diverse frenum

morphology in Permanent dentition.

Material and Methods

Table 1. Sex-wise distribution of frenum morphology according to Modified Sewerins typology.

Fig 1. Simple frenum

Fig 2. Simple frenum with appendix

Fig 3. Simple frenum with nichum and a lateral labial frenum

Fig 4. Simple frenum with nodule

Fig 5. Simple frenum with nodule and a lateral labial frenum

Fig 6. Bifid labial frenum

Fig 7. Persistent Tectolabial frenum

Figure 8.- Double frenum

Figure 9- . Absence of labial frenum

You might also like