Lingual frenulum and malocclusion: An overlooked tissue or a minor issue

Abstract

As the grade of tongue-tie increased, its association with Classes I and II malocclusion decreased. The lower grades of tongue-tie are associated with increased lower incisor crowding. Shorter, tight frenulums are more associated with maxillary constriction, anterior open bite, and spacing of the lower anteriors.

Oral dysfunction as a cause of malocclusion

“…The frenulum's upper and lower insertion points, its thickness and flexibility and length of free anterior tongue all impact lingual range of motion and oral function. Ankyloglossia has been correlated with reduced inter‐canine and inter‐molar width, SMA, HNP, AOB, overjet and incisor spacing . The vertical lift to the hard palate, and not horizontal extension past the incisors, is the most accurate measure of normal lingual function …”

Aetiology, diagnosis and treatment of Ankyloglossia

“…It is important to note that as opposed to what one may think, greater teeth irregularities were observed in milder cases of AG. The reason is that frenulums with better mobility appear in grades I or II of AG and in this way the tongue is able to apply greater force on the incisors, contrary to types III or IV of AG where the tongue function is severely limited 19 .…”

“…In a study conducted by Vaz and Bai 19 , it became perceptible that children with AG may present maxillary protrusion and open bite. Normally while deglutition, the tongue elevates on the palate to create a seal, thus supporting it in order to obtain its normal shape.…”

“…In that case, especially if the mouth floor maintains its elasticity, it may not affect the tongue's normal mobility 8 . more, in cases of severe AG, the tongue is positioned lower in the mouth than normal, which may result in the disproportionate growth of the two jaws (growth of the maxilla is not stimulated as there is no or little contact with the tongue) and cause a Class III malocclusion 19 . It is important to note that as opposed to what one may think, greater teeth irregularities were observed in milder cases of AG.…”

“…Normally while deglutition, the tongue elevates on the palate to create a seal, thus supporting it in order to obtain its normal shape. In children with AG though, the short frenum restricts the upward movement of the tongue, which thrusts forward during swallowing, pressing the upper anteriors up and out 8,10,19 . What is open.…”