IOSR Journal of Dental and Medical Sciences (IOSR-JDMS) e-ISSN: 2279-0853, p-ISSN: 2279-0861.Volume 14, Issue 9 Ver. I (Sep. 2015), PP 97-100 www.iosrjournals.org DOI: 10.9790/0853-149197100 www.iosrjournals.org 97 | Page Prevalence of Labial Frenum Attachment and its Relation to Diastemia and Black Hole in Kurdish Young Population Dler A. Khursheed 1 *, Shamal S. Zorab 1 , Faraedon M. Zardawi 1 , Azheen J. Ali 2 , Ranjdar M. Talabani 3 1 (Department of Periodontics, School of Dentistry/ University of Sulaimani, Iraq) 2 (Department of Orthodontics, School of Dentistry/ University of Sulaimani, Iraq) 3 (Department of Conservative, School of Dentistry/ University of Sulaimani, Iraq) Abstract: Introduction: Frenum appears as a fold of mucous membrane extending from the mucous lining of the labial mucous membrane towards the crest of the residual ridge on the labial surface. Labial frenum is a dynamic and often unstable structure and it will be changed in shape, size, and position during the different stages of growth and development. Midline diastemia is a distinctive space usually of about 0.5 mm between mesial surfaces of two teeth. It is more frequently seen between upper maxillary incisors causing esthetic and phonetic problems Aims and Objectives: To determine the prevalence of high frenal attachment and maxillary median diastemia in Sulaimani population. Materials and Methods: This cross sectional study was conducted on 279 patients (132 male and 147 female) who visited Oral Diagnosis Department of School of Dentistry University of Sulaimani for different purposes of dental treatments. The ages of the patients were divided into two groups (10 to 20) and (20-30) years. Examination was done on the dental chair;the frenum morphology was determined by using the direct visual method under dental unit light. Results: The results showed that about 68.8% of the patients had gingival frenal attachment, followed by papillary 16.5, mucosal 12.5 and least frequent papillary penetrating 2% respectively. Of 279 patients, 239 of them had complete maxillary midline closure, 25 of them had diastemia and 15 recorded black hole. Conclusion: This study found that gingival frenal attachment constituted the higher percentage among all frenal attachment in all age and sex groups. Complete contact between maxillary central incisors comprisedthe higher percentage followed by diastemia and black hole. Keywords: Frenum, Diastemia, Black Hole I. Introduction Frenum is a fold of mucous membrane consisting of highly vascularized connective tissue covered with epithelium. It contains a variable amount of collagenous fibrous tissue 1 . This fibrous tissue attaches the lip to the alveolar mucosa and underlying periostium 2 . A normal frenum attaches apically to the free gingival margin so as not to exert a pull on the zone of the attached gingiva and usually terminating at the mucogingival junction. However, its level may vary from the height of vestibule to the crest of the alveolar ridge and even to the incisal papilla area in the anterior maxilla 3 . Labial frenum is a dynamic and often changeable structure and itgoes through variation in shape, size, and position during the different stages of growth and development. During growth, it tends to decrease in size and lose clinical importance. In young children, the frenum is generally wide and thick, and during growth it becomes thin and small 4 .Their primary function of labial freniiis to provide stability of the upper and lower lips 5 . Midline diastemia is a distinctive space usually of about 0.5 mm between mesial surfaces of two central teeth 6 .It is more frequently seen between upper maxillary central incisors causing esthetic and phonetic problems 7 . Genetic, dentoalveolar disproportion, missing tooth, peg shaped lateral incisors, unerupted midline supernumerary teeth, proclination of the upper labial segment or increased anterior overbite are considered as primary etiologic factors for this structural phenomenon. Furthermore, rotated teeth, parafunctional oral habits, such as thumb/finger sucking or abnormal tongue posture, orthodontic treatment, as in cases of rapid palatal expansion or false teeth movement, pathologic teeth migration due to periodontal disease and prominent labial frenum may regard as key etiologic factors for producing maxillary midline diastemia 8,9 . Distribution of different types of high frenal attachment and interdental spaces between maxillary central incisors in Sulaimani population has not been studied widely. Therefore, the purpose of this study, therefore, is to determine the prevalence of high frenal attachment and maxillary median diastemia in Sulaimani population.