# Surgical Wound Repair with Innovative Hemostatic Glue: Clinical Case Report
## 3 Discussion  
There have been numerous attempts by various authors to classify frenula from a clinical-anatomical point of view [5]. One of the most accredited identifies the various types of frenula about the insertion site by dividing them into:  
1. mucous attachment frenulum when the frenulum inserts into the mucosa. 2. frenulum with gingival attachment when it is inserted into adherent gingiva. 3. the papillary-attached frenulum when inserted into the papilla. 4. frenulum with penetrating papillary attachment when the frenulum fibers pass through the interincisive papilla and insert into the adherent palatine or lingual gingiva. Previous studies classified the frenulum into two main morphotypes--thick frenulum and thin frenulum--and about the insertion site: high (alveolar mucosa), middle (adherent gingiva), and low (marginal gingiva) [19; 20]. More than 80% of patients who have diastema at nine years of age cease to have it at sixteen, without any therapy [21]. However, sometimes the frenectomy is indicated to reduce the possibility of a \"pull syndrome\" due to the presence of a pathological frenulum configuration [5; 6]. Classical frenuelectomy (V-shaped) is a technique proposed by [PERSON], which consists of a V-shaped incision of the edges of the frenulum, the removal of its coronal insertion, and its apical repositioning [22]. The intervention is completed by the horizontal and vertical incisions of the periosteal fibers and the affixing of sutures. It is clinically the simplest, but it determines the formation of scar tissue that can cause periodontal problems [22; 23; 24]. The Z-plasty incision is more complicated and aggressive, but it leads to reduced scar formation. It involves a Z-incision to make two triangular flaps of equal size that are transposed and sutured [23; 24]. This technique does not remove the frenulum but is intended to soften the traction of the frenulum on the interdental soft tissue. The Z-plasty technique was considered ideal for large, thick, and hypertrophic frenula, with low insertion associated with diastema and short vestibule. Nevertheless, it allows both the removal of fibrous tissue and the increase in the height of the vestibule [24; 25]. During a vestibular sulcus extension, the mucous membrane is raised and placed apically to the gingival margin and sutured to the periosteum while the wound area is uncovered. However, it has a high recurrence rate [8; 26]. The frenectomy associated with a free gingiva peduncle positioned laterally is a technique indicated after orthodontic treatment of the diastema to minimize recurrence and excessive scar tissue formation [24; 25; 26]. Electrosurgery is recommended in patients with low compliance and bleeding problems, as traditional surgery would cause problems in obtaining adequate hemostasis [27]. However, laser frenuelectomy has been recently proposed. Diode lasers, YAG lasers, carbon dioxide lasers, and erbium lasers were implemented. Usually, with laser frenuelectomy, patients experience less pain, less bleeding during the surgical procedure, no need for suturing, and fewer surgical and functional complications and need for analgesics [4; 28]. However, the need for proper sealing of the surgical wound is mandatory to achieve complete healing of the site. The suture is the most used technique to ensure a repositioning of the flap, even if the needle penetration during suturing also causes tissue trauma [9]. Silk is the most universally used suture material in dentistry and many other surgical disciplines [9; 29]. However, it is non-absorbable; thus, there is a need for a second appointment to remove the sutures. Moreover, although absorbable sutures are available, most have unpredictable resorption rates in the oral cavity; they may weaken and dissolve early or remain in the incision area for too long [30]. These have prompted the need for an alternative method of wound closure. Previous studies reported the use of plastic adhesives for tissue suturing in surgical procedures [31; 32].