A frenum or frenulum is a mucous tissue connecting the cheeks, tongue, or lips to the gum area (oral vestibule).
The classification of frenal attachments is based on the extent of attachment of fibers (Placek et al 1974):
-Mucosal attachment: The frenal attachment is positioned at the mucogingival junction.
-Gingival attachment: The frenal attachment is inserted within the attached gingiva.
-Papillary attachment: The frenal attachment extends up to the interdental papilla.
-Papilla penetrating attachment: The frenal attachment
crosses the alveolar process and extends up to the palatine papilla.
-The frenum pulls at the marginal gingiva
-The frenum hinders the hygiene
-The frenum is hypertrophic, unesthetic
-The frenum is associated with a periodontal pathology such as a recession, persistent inflammation, periodontal pocket
-The frenum is hypertrophic and associated with a diastema, requiring orthodontic treatment to close it
-The lingual frenum is short, limiting the mobility of the tongue
-The frenum prevents the creation of a stable removable prosthesis
Frenectomy indications in children:
A frenectomy is only indicated:
-After the eruption of the six anterior teeth
-After the age of 8 years old
-After verifying that the vertical facial bone development is normal
NB: As the age progresses, the frenum tends to migrate apically.
A frenum is not responsible for a periodontal pathology or diastema but may be an anatomical predisposing factor.
Diagnosing an abnormal frenum attachment:
-During the traction we have:
*Blanching around the alveolar attachment of the frenum due to ischemia or movement of the papillary tip
*Opening of the gingival sulcus
*Instability of a removable prosthesis
*Apical traction of tissue bordering a recession
-Frenum is associated with a lack of keratinous tissue
-Accumulation of plaque because brushing is difficult
-Papillary attachment associated with a diastema
-Frenectomy is the complete removal of the frenum, including its attachment to the underlying bone.
-Frenotomy is the incision and the relocation of the frenal attachment.