Frenulumun Periodontal Denge Üzerindeki Rolü: Anatomiden Biyolojik Risk Modeline
Özet
Frenulum bağlantısının periodontal dokular üzerindeki etkisi, güncel periodontal yaklaşım çerçevesinde yeniden değerlendirilen konular arasında yer almaktadır. Geleneksel olarak sınırlı klinik öneme sahip anatomik bir yapı olarak kabul edilen frenulumun, bazı bireylerde periodontal stabiliteyi etkileyebilecek biyomekanik ve morfolojik bir değişken olarak ele alınması gerektiği düşünülmektedir. Özellikle koronal yerleşimli, fonksiyon sırasında gerilim oluşturan veya yetersiz keratinize doku, ince periodontal fenotip, plak birikimi ve inflamasyon gibi ek duyarlılık faktörleriyle birlikte bulunan frenulum bağlantılarının klinik açıdan daha anlamlı olabileceği bildirilmektedir. Bu kapsamda frenulumun gingival çekilme, orta hat diasteması, plak retansiyonu ve ortodontik stabilite ile ilişkisi güncel literatür doğrultusunda incelenmektedir. Temel yaklaşım, frenulumun tek başına primer etiyolojik bir unsur olarak değil, bireysel biyolojik ve klinik koşullar içinde değerlendirilmesi gereken modifiye edici bir risk bileşeni olarak yorumlanmasıdır. Bu doğrultuda, rutin ve profilaktik cerrahi girişimler yerine seçici, kanıta dayalı ve hasta odaklı klinik karar verme anlayışı ön plana çıkarılmaktadır.
The influence of frenum attachment on periodontal tissues has become an increasingly relevant topic within contemporary periodontal concepts. Traditionally regarded as an anatomical structure of limited clinical importance, the frenum is now considered a potential biomechanical and morphologic variable that may affect periodontal stability in selected individuals. Frenum attachments that are coronally positioned, functionally active, or associated with additional susceptibility factors such as insufficient keratinized tissue, a thin periodontal phenotype, plaque accumulation, and inflammation may have greater clinical significance. In this context, the relationship of the frenum with gingival recession, midline diastema, plaque retention, and orthodontic stability is examined in light of current evidence. The main perspective of this chapter is that the frenum should not be interpreted as an isolated primary etiologic factor, but rather as a modifying risk component that must be assessed within the individual biological and clinical context. Accordingly, emphasis is placed on selective, evidence-based, and patient-centered clinical decision making instead of routine prophylactic surgical intervention.
Referanslar
Caton JG, Armitage G, Berglundh T, Chapple ILC, Jepsen S, Kornman KS, et al. A new classification scheme for periodontal and peri-implant diseases and conditions—Introduction and key changes from the 1999 classification. J Periodontol. 2018;89(Suppl 1):S1–S8. doi:10.1002/JPER.18-0157.
Tugnait A, Clerehugh V. Gingival recession—its significance and management. J Dent. 2001;29(6):381–393. doi:10.1016/S0300-5712(01)00024-0.
Cortellini P, Bissada NF. Mucogingival conditions in the natural dentition: Narrative review, case definitions, and diagnostic considerations. J Clin Periodontol. 2018;45(Suppl 20):S190–S198. doi:10.1111/jcpe.12952.
Chapple ILC, Van der Weijden F, Doerfer C, Herrera D, Shapira L, Polak D, et al. Primary prevention of periodontitis: managing gingivitis. J Clin Periodontol. 2015;42(Suppl 16):S71–S76. doi:10.1111/jcpe.12366.
Jepsen S, Caton JG, Albandar JM, Bissada NF, Bouchard P, Cortellini P, et al. Periodontal manifestations of systemic diseases and developmental and acquired conditions: Consensus report of Workgroup 3 of the 2017 World Workshop. J Periodontol. 2018;89(Suppl 1):S237–S248. doi:10.1002/JPER.17-0733.
Cairo F, Nieri M, Cincinelli S, Mervelt J, Pagliaro U. The interproximal clinical attachment level to classify gingival recessions and predict root coverage outcomes: An explorative and reliability study. J Clin Periodontol.2011;38(7):661–666. doi:10.1111/j.1600-051X.2011.01732.x.
Chambrone L, Tatakis DN. Periodontal soft tissue root coverage procedures: A systematic review from the AAP Regeneration Workshop. J Periodontol. 2015;86(Suppl 2):S8–S51. doi:10.1902/jop.2015.130674.
Wennström JL. Mucogingival considerations in orthodontic treatment. Semin Orthod. 1996;2(1):46–54. doi:10.1016/S1073-8746(96)80018-2.
Lin GH, Chan HL, Wang HL. The significance of keratinized mucosa on implant health: A systematic review. J Periodontol. 2013;84(12):1755–1767. doi:10.1902/jop.2013.120688.
Kao RT, Pasquinelli K. Mucogingival considerations in orthodontic treatment. Dent Clin North Am.2007;51(2):273–286. doi:10.1016/j.cden.2006.12.006.
Barootchi S, Tavelli L, Di Gianfilippo R, Majzoub J, Wang HL. Soft tissue phenotype modification predicts gingival margin stability: A systematic review and meta-analysis. J Clin Periodontol. 2022;49(6):560–572. doi:10.1111/jcpe.13641.
Newman MG, Takei HH, Klokkevold PR, Carranza FA (eds). Carranza’s Clinical Periodontology. (Mukogingival deformities/conditions; frenal pull–related değerlendirme; keratinize doku ve yumuşak doku cerrahileri bölümleri). 13th ed. St. Louis: Elsevier; 2019.
Miron RJ, Sculean A (eds). Periodontal and Implant Therapy: Advances in Regenerative and Reconstructive Approaches. (Büyüme faktörleri, kollajen matriksler, rejeneratif biyomateryaller ve doku mühendisliği bölümleri). Hoboken: Wiley-Blackwell; 2019.
Lang NP, Löe H. The relationship between the width of keratinized gingiva and gingival health. J Periodontol.1972;43(10):623–627. doi:10.1902/jop.1972.43.10.623.
Mangano F, Gandolfi A, Luongo G, Logozzo S. Intraoral scanners in dentistry: a review of the current literature. BMC Oral Health. 2017;17:149. doi:10.1186/s12903-017-0442-x.
Placek M, Skach M, Mrklas L. Significance of the labial frenum attachment in periodontal disease in man. Part I. Classification and epidemiology of the labial frenum attachment. J Periodontol. 1974;45(12):891–894.
Huang WJ, Creath CJ. The midline diastema: a review of its etiology and treatment. J Am Dent Assoc.1995;126(11):1489–1497. doi:10.14219/jada.archive.1995.0097.
Moyers RE. Handbook of Orthodontics. (Midline diastema gelişimi, büyüme ile spontan kapanma ve frenulumun gelişimsel değişimi bölümleri). 4th ed. Chicago: Year Book Medical Publishers; 1988.
Steiner GG, Pearson JK, Ainamo J. Changes of the marginal periodontium as a result of labial tooth movement in monkeys. J Periodontol. 1981;52(6):314–320. doi:10.1902/jop.1981.52.6.314.
Roccuzzo M, Grusovin MG, Feletto F, Dalmasso P, Aglietta M. Soft tissue conditions and marginal bone loss around implants: A systematic review. Clin Oral Implants Res. 2012;23(Suppl 6):23–38. doi:10.1111/j.1600-0501.2012.02508.x.
Siaw TL, Hashimoto K, Meehan C, Hayashi Y, Hasegawa M. Intraoral scanning of soft tissues: A scoping review. J Prosthodont Res. 2025;69(4):583–595. doi:10.2186/jpr.JPR_D_24_00156.
Bibin L, Nithin S, Nair AS, Wadhwa J, Dutta S, John A. Artificial intelligence in periodontology: A scoping review. J Periodontol. 2023;94(2):155–172. doi:10.1002/JPER.22-0317.
Referanslar
Caton JG, Armitage G, Berglundh T, Chapple ILC, Jepsen S, Kornman KS, et al. A new classification scheme for periodontal and peri-implant diseases and conditions—Introduction and key changes from the 1999 classification. J Periodontol. 2018;89(Suppl 1):S1–S8. doi:10.1002/JPER.18-0157.
Tugnait A, Clerehugh V. Gingival recession—its significance and management. J Dent. 2001;29(6):381–393. doi:10.1016/S0300-5712(01)00024-0.
Cortellini P, Bissada NF. Mucogingival conditions in the natural dentition: Narrative review, case definitions, and diagnostic considerations. J Clin Periodontol. 2018;45(Suppl 20):S190–S198. doi:10.1111/jcpe.12952.
Chapple ILC, Van der Weijden F, Doerfer C, Herrera D, Shapira L, Polak D, et al. Primary prevention of periodontitis: managing gingivitis. J Clin Periodontol. 2015;42(Suppl 16):S71–S76. doi:10.1111/jcpe.12366.
Jepsen S, Caton JG, Albandar JM, Bissada NF, Bouchard P, Cortellini P, et al. Periodontal manifestations of systemic diseases and developmental and acquired conditions: Consensus report of Workgroup 3 of the 2017 World Workshop. J Periodontol. 2018;89(Suppl 1):S237–S248. doi:10.1002/JPER.17-0733.
Cairo F, Nieri M, Cincinelli S, Mervelt J, Pagliaro U. The interproximal clinical attachment level to classify gingival recessions and predict root coverage outcomes: An explorative and reliability study. J Clin Periodontol.2011;38(7):661–666. doi:10.1111/j.1600-051X.2011.01732.x.
Chambrone L, Tatakis DN. Periodontal soft tissue root coverage procedures: A systematic review from the AAP Regeneration Workshop. J Periodontol. 2015;86(Suppl 2):S8–S51. doi:10.1902/jop.2015.130674.
Wennström JL. Mucogingival considerations in orthodontic treatment. Semin Orthod. 1996;2(1):46–54. doi:10.1016/S1073-8746(96)80018-2.
Lin GH, Chan HL, Wang HL. The significance of keratinized mucosa on implant health: A systematic review. J Periodontol. 2013;84(12):1755–1767. doi:10.1902/jop.2013.120688.
Kao RT, Pasquinelli K. Mucogingival considerations in orthodontic treatment. Dent Clin North Am.2007;51(2):273–286. doi:10.1016/j.cden.2006.12.006.
Barootchi S, Tavelli L, Di Gianfilippo R, Majzoub J, Wang HL. Soft tissue phenotype modification predicts gingival margin stability: A systematic review and meta-analysis. J Clin Periodontol. 2022;49(6):560–572. doi:10.1111/jcpe.13641.
Newman MG, Takei HH, Klokkevold PR, Carranza FA (eds). Carranza’s Clinical Periodontology. (Mukogingival deformities/conditions; frenal pull–related değerlendirme; keratinize doku ve yumuşak doku cerrahileri bölümleri). 13th ed. St. Louis: Elsevier; 2019.
Miron RJ, Sculean A (eds). Periodontal and Implant Therapy: Advances in Regenerative and Reconstructive Approaches. (Büyüme faktörleri, kollajen matriksler, rejeneratif biyomateryaller ve doku mühendisliği bölümleri). Hoboken: Wiley-Blackwell; 2019.
Lang NP, Löe H. The relationship between the width of keratinized gingiva and gingival health. J Periodontol.1972;43(10):623–627. doi:10.1902/jop.1972.43.10.623.
Mangano F, Gandolfi A, Luongo G, Logozzo S. Intraoral scanners in dentistry: a review of the current literature. BMC Oral Health. 2017;17:149. doi:10.1186/s12903-017-0442-x.
Placek M, Skach M, Mrklas L. Significance of the labial frenum attachment in periodontal disease in man. Part I. Classification and epidemiology of the labial frenum attachment. J Periodontol. 1974;45(12):891–894.
Huang WJ, Creath CJ. The midline diastema: a review of its etiology and treatment. J Am Dent Assoc.1995;126(11):1489–1497. doi:10.14219/jada.archive.1995.0097.
Moyers RE. Handbook of Orthodontics. (Midline diastema gelişimi, büyüme ile spontan kapanma ve frenulumun gelişimsel değişimi bölümleri). 4th ed. Chicago: Year Book Medical Publishers; 1988.
Steiner GG, Pearson JK, Ainamo J. Changes of the marginal periodontium as a result of labial tooth movement in monkeys. J Periodontol. 1981;52(6):314–320. doi:10.1902/jop.1981.52.6.314.
Roccuzzo M, Grusovin MG, Feletto F, Dalmasso P, Aglietta M. Soft tissue conditions and marginal bone loss around implants: A systematic review. Clin Oral Implants Res. 2012;23(Suppl 6):23–38. doi:10.1111/j.1600-0501.2012.02508.x.
Siaw TL, Hashimoto K, Meehan C, Hayashi Y, Hasegawa M. Intraoral scanning of soft tissues: A scoping review. J Prosthodont Res. 2025;69(4):583–595. doi:10.2186/jpr.JPR_D_24_00156.
Bibin L, Nithin S, Nair AS, Wadhwa J, Dutta S, John A. Artificial intelligence in periodontology: A scoping review. J Periodontol. 2023;94(2):155–172. doi:10.1002/JPER.22-0317.
