The frenum is a muscular insert designed to connect the attachments of the oral cavity to the gum lining.
There are three of them, two labial (one for each lip) and one lingual.
They do not normally interfere with the normal disposition of the teeth or the performance of functions.
In particular situations, which occur in about 5% of the population, braces, due to their inappropriate position or length, disturb the normal functionality of the dento-maxillary apparatus.
Role
The function of the frenum is to maintain harmony between the lips, tongue and oral cavity from the time of fetal growth.
Labial frenulum
There are many situations where the frenum is present only on the upper lip. It is usually found on the midline, on the inner side of the lip.
If the insertion of the upper lip frenum is low, it can interfere with the growth and disposition of the in symbionts. Thus, most commonly, diastema occurs, the non-physiognomic space between the two central incisors.
The treatment that can be carried out in case of low frenum insertion is surgical removal.
Orthodontic closure of the resulting space is also ordered.
Closure of the interdental space before surgical removal of the frenum is indicated to prevent postoperative scar tissue from interfering with orthodontic treatment.
Lingual frenulum
It is placed on the underside (ventral) of the tongue; the other insertion is on the buccal floor.
Its conformation directly affects phonation and swallowing.
A common abnormality is the short frenum, which prevents the tongue from reaching the palate and thus, from childhood, underdevelopment of the hard palate occurs.
Functional implications of abnormal frenum
Changes in the position, structure or insertion of the frenum cause problems that affect the child from the newborn stage, with repercussions on the harmonious development of the whole body.
Feeding: during the act of swallowing, the tongue, by positioning itself on the hard palate, pushes the food bowl towards the lower digestive tract. If too short a lingual frenum prevents it from doing this, swallowing will be incomplete and ineffective.
Phonation: the limitation of the lips and tongue to make the full and wide movements necessary for effective phonation leads to poor pronunciation of some lip and tongue sounds.
Aesthetics: aesthetics may be affected by the development of diastema, found in conditions of a low upper lip frenum.
Self-cleaning: the tongue also has the role of mobilizing saliva, with a role in cleaning dental surfaces. If this function cannot be fulfilled, there is a very high chance of caries.
Orthodontic problems: malocclusion occurs and can be corrected by orthodontic treatment.
Social problems: the existence of diastema and poor pronunciation of certain sounds can affect the patient’s quality of social life.
Management of oral frenum anomalies
Surgical treatment of frenum anomalies is the generally accepted treatment.
Its invasiveness depends on the severity of the abnormality and the degree to which it impedes normal activities and can range from clearance incisions, which allow increased mobility of the adjacent structure or, more invasively, cutting, frenectomy of muscle fibers with repositioning.
Each case is different, the degree of damage to the functions of the dento-maxillary apparatus varies from one patient to another, which is why the treatment plan is carried out following consultation by specialists from several branches of dentistry.
