Feasibility and use of quantitative tools for the diagnosis of Ankyloglossia: A systematic review

Background

Ankyloglossia, commonly known as tongue tie, is a congenital condition wherein the lingual frenum is tethered to the floor of the mouth. The classification protocols traditionally used for the diagnosis of ankyloglossia that have been described in literature lack coherence in terms of their subjective nature and application across different age groups. The use of quantitative tools provides a means of assessing the lingual frenulum that is both reproducible as well as objective, improving the accuracy of diagnoses and reducing operator bias.

Aim

This systematic review aims to identify the quantitative tools used in the measurement of lingual frenum and to assess their feasibility in clinical practice.

Design

The research question was framed using PECO format. A comprehensive search was conducted through 9 databases up to March 2025, including cross sectional, cohort studies and randomized control trials restricted to those published in the English language. Study quality was assessed, and data were managed using Rayyan software.

Results

The search identified 3788 articles. After duplicate removal, the titles and abstract of 1664 were screened, resulting in the review of 46 full text articles. 17 studies were included in the final review, consisting of 11 cross-sectional studies, 4 cohort studies and 2 randomized control trials.

Conclusion

Based on the available literature, a recommendation for a diagnostic quantitative tool cannot be given due to heterogenicity and low certainty of evidence of the included articles. While some of the instruments directly measured the length of the lingual frenum, other instruments relied on functional parameters to define the frenum, leading to variation in clinical outcome. Quantitative measures can assist in the establishment of a standardized diagnostic threshold to bring about evidence-based treatment planning.