# Surgical Wound Repair with Innovative Hemostatic Glue: Clinical Case Report
## 2 Case Study  
The patient was a 34-year-old female in good general health. Medical anamnesis did not reveal any pathologies, use of drugs, or allergies. From the dental point of view, the patient was in I class sec. Angle and presented a vestibular gingival frenulum (sec. Mirko classification number 2) [5] with \"pull syndrome\" action on the right central incisor [Figures 2 and 3]. The patient's complaint was the esthetic misalignment of the gingival profile of the lower incisors.  
Figure 3: Lateral view of the mandibular frenulum.  
Figure 2: Preoperative vestibular gingival frenulum showing a “pull syndrome” action on the right central incisor.  
The presence of a marginal insertion frenulum is a contraindication for the execution of the coronally advanced flap (CAF). In this case, performing a frenectomy at least 6 months before root covering surgery is necessary. Frenulectomy consists of the following:  
1. deep partial thickness incision (blade parallel to the periosteum) made at the level of the external insertion of the frenulum;
2. elimination of superficial mucous tissue and muscle of the frenulum;
3. a series of detached points with periosteal anchorage for the apical positioning of the lining mucosa of the lip and the second intention healing of the exposed periosteum.  
The elimination of the frenulum and a correct brushing technique allows an improvement in the quantity/quality of the apical keratinized tissue to the recessions of the incisors. Therefore, usually 6 months after the frenulectomy, there are ideal conditions to perform a coronally displaced flap for root covering [2,8].  
The patient was proposed to undergo a frenulectomy and wait for 6 months before executing a CAF. Patient released consent to the treatment proposed.  
Local anesthesia with mepivacaine and adrenaline 1:100,000 was used. A deep partial thickness incision was made at the level of the external insertion of the frenulum, and subsequently, the portion of superficial and muscular mucous tissue of the frenulum was eliminated. Three detached points were given to periosteal anchorage to apically position the lining mucosa of the lip and allow healing by the second intention of the exposed periosteum [Figure 4].  
A layer of frabond surgical glue (Peters Surgical, Boulogne-Billancourt, France) was then applied to isolate the tissues from the oral cavity and between the alveolar mucosa and the lip mucosa [Figure 5].  
Figure 4: Postoperative vestibular gingival frenulum after the surgical procedure.  
The patient took a dose of analgesics (Ibuprofen cpr 600 mg) at the end of the surgery. No additional painkillers had to be hired. No antibiotic therapy was prescribed. The patient was instructed in hygiene maneuvers and rinsed with 0.12% chlorhexidine-based mouthwash for 15 days. The glue was partially removed at 7 days, and for the remaining, the natural disposal time was expected [Figures 6 and 7].  
Figure 5: After the surgical procedure, a layer of surgical glue was placed to fix the wound and achieve hemostasis.  
Figure 6: Clinical image of the glue on the surgical site after 1 week.