# Surgical Wound Repair with Innovative Hemostatic Glue: Clinical Case Report
## 1 Introduction  
Frenula are folds of connective tissue that join the inner wall of the lips and cheeks to the maxillary and mandibular alveolar processes (labial frenula) or the mouth floor to the lower part of the tongue (lingual frenula) [1]. Frenula tissue is formed by connective cells, mostly fibroblasts, and an extracellular matrix composed of collagen fibers, elastic fibers, rare muscle fibers, and fundamental substances [2]. Cadaver studies have demonstrated that these frenula are composed of dense collagenous connective tissue, often at the interface of the musculature [1, 2]. The labial frenulum may present structure anomalies and may be associated with unwanted effects, such as the persistence of the median frenulum between the central incisors and gingival, leading to periodontal recessions [3]. Therefore, the frenula may become pathological if anatomical anomalies are present in relation to their insertion, length, and shape and to the type and quantity of fibers contained in the extracellular matrix [3, 4]. Since the frenulum has a connection function between muscular structures (tongue, lips, cheeks) and maxillary or oral floor, it should allow an optimal balance between anchoring and movement [1, 2, 3, 4]. Thus, a fibrous and/or short lingual frenulum can reduce lingual movements as well as a labial frenulum with a pathological insertion can cause abnormal tractions and ischemia of the attacking gingival area [3]. The correct insertion of the labial frenula is in correspondence with the mucogingival junction so as not to have any interference with the attachment of the adherent gingiva [4]. Therefore, a frenulum with abnormal insertion, in association with a thin gingival biotype, can be potentially dangerousin developing progressive traction ischemia and recessions of the marginal and papillary gingiva. This condition is known as \"pull syndrome\" [5]. Many potential issues have been claimed to be related to tight maxillary and mandibular labial ties, including the formation of a midline diastema between the teeth, increased caries and periodontal disease, gingival recession, difficulty in wearing dentures or retainers, difficulty with lip mobility, and possible esthetic or psychological consequences [5; 6]. Due to the high biological memory of the labial frenula, whatever the surgical technique used, the frenuelectomy must include the resection of its deep periosteal insertions up to the mucogingival line in addition to the resection of the frenulum to avoid recurrence [6; 7]. Therefore, there are many surgical approaches proposed for frenuelectomy based on the use of surgical blades, electrospray, or laser [8]. However, regardless of the technique, the basic goals of surgical closure remain an appropriate wound closure to reduce the dead space, minimize the risk of infection and properly approximate the wound edges to achieve an acceptable aesthetic and functional outcome [3]. The most common method of wound closure is suturing, which presents some drawbacks related to tissue trauma, the need for a second appointment for suture removal, and the unpredictable resorption rate [9]. To overcome these disadvantages, plastic adhesives (cyanoacrylate) were proposed as a viable alternative to conventional sutures [10; 11; 12]. In the last few years, tissue adhesives have been studied to ensure the following properties: adequate adhesive strength, appropriate polymerization in a moist environment, biocompatibility, stability, and good working time [11; 12]. In this regard, cyanoacrylate adhesives seemed to be a good option in medicine as well as dentistry [Figure 1], although they can induce a localized allergic response in 0.5% to 14% of patients, so a good anamnesis is recommended [11; 12; 13]. Cyanoacrylate glue is an acrylic resin that consists of two separate liquids, one for pouring into the mold and another used sparingly as a hardener, but in the case of cyanoacrylate glue, the hardener is water [14; 15].