Association between maxillary labial frenulum morphology and gingival health, midline diastema and anterior caries in children

To investigate the distribution of various morphological types of the maxillary labial frenulum in children between 2 and 13 years of age and to evaluate the association between frenulum morphology and dentition stage, gingival health, presence of midline diastema, and caries in the maxillary anterior teeth. This cross-sectional study enrolled 381 children aged 2–13 years from the Pediatric Dentistry clinics of Izmir Tınaztepe University and Ege University Faculty of Dentistry. Parental written informed consent and ethical approval were obtained. Frenulum morphology was classified according to Mirko (mucosal, gingival, papillary, or papilla penetrating). Dentition stage (primary, mixed, or permanent), gingival health (Löe & Silness Gingival Index), and the presence of midline diastema and maxillary anterior caries (present/absent) were recorded. Data were analyzed using SPSS version 27.0, with associations between categorical variables examined using Pearson’s chi-square or Fisher’s exact tests ( p < 0.05). The study sample of 381 children consisted of 51.4% girls and 48.6% boys, with a mean age of 7.58 ± 2.46 years. Primary dentition was present in 29.9% of participants, mixed dentition in 63.8%, and permanent dentition in 6.3%. The most common frenulum types were papillary (37.2%) and gingival (36.5%), followed by mucosal (17.2%) and papilla penetrating (9.1%). Maxillary midline diastema was detected in 47.1% of children, and caries in the upper anterior teeth in 28.1%. The most frequent gingival index score was 1 (58.3%). Frenulum type was significantly associated with dentition stage ( p = 0.006) and the presence of midline diastema ( p < 0.001). Specifically, the papilla penetrating frenulum type was significantly more common among children with midline diastema ( p < 0.001). Different frenulum types were most frequently observed during the mixed dentition stage. No significant association was found between frenulum type and gender ( p = 0.470), gingival index ( p = 0.748), or maxillary anterior caries ( p = 0.120). A significant association was also observed between higher gingival index scores and increased caries prevalence ( p < 0.001). This cross-sectional study demonstrated a significant association between maxillary labial frenulum morphology and both dentition stage and the presence of maxillary midline diastema in children aged 2 to 13 years. The papilla penetrating frenulum type was significantly more common among children with midline diastema. Different frenulum types were most frequently observed during the mixed dentition stage. However, no significant association was found between frenulum type and gingival index scores or the presence of caries in the maxillary anterior teeth. These findings indicate that frenulum morphology is associated with certain clinical parameters, particularly dentition stage and midline diastema, but not with gingival inflammation or anterior caries in this study population.