The maxillary labial fraenum: A controversy of oral surgeons vs. orthodontists

The maxillary labial fraenum is a normal anatomic structure in the oral cavity, formed by mucous membrane and connective tissue. Although it is a normal structure, its presence has been associated with some unpleasant and even pathological situations. Specifically, a thick, hypertrophic or broad fibrous fraenum has been accused of causing a maxillary midline diastema, interfering with plaque removal, causing tension and gingival recession. A surgical removal of the fraenum is indicated in order to prevent these situations or facilitate orthodontic closure of the diastema. Frenectomy is the complete removal of the fraenum, including its attachment to the underlying bone. As shown in the literature there has been a controversy among researchers regarding the need of frenectomy and the time of the surgery. The purpose of this study was to demonstrate the controversy of researchers regarding the removal of the maxillary labial fraenum, as a result of the study of the literature. Additionally, there has been an attempt to suggest the appropriate therapeutic strategy and indications for frenectomy, counting the medical experience and the patient's needs. At the beginning of the study, it was important to cite the characteristics of normal and abnormal fraenum and consequences that presence of a pathological fraenum causes. Finally, there is a brief description of the most important surgical techniques for removal of the maxillary labial fraenum.