Association between superior labial frenum and maxillary midline diastema - a systematic review

Int J Pediatr Otorhinolaryngol. 2022 May;156:111063. doi: 10.1016/j.ijporl.2022.111063. Epub 2022 Feb 26.


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.

Results/discussion: 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.

Keywords: Diastema; Frenectomy; Frenotomy; Frenulum; Frenum; Maxillary midline diastema; Midline diastema.

Publication types

  • Review
  • Systematic Review

MeSH terms

  • Child
  • Diastema* / etiology
  • Humans
  • Incisor
  • Labial Frenum* / surgery
  • Recurrence