During or after the orthodontic closure, persistent diastemas are frequently the result of a high frenum attachment. A labial frenectomy is a complete removal of the frenum attachment, which typically attaches to the space between the upper two anterior teeth and the centre of the upper lip. It might be required if there is space between the teeth due to a frenulum positioned too high on the gums. Many surgical technique modifications, including Miller\'s technique, Z-plasty, and V-Y-plasty, have been established since the conventional classical frenectomy procedure was initially presented to cope with the difficulties associated with an aberrant labial frenum. This case report demonstrates that a Z-plasty approach was used to remove the 21-year-old female patient\'s high papillary-type labial frenum attachment and how orthodontic treatment led to the closure of the midline diastema. For several reasons, the frenectomy procedure with Z-plasty proved to be reliable and yielded outstanding aesthetic outcomes for the removal of the aberrant labial frenum connection. Understanding Z-plasty will enable primary intention-based tissue healing, reduce the risk of tissue contractures, shorten the patient\'s recovery, and enhance the patient\'s aesthetic outcomes.

BACKGROUND: Pediatric otolaryngologists have seen an increased focus on upper lip frenum as a possible culprit for feeding difficulties and the development of maxillary midline diastema (MMD). This increase may be encouraged by parents\' exposure to medical advice over the internet about breastfeeding and potential long-term aesthetic concerns for their children. Subsequently, there has been increased pressure on pediatric otolaryngologists to perform superior labial frenectomies. There has been a reported 10-fold increase in frenectomies since the year 2000. However, there is no consensus within the literature regarding the benefit of superior labial frenectomy in preventing midline diastema.
OBJECTIVE: To provide physicians and parents with the most updated information by systematically reviewing the available literature for the association between superior labial frenum and midline diastema.
METHODS: A literature search was performed in MEDLINE (PubMed), EMBASE, Web of Science, the Cochrane Library and Dental and Oral Sciences Source (DOSS). Using the Covidence platform, a systematic review was conducted. The initial 314 articles identified underwent systematic review and 11 studies were included in the final review.
CONCLUSIONS: Available data, primarily from the dental literature, showed that two subtypes of frenum: papillary and papillary penetrating frenum, are associated with maxillary midline diastema. Superior labial frenectomy should be delayed until permanent lateral incisors have erupted, as this can spontaneously close the physiological MMD. Current literature recommends against frenectomy before addressing the diastema with orthodontics, which helps to prevent diastema relapse. It is also imperative to rule out other odontogenic and oral cavity causes of diastema, such as thumb sucking, dental agenesis, and other causes. Online information may not always be fully representative and should be interpreted in the full context of the patient\'s medical history before referral for surgical intervention.

The health risks associated with aspiration and ingestion of foreign bodies in children are well known. The increased availability of magnetic toys have added to these risks. A 7-year-old girl presented at the Department of Maxillofacial and Oral Surgery at the University of Pretoria Oral and Dental Hospital with a complaint of pain under the tongue. Examination revealed that magnetic balls had been lodged on either side of the lingual frenum. The patient experienced pain and was unable to dislodge the magnets. This case report documents patient presentation and management and concludes with a brief discussion of potential complications associated with the oral intake of magnets. Though multiple cases documenting the complications associated with ingestion of magnets have been reported, reports of primary oral complications are scant. This case contributes to existing evidence for the dangers associated with high strength magnets used as toys by children.

OBJECTIVE: Frenum is a mucous membrane fold that attaches the lip and the cheek to the alveolar mucosa, gingiva, and the underlying periosteum. The frena may jeopardize the gingival health when they are attached too closely to the gingival margin, either due to interference in the plaque control or due to muscle pull. Identifying labial frenum attachment and its association with oral hygiene helps in primary prevention of gingival health. The purpose of this study was to examine the prevalence of the various types of maxillary labial frenum attachment and its association with oral hygiene status in adolescent population.
METHODS: A total of 300 adolescents between 13 and 18 years were selected randomly. They were clinically examined for maxillary frenum attachment. Placek\'s classification of the labial frenum attachments was used to check the origin of frenum. Oral hygiene index (simplified) was recorded and results were subjected to statistical analysis.
RESULTS: Among 300 examined children 53% were males and 47% were females. The prevalence of the maxillary labial frenum was gingival type (39%) followed by mucosal (28.3%), papillary (23.7%), and papillary penetrating type (9.0%). The gingival type of frenal attachment was statistically significant among different age of children and also between different types of frenal attachment and oral hygiene status (p value < 0.001). There was no significance between frenum attachment and gender.
CONCLUSIONS: The type of frenal attachment is strongly associated with oral hygiene status. as the age progresses the frenum tends to migrate apically. However, our study did not reveal any relationship between the gender and type of frenal attachment.

The frenum is a mucosal fold that attaches the lips or cheeks to the alveolar mucosa, gingiva, and underlying periosteum. Consequences of an abnormal frenal attachment include gingival recession, decreased vestibular depth, decreased range of lip movement, and involvement of interdental papilla, causing a diastema. Several methods to eliminate ectopic frenal attachments have been suggested, including frenectomy (elimination) and frenotomy (repositioning). This case report describes the use of a modified frenectomy technique in a 15-year-old girl with excess gingiva between the maxillary central incisors, which exhibited a 3-mm diastema. First, a semilunar primary incision was made in the palatal surface at a 5-mm distance from the tip of the papilla. Next, sulcular incisions were made around the tooth, and the papilla was transposed to the buccal via a papilla preservation flap. After complete elimination of frenal attachments in the bone, the flap was repositioned and sutured to the palatal surface. Afterward, the frenum was classically cut and sutured. Through this approach, the position of the frenum was changed apically without invading the papilla. At the 3-month follow-up, it was found that the modified technique (combination of papilla preservation flap and frenotomy) had minimized the surgical scar on the buccal surface, preserved the papilla, and yielded optimal esthetic results.

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.
OBJECTIVE: 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.
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.
CONCLUSIONS: 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.

BACKGROUND: The upper labial frenum is a normal anatomic structure with inherent morphological variations. Frenum has variations depending upon the attachment of fibers along with the presence of structural variations.
OBJECTIVE: The aim of this study was to evaluate the prevalence of frenal variations in a diverse ethnic population of Sundernagar, Himachal Pradesh.
METHODS: This study was conducted on 500 subjects within age group of 16-40 years (285 females, 215 males). Intraoral examination was done to evaluate the variations in frenum and photographs were taken.
RESULTS: In this study, depending upon structural variations, normal frenum was most common followed by frenum with nodule while frenum with appendix was found to be least common. However, no significant difference was found between males and females (P > 0.05) with respect to all frenal attachments. Furthermore, other structural variations were found in the diverse population of Sundernagar, Himachal Pradesh.
CONCLUSIONS: Upper labial frenum is a small anatomical landmark in the oral cavity found to have diverse morphology. The dentist needs to give due importance for frenum assessment during the oral examination.

Common treatment for buccal gingival recession caused by an aberrant frenal attachment includes elimination of the frenum and treatment of the gingival recession by soft tissue graft to increase the width of the attached gingiva that in turn results in root coverage. Keratinised gingival, if present in adequate amount, maintains the gingival health by protecting the marginal gingiva. This not only considers the desires of the patient but also explores the potential regenerative capacity of the tissues. This report describes a novel single-stage procedure for increasing the width of the attached gingiva and eliminating the aberrant frenal attachment.

BACKGROUND: The orofacial musculature plays a pivotal role in maintaining a balance in positioning of the teeth and any imbalance which occurs in this , results in malocclusion. Lingual frenum is a soft tissue structure which tethers the ventral surface of the tongue to the floor of the mouth.
OBJECTIVE: This study was performed to analyze the lingual frenal lengths in skeletal class I, class II and Class III malocclusion and to correlate relationship between both.
METHODS: This study comprised of 30 subjects, with 10 in each group and an impression was made with the maximum mouth opening position and the tip of tongue touching the incisive papilla. The length of the lingual frenum was then measured from the casts. The maximum mouth opening position was also determined by measuring the interincisal distance with the maximum mouth opening position. Statistical analysis was done to analyze the relationship between both.
RESULTS: The lingual frenum was found to be longest in class III malocclusion, with a statistical significant value of p<0.01. The class II and class I malocclusion did not show much difference. The maximum mouth opening position was also increased in class III malocclusion, followed by class II and class I malocclusion, in a descending order.
CONCLUSIONS: The lingual frenum exerts erratic forces and a long lingual frenum pushes the mandibular anteriors forwards, resulting in malocclusion. Hence, a relationship between the lingual frenum and malocclusion is essential, so that the erratic forces can be eliminated and excellent results can be achieved, following the correction of malocclusion.

Pathological tooth migration is a characteristic sign of an advanced form of chronic periodontitis. The etiology of pathological tooth migration is complex and multifactorial. Usually treatment of pathological migration includes a multidisciplinary approach. However, in some cases, spontaneous repositioning of the pathologically migrated teeth has been reported following periodontal therapy alone. In the present report, following periodontal surgery, there was a spontaneous repositioning of the migrated teeth and restoration of dento-facial esthetics. The treatment options in cases of pathological tooth migration, based on the severity, are also discussed.