An Insight into the Role of the Maxillary Labial Frenum in the Growth of the Maxilla: A Systematic Review

Abstract

Background: The review attempts to provide synthesis of published studies evaluating the influence of an aberrant frenum attached close to the gingival margin or with inadequate width of attached gingiva on the growth of the maxilla.Methodology: This review was reported using the PRISMA checklist as a template. PubMed, EBSCO and Google scholar were searched for in earlier publications up to January 2019. In addition, reference lists of the included studies were hand searched. The eligibility criteria were listed out based on Population, Intervention, Comparison, Outcome, Study type (PICOS) concept.Results: A total of 148 articles were found by database search strategies and 27 additional studies by hand search. Finally three cross sectional and one longitudinal study were selected based on the eligibility criteria. A meta-analysis was not justified. Risk of bias was assessed using AXIS tool for cross sectional studies and Newcastle-Ottawa scale for longitudinal study. Common weaknesses of the studies were failure to justify or calculate the sample size and insufficient statistical reporting.Conclusion: This review reveals that there is a need for methodologically standardized studies that will throw light on to the physiological importance of labial frenum in the growth of the nasomaxillary complex.