The relationship between the shape of the maxillary labial frenulum and a gummy smile and intraoral pathology

Relevance. An upper lip tie causes different pathological conditions. The popular aberrant frenulum classifications are ambiguous.The study aimed to assess different classifications of the maxillary labial frenulum in the context of a gummy smile, diastema, gingival recession and tissue ischemia relationship.Materials and methods. Photographs documented the type of smile and the pathological conditions of 41 patients aged 9 – 39 y.o. The study measured the maxillary central incisor height on the plaster model and compared the frontal view of the smile and the teeth to the size of the central incisor and with each other. Measurements were carried out.Results. A gummy smile is more common in individuals with a V-shaped frenulum independent of its width (61%, 14 patients, X2 = 13.06; p = 0.01) or in individuals with a wide frenulum independently of its shape (83%, 19 patients). 50% of all toothy smile cases are in the narrow frenulum group (69% in the group, nine patients). All cases with a lip tie (3 patients) showed a toothy smile (X2 = 10.29; p = 0.01). The group of the I-shaped frenulum attached at the gingival level demonstrated a diastema. Tissue ischemia is more prevalent in the group with the V-form frenulum, the frenulum ischemia and the attached gingiva or insertion point ischemia. It occurs separately from gingival recession only in V-shaped frenulum cases. The gingival recession prevails in X-shaped frenulum cases in the alveolar insertion point area (87.5%, four subjects) (p ≤ 0.05).Conclusion. The received data are paramount for decision-making about the necessary treatment technique.