Modified coronally advanced flap technique in the treatment of fibrous epulis: A case report with 1-year follow-up.

Abstract

Currently, the treatment of epulis is primarily surgical excision, which would greatly affect the aesthetics of patients if happened in the anterior region. It's challenging for clinicians to balance the aesthetic after surgery and less surgical trauma. To overcome this disadvantage, the authors propose the modified coronally advanced flap technique which applies the principles of minimally invasive surgery to provide satisfactory therapeutic results in fibrous epulis. We report a case of an 18-year-old female with the chief complaint of a gingival swelling in the right upper anterior region. After the initial periodontal therapy, the modified surgical approach was applied to this patient. Unlike conventional coronally advanced flap technique, an additional incision was made, and the free portion was rotated into the adjacent space to completely cover the trauma, which avoided the use of the second operative zone. The gingiva recovered with normal color, contour, and consistency after surgery, the papilla filled up the proximal space well and was in good harmony with the adjacent papillae. The surgical results remained stable during the follow-up period. The use of modified coronally advanced flap technique allows the clinician to successfully resume the natural appearance of gingiva in the treatment of fibrous epulis, as well as simplify the surgical approach, shorten the operative time, and demonstrate no tendency of recurrence. Why is this case new information? This novel technique not only removes the epulis, but also takes into account the postoperative aesthetics of the surgery at the same time. This minimally invasive surgical technique reduces operative time and increases patient comfort. Keys to successful management of this case are as follows: (i) Adequate preoperative assessment of the location of the additional incision; (ii) tension-free coronal flap advancement. What are the primary limitations to success in this case? Clinical studies with long-term outcomes of this approach are needed. This procedure may be limited to larger gingival tumors.