Vol 76, No 3 (2017)
Original article
Published online: 2016-12-20

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Diastema size and type of upper lip midline frenulum attachment

A. Sękowska1, R. Chałas2
Pubmed: 28026850
Folia Morphol 2017;76(3):501-505.


Background: Diastema is a space between teeth. The most often is maxillary midline diastema between upper central incisors. One of the main causes of diastema is enlarged upper lip frenulum attachment. The aim of the study was to assess frenulum attachment in patients with diastema and investigate if type of upper lip frenulum attachment has an impact on the width of diastema.

Materials and methods: Upper lip frenulum attachment was assessed clinically in two groups of adult patients: study group with diastema and control group without diastema. Moreover the width of diastema was measured on plaster models of dentition. The results were statistically analysed.

Results: In study material the most often was diastema in range more than 2 mm. There were statistically significant differences between study and control group in upper lip frenulum attachment (p < 0.05). Normal frenulum attachment (mucosal or gingival) was typical for group without diastema, but enlarged frenulum (papillary or papilla penetrating) was characteristic for diastema group. Type of frenulum had significant (p < 0.05) impact to the width of diastema. Small diastema (≤ 2 mm) more often coexisted with normal frenulum. Oversized frenulum was observed in the big diastema (> 2 mm).

Conclusions: Patients with diastema have more often oversized upper lip frenulum attachment then patients without diastema. The most often type of frenulum in patients with diastema is papillary and papilla penetrating type. Type of upper lip frenulum attachment has an impact to the size of diastema.

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  1. Andrews LF. The six keys to normal occlusion. Am J Orthod. 1972; 62(3): 296–309.
  2. Attia Y. Midline diastemas: closure and stability. Angle Orthod. 1993; 63(3): 209–212, doi: 10.1043/0003-3219(1993)063<0209:MDCAS>2.0.CO;2.
  3. Bednarz W, Bednarz B. Zabieg frenulektomii częścią periodontologiczno-ortodontycznego leczenia diastemy prawdziwej. Mag Stomatol. 2014; 24: 20–26.
  4. Bednarz W, Sokołowski B. Kompleks śluzówkowo-dziąsłowy w wieku rozwojowym. e-Dentico. 2007; 1: 58–64.
  5. Bernabé E, Flores-Mir C. Influence of anterior occlusal characteristics on self-perceived dental appearance in young adults. Angle Orthod. 2007; 77(5): 831–836.
  6. Bhattacharya P, Raju PS, Bajpai A. Prognosis v/s etiology: midline papilla reconstruction after closure of median diastema. Ann Essences Dent. 2011; 3(1): 37–40.
  7. Bjork A, Krebs A, Solow B. A method for epidemiological registration of malocclusion. Acta Odontol Scand. 1964; 22: 27–41.
  8. Brunelle JA, Bhat M, Lipton JA. Prevalence and distribution of selected occlusal characteristics in the US population, 1988-1991. J Dent Res. 1996; 75 Spec No: 706–713.
  9. Choi SH, Kim JS, Cha JY, et al. Effect of malocclusion severity on oral health-related quality of life and food intake ability in a Korean population. Am J Orthod Dentofacial Orthop. 2016; 149(3): 384–390.
  10. Chu CH, Zhang CF, Jin LJ. Treating a maxillary midline diastema in adult patients: a general dentist's perspective. J Am Dent Assoc. 2011; 142(11): 1258–1264.
  11. Delli K, Livas C, Sculean A, et al. Facts and myths regarding the maxillary midline frenum and its treatment: a systematic review of the literature. Quintessence Int. 2013; 44(2): 177–187.
  12. Díaz-Pizán ME, Lagravère MO, Villena R. Midline diastema and frenum morphology in the primary dentition. J Dent Child (Chic). 2006; 73(1): 11–14.
  13. España P, Tarazona B, Paredes V. Smile esthetics from odontology students' perspectives. Angle Orthod. 2014; 84(2): 214–224.
  14. Farronato G, Salvadori S, Giannini L, et al. Congenital macroglossia: surgical and orthodontic management. Prog Orthod. 2012; 13(1): 92–98.
  15. Gkantidis N, Kolokitha OE, Topouzelis N. Management of maxillary midline diastema with emphasis on etiology. J Clin Pediatr Dent. 2008; 32(4): 265–272.
  16. Harris EF, Glassell BE. Sex differences in the uptake of orthodontic services among adolescents in the United States. Am J Orthod Dentofacial Orthop. 2011; 140(4): 543–549.
  17. Huang WJ, Creath CJ. The midline diastema: a review of its etiology and treatment. Pediatr Dent. 1995; 17(3): 171–179.
  18. Joneja P, Pal V, Tiwari M, et al. Factors to be considered in treatment of midline diastema. Int J Curr Pharm Res. 2013; 5: 1–3.
  19. Kadouch DJM, Maas SM, Dubois L, et al. Surgical treatment of macroglossia in patients with Beckwith-Wiedemann syndrome: a 20-year experience and review of the literature. Int J Oral Maxillofac Surg. 2012; 41(3): 300–308.
  20. Kerosuo H, Hausen H, Laine T, et al. The influence of incisal malocclusion on the social attractiveness of young adults in Finland. Eur J Orthod. 1995; 17(6): 505–512.
  21. Kokich VO, Kokich VG, Kiyak HA. Perceptions of dental professionals and laypersons to altered dental esthetics: asymmetric and symmetric situations. Am J Orthod Dentofacial Orthop. 2006; 130(2): 141–151.
  22. Korkut B, Yanikoglu F, Tagtekin D. Direct midline diastema closure with composite layering technique: a one-year follow-up. Case Rep Dent. 2016; 2016: 6810984.
  23. Krooks L, Pirttiniemi P, Kanavakis G, et al. Prevalence of malocclusion traits and orthodontic treatment in a Finnish adult population. Acta Odontol Scand. 2016; 74(5): 362–367.
  24. Marques LS, Filogônio CA, Filogônio CB, et al. Aesthetic impact of malocclusion in the daily living of Brazilian adolescents. J Orthod. 2009; 36(3): 152–159.
  25. Mattos CT, da Silva DL, Ruellas AC. Relapse of a maxillary median diastema: closure and permanent retention. Am J Orthod Dentofacial Orthop. 2012; 141(1): e23–e27.
  26. Moffitt AH, Raina J. Long-term bonded retention after closure of maxillary midline diastema. Am J Orthod Dentofacial Orthop. 2015; 148(2): 238–244.
  27. Oesterle LJ, Shellhart WC. Maxillary midline diastemas: a look at the causes. J Am Dent Assoc. 1999; 130(1): 85–94.
  28. Onyeaso C. Prevalence of malocclusion among adolescents in Ibadan, Nigeria. Am J Orthod Dentofac Orthop. 2004; 126(5): 604–607.
  29. Placek M, Skach M, Lubor M. Significance of the Labial Frenum Attachment in Periodontal Disease in Man. Part 1. Classification and Epidemiology of the Labial Frenum Attachment. J Periodontol. 1974; 45(12): 891–894.
  30. Scapini A, Feldens CA, Ardenghi TM, et al. Malocclusion impacts adolescents' oral health-related quality of life. Angle Orthod. 2013; 83(3): 512–518.
  31. Shashua D, Artun J. Relapse after orthodontic correction of maxillary median diastema: a follow-up evaluation of consecutive cases. Angle Orthod. 1999; 69(3): 257–263, doi: 10.1043/0003-3219(1999)069<0257:RAOCOM>2.3.CO;2.
  32. Sullivan TC, Turpin DL, Artun J. A postretention study of patients presenting with a maxillary median diastema. Angle Orthod. 1996; 66(2): 131–138, doi: 10.1043/0003-3219(1996)066<0131:APSOPP>2.3.CO;2.
  33. Thilander B, Pena L, Infante C, et al. Prevalence of malocclusion and orthodontic treatment need in children and adolescents in Bogota, Colombia. An epidemiological study related to different stages of dental development. Eur J Orthod. 2001; 23(2): 153–167.
  34. Tyrologou S, Koch G, Kurol J. Location, complications and treatment of mesiodentes--a retrospective study in children. Swed Dent J. 2005; 29(1): 1–9.
  35. Wacińska Dr, Zadurska M, Zwierzchowska H. Wędzidełka wargi górnej – w aspekcie ortodoncji, periodontologii, protetyki i estetyki. Nowa Stom. 2007; 12: 134–138.
  36. Witt M, Flores-Mir C. Laypeople’s preferences regarding frontal dentofacial esthetics. J Am Dent Assoc. 2011; 142(6): 635–645.