Maxillary Labial Frenulum: A Scoping Review of Classification, Diagnosis and Evidence-Based Treatment

Purpose: The maxillary labial frenulum (MLF) has been implicated in clinical concerns, including breastfeeding difficulties, midline diastema and oral hygiene challenges. Despite multiple classification systems, a lack of consensus persists regarding the clinical significance of MLF variations and indications for surgical intervention. This review evaluates existing classification systems, diagnostic approaches and treatment considerations to provide an evidence-based framework for clinical decision-making. Methods: A literature search was conducted using PubMed, Scopus and EMBASE. Studies were screened through a multi-phase process and their quality was assessed using the Critical Appraisal Skills Program. Results: Sixteen studies met the inclusion criteria. Classification systems varied widely, with limited clinical applicability. Midline diastema often resolves naturally, questioning the necessity of early frenectomy. Surgical intervention is only advised when MLF impedes oral hygiene or contributes to orthodontic relapse. Conclusions: Variability in the classification and management of the MLF may contribute to inconsistent clinical decisions. Evidence-based guidelines are needed to support appropriate intervention and reduce the risk of unnecessary procedures.