{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T01:43:44Z","timestamp":1760060624182,"version":"build-2065373602"},"reference-count":20,"publisher":"MDPI AG","issue":"9","license":[{"start":{"date-parts":[[2025,9,8]],"date-time":"2025-09-08T00:00:00Z","timestamp":1757289600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Dentistry Journal"],"abstract":"<jats:p>Background\/Objectives: The maxillary labial frenum (MLF) is a connective tissue structure attaching the upper lip to the maxillary alveolar process. Its morphology varies significantly among individuals and is often most prominent during early childhood. While hypertrophic or low-attaching frena have been associated with diastemas, feeding issues, and speech impairments, there is no causal evidence supporting early surgical intervention. This review aims to examine current evidence regarding the timing and necessity of frenectomy procedures and to evaluate the implications of early versus delayed intervention. Methods: A narrative review was conducted using twenty peer-reviewed articles published in the past 10 years, with one additional article from 2012 included for its ongoing relevance. Databases searched included PubMed, the NIH database, the Reference Manual of Pediatric Dentistry, and journals from the American Academy of Pediatrics. Inclusion criteria were English-language, peer-reviewed studies that addressed the morphology, classification, diagnosis, management, and outcomes of MLFs across age groups. Excluded were studies focusing solely on mandibular, buccal, or lingual frena; non-English publications; case reports; and articles lacking full-text availability. Results: The literature suggests that premature frenectomy, prior to the eruption of permanent maxillary canines, typically between 9 and 12 years of age, is associated with frenum regrowth, surgical complications, and orthodontic relapse. Additionally, a lack of standardized diagnostic criteria contributes to inconsistent clinical decision-making. Conservative management, including monitoring, is strongly recommended as the frenum often migrates apically as the maxilla develops. Factors such as airway obstruction and developmental delays should be ruled out before considering surgery. Conclusions: There is insufficient evidence to support early surgical intervention for MLF-related concerns. A conservative, individualized approach, delaying frenectomy until after permanent canine eruption, may minimize complications, improve long-term outcomes, and allow the frenum to migrate apically as the patient develops. Standardized diagnostic tools are urgently needed to guide clinical decision-making.<\/jats:p>","DOI":"10.3390\/dj13090414","type":"journal-article","created":{"date-parts":[[2025,9,9]],"date-time":"2025-09-09T12:15:17Z","timestamp":1757420117000},"page":"414","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Timing of Treatment for Patients with Hypertrophic Maxillary Labial Frena"],"prefix":"10.3390","volume":"13","author":[{"given":"Veronica Lexa","family":"Marr","sequence":"first","affiliation":[{"name":"College of Dental Medicine, Roseman University of Health Sciences, 10894 S. River Front Parkway, South Jordan, UT 84095, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Lauren Grace","family":"Stewart","sequence":"additional","affiliation":[{"name":"College of Dental Medicine, Roseman University of Health Sciences, 10894 S. River Front Parkway, South Jordan, UT 84095, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2827-3740","authenticated-orcid":false,"given":"Man","family":"Hung","sequence":"additional","affiliation":[{"name":"College of Dental Medicine, Roseman University of Health Sciences, 10894 S. River Front Parkway, South Jordan, UT 84095, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5985-6538","authenticated-orcid":false,"given":"Val Joseph","family":"Cheever","sequence":"additional","affiliation":[{"name":"College of Dental Medicine, Roseman University of Health Sciences, 10894 S. River Front Parkway, South Jordan, UT 84095, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2025,9,8]]},"reference":[{"key":"ref_1","unstructured":"American Academy of Pediatric Dentistry (2024). Policy on management of the frenulum in pediatric patients. Ref. Man. Pediatr. Dent., 73\u201378."},{"key":"ref_2","unstructured":"(2024, October 10). Frenum (Frenulum in Mouth). Available online: https:\/\/my.clevelandclinic.org\/health\/body\/frenum-mouth-frenulum."},{"key":"ref_3","first-page":"1587","article-title":"Frenectomy: A review with the reports of surgical techniques","volume":"6","author":"Devishree","year":"2012","journal-title":"J. Clin. Diagn. Res."},{"key":"ref_4","doi-asserted-by":"crossref","unstructured":"Inchingolo, A.M., Malcangi, G., Ferrara, I., Viapiano, F., Netti, A., Buongiorno, S., Latini, G., Azzollini, D., De Leonardis, N., and de Ruvo, E. (2023). Laser surgical approach of upper labial frenulum: A systematic review. Int. J. Environ. Res. Public Health, 20.","DOI":"10.3390\/ijerph20021302"},{"key":"ref_5","doi-asserted-by":"crossref","unstructured":"Kinney, R., Burris, R.C., Moffat, R., and Almpani, K. (2024). Assessment and management of maxillary labial frenum\u2014A scoping review. Diagnostics, 14.","DOI":"10.3390\/diagnostics14161710"},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"954","DOI":"10.1177\/0194599820913605","article-title":"Maxillary Frenulum in Newborns: Association with Breastfeeding","volume":"162","author":"Razdan","year":"2020","journal-title":"Otolaryngol. Head Neck Surg."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"786","DOI":"10.1016\/j.ajodo.2022.06.027","article-title":"Longitudinal changes of the insertion of the maxillary labial frenum in children and adolescents undergoing orthodontic treatment","volume":"163","author":"Schuepbach","year":"2023","journal-title":"Am. J. 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Otorhinolaryngol."}],"container-title":["Dentistry Journal"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2304-6767\/13\/9\/414\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,9]],"date-time":"2025-10-09T18:42:13Z","timestamp":1760035333000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2304-6767\/13\/9\/414"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,9,8]]},"references-count":20,"journal-issue":{"issue":"9","published-online":{"date-parts":[[2025,9]]}},"alternative-id":["dj13090414"],"URL":"https:\/\/doi.org\/10.3390\/dj13090414","relation":{},"ISSN":["2304-6767"],"issn-type":[{"type":"electronic","value":"2304-6767"}],"subject":[],"published":{"date-parts":[[2025,9,8]]}}}