Releasing Incisions Research Articles

Metacarpal Small Incision for Carpal Tunnel Syndrome.

Endoscopic carpal tunnel release (ECTR) techniques have been established as a successful treatment for carpal tunnel syndrome and have proven equally effective as traditional open carpal tunnel release (OCTR) techniques in relieving pain and numbness. However, patients who undergo OCTR are more likely to experience scar tenderness and pillar pain and take longer to return to work. We present here a method of metacarpal small incision for carpal tunnel release (MSICTR) as a safe, reliable, cost-effective alternative surgical decompression of the median nerve of the wrist. This technique utilizes a metacarpal small incision and direct visualization of the median nerve and carpal tunnel contents, reducing the risk of permanent injury and neurasthenia when compared to traditional OCTR. MSICTR is also suitable for the examination of the median nerve, surrounding tendon sheath, or space-occupying lesions. MSICTR is associated with shorter operation times, less postoperative pain, faster recovery, and improved cosmetic results when compared to traditional OCTR. Therefore, MSICTR is an effective surgical decompression of the median nerve for the treatment of carpal tunnel syndrome.

Patient-reported outcome measures after periodontal surgery

ObjectivesThe present study aimed to explore the impact of different periodontal surgical treatments on the quality of life and postoperative morbidity.Materials and methodsThe present study is a single-center, prospective, observational cohort trial. One hundred fifty-five patients, referred to the Periodontal Department of Bologna University who needed periodontal surgical treatment, were recruited. The self-reported perception of the postoperative course was assessed using the following anonymous questionnaires: Italian oral health impact profile (I-OHIP-14), visual analog scale (VAS) to evaluate the intensity of the pain, and 5-point Likert scale.ResultsPatients reported a mean OHIP-14 total score of 9.87±8.5 (range 0–42), significantly influenced by the female sex, flap extension, and periodontal dressing. A mean VAS score of 2.96±2.39 (range 0–9) was calculated, and was found to be influenced by the presence of vertical releasing incisions and palatal flap extension. Of the 155 subjects, 40 (25.8%) patients reported bleeding as a post-surgical complication, 96 (61.9%) swelling, 105 (67.7%) eating discomfort, and 44 (28.4%) reported speech discomfort.ConclusionsWithin the limitations of the nature of the present study, periodontal surgical procedures have a low impact on patients’ quality of life evaluated through the OHIP-14 and VAS pain questionnaires.Clinical relevancePeriodontal surgical procedures are safe procedures, with a limited duration of postoperative discomfort as well as the incidence of complications.

Transverse mini-incision for carpal tunnel release

Background: Carpal tunnel syndrome is a commonly prevalent entrapment neuropathy characterized by median nerve compression within the carpal tunnel. The aim of this study was to compare the outcomes of transverse mini-incision and traditional mini-palm incision for carpal tunnel release. Methods: A non-randomized interventional study was done at Kurmitola General Hospital, Dhaka and US Bangla Medical College Hospital, Narayangonj between January 2019 and December 2021. Forty-two patients diagnosed with idiopathic carpal tunnel syndrome were allocated to the transverse mini-incision group (n=20) and traditional mini-palm incision group (n=22). Results: Patients operated with transverse mini-incision returned to their work significantly earlier (mean 10.3 days) than patients operated with traditional mini-palm incision (mean 18.7 days). No significant difference was found between transverse mini-incision group and traditional mini-palm incision group as determined by the McGill pain score improvement (P=0.16), the Bangla version of the Boston carpal tunnel questionnaire symptom severity score (P=0.61) and functional severity score (P=0.43). Conclusion: Transverse mini-incision is comparable to the traditional mini-palm incision in terms of pain, other symptoms, and functional outcome. However, patients in transverse mini-incision group could return earlier to work. Bangabandhu Sheikh Mujib Medical University Journal 2023;16(3): 167-171

Impact of laparoscopic repair on type III/IV giant paraesophageal hernias: a single-center experience

PurposeGiant paraesophageal hernia (GPEH) is a challenging problem for surgeons because of its high recurrence rate. This study was conducted to compare the outcomes in type IV vs. type III GPEHs after laparoscopic repair. Other outcomes included peri-operative morbidity and long-term quality of life.MethodsA retrospective analysis of 130 GPEH patients in a period between 2010 and 2019 underwent a tailored laparoscopic repair in our tertiary center with a minimum follow-up of 48 months. Operative steps included hernial sac excision, crural repair, relaxing incisions, and mesh cruroplasty with special indications.ResultsThe study enrolled 90 patients with type III and 40 patients with type IV GPEH. Type IV GPEH patients were older, more fragile, and scored worse on ASA classification, aside from having a more challenging surgical technique (wider crura, weaker muscles, increased need for release incisions, and mesh cruroplasty).Type IV GPEHs had a prolonged operative durations, and a higher conversion rate. Additionally, the same group showed increased morbidity, mortality, and re-operation rates. With a mean follow-up of 65 months (range 48–150 months), the incidence of recurrence was 20.7%, with an increased incidence in type IV GPEH (37.5% vs. 13.33% in type III GPEH). Type IV GPEH, low pre-operative albumin, larger crural defect, and low surgeon experience were significant risk factors for recurrence after laparoscopic repair of GPEH.ConclusionType IV GPEH has a higher peri-operative morbidity and recurrence rate; so, a more tailored laparoscopic repair with a high surgeon experience is needed.

Evaluation of PRF Membrane with Coronally Advanced Flap with and without Vertical Releasing Incisions for the Treatment of Gingival Recessions.

The aim of the current study was to compare the esthetic results for subjects with Miller Class I and II gingival recession (GR) abnormalities using platelet-rich fibrin (PRF) membrane with coronal advanced flaps (CAFs) with and without vertical releasing incisions (VRIs; the envelope-type flap and the flap with VRIs). Seven defects from each of the test and control groups made up of fourteen defects total. In the test group, PRF + CAF was performed without VRI, while in the control group, VRI was used. Gain in root coverage was the main result, with secondary results including papillary bleeding index (PBI), plaque index (PI), relative gingival margin level, relative attachment level, probing pocket depth, recession depth, width of keratinized gingiva (WKG), and gingival thickness. After 3 months of therapy, a clinical evaluation was conducted. No significant difference was observed between the two groups in terms of recession reduction (2.08 ± 0.5 vs 1.91 ± 0.66 mm), clinical attachment level (CAL) gain (2.08 ± 0.5 vs 1.91 ± 0.66 mm), and increase in WKG (2.66 ± 0.88 vs 2.58 ± 0.51 mm) for test and control groups, respectively. For the treatment of GR, both groups are efficient. However, the CAF + PRF without VRI group showed higher patient compliance and lower postoperative morbidity. The PRF membrane with CAF with or without VRI provide effective treatment option for GR. CAF + PRF without VRI is easy to perform and has less postoperative complications.

Comparative Study of Carpal Tunnel Release by Limited Incision and Traditional Open Technique in Carpal Tunnel Syndrome

Aim: Current study aimed to compare the limited palmar incision for carpal tunnel release (CTR) with a traditional open technique. Outcomes were analysed between the groups on the basis of reduction in size of scar, allowing more conservative surgical approach. Method: A total of 50 patients with Carpal Tunnel Release were included and divided equally into two groups: control group for patients with traditional open technique and study group for patients with carpal tunnel release undergoing limited incision. In control group carpal tunnel release was done by traditional open technique while in study group carpal tunnel release was done by limited incision. Results: Mean operation time was 20.32±1.314 mm for control group, whereas in study group, it was much lower i.e. 12.68±2.3. Significant symptomatic relief was noted in both groups. Lesser post op pain was noted in the study group. A significant improvement was noted in hand grip, key pinch, tip pinch and palmers Pinch when compared from Pre-op and Post-op in control group (p<0.001) and study group (p<0.001). Under control group, the mean return to daily activity was 4.32±0.8 days while for study group; it was almost half i.e. 2.08±0.76 days. Under control group, mean return to work was 7.16±1.37 days whereas for study group, it was 4.88±1.48. Shorter postoperative scars were observed in mini-transverse wrist incision technique. Mean scar length was 18.6±0.86 mmm for control group while it was little lower 14.68±0.99 for study group. The mean scar width was 1.8±0.408 mm for control group while 1.22±0.52 for study group. No wound healing related complications were noted in any patient. Conclusion: It was concludes the carpal tunnel release by limited incision and traditional open technique in patients with carpal tunnel syndrome provides good symptomatic relief, in lesser operative time. However, patients noted less post-operative pain, early return to daily activity, early return to work with lesser scar load ...

Microbiological Retention on PTFE versus Silk Suture: A Quantitative Pilot Study in Third Molar Surgery

Background: Mandibular third molar (M3M) removal and management of postoperative complications represent a common matter of interest in oral and maxillofacial surgery. This potential quantitative study assessed the ability of two types of surgical sutures, Silk and polytetrafluoroethylene polymer (PTFE), to carry aerobic and anaerobic bacteria on wounds after mandibular third molar surgery, with a collection of the stitches at the suture removal and study in the laboratory on the basis of colony-forming units. Methods: This prospective quantitative study sampled a total of 10 consecutive healthy patients for mandibular third molar surgery at the Oral Surgery School, Dentistry and Dental Prosthodontics, Department of Medical Biotechnologies, University of Siena, Siena, Italy. The mean age of the patients was 31 years (range 25-40 years), seven patients were male and three patients were female. Inclusion criteria were: presence of a partially impacted mandibular third molar. Exclusion criteria were: smoking and diabetes mellitus. Extraction of the mandibular third molar was performed under local anesthesia: after the third molar surgery, two sutures were applied on the surgical site distally to the second mandibular molar: one single 3/0 silk stitch; one single 3/0 PTFE stitch. No sutures were applied on the release incision. Sutures were removed after 7 days and were immediately conserved and sent to the laboratory to be rated on the basis of colony-forming units (CFUs). CFUs were evaluated and reported on GraphPad Prism and transformed into its base 10 logarithm. Data were analyzed with a non-parametric Wilcoxon test, and p-values < 0.05 were evaluated as statistically significant. Results: All the patients attended the suture removal date, and all the sutures were present in the site. None of the surgical sites presented dehiscence. No stitch loss was reported, and no patient reported mouth washing or tooth brushing in the surgery site. All interventions were uneventful and no major complications were reported after M3M surgery. Bacterial retention resulted as statistically greater in silk sutures rather than PTFE sutures, both in Brain Heart Infusion samples (p = 0.003) and Wilkins-Chalgren anaerobe samples (p = 0.002). Conclusions: We found the PTFE suture to be superior to the silk suture in a reduction in the bacterial biofilm in both aerobic and anaerobic evaluations after M3M surgery.

Incisional Release and Fat Grafting for the Surgical Management of Perioral Fibrosis in Scleroderma: A Technical Report and Institutional Review.

Scleroderma (systemic sclerosis [SSc]) is a rare autoimmune, connective tissue disorder. Perioral fibrosis is a local cutaneous complication, negatively impacting functional capabilities and aesthetic satisfaction. Fat grafting has been postulated to aid in the management of SSc fibrosis thanks to stem cell enrichment. This technique's success has been demonstrated using different graft origin sites and different injection targets. We aim to demonstrate our SSc patients' success using abdominal fat and perioral target. We queried our records for patients with preexisting SSc who underwent incisional release and fat grafting for perioral fibrosis from 2018 to 2021. For perioral release, a semisharp cannula was tunneled under the vermilion border into the vermilion and along the skin. For grafting, cannulas were used to infiltrate the fat with a retrograde filling technique in a radial-fanning manner. Their autoimmune diagnosis, anesthetic risk assessment, systemic disease complications, and degree of presenting symptoms were reviewed along with their postoperative outcomes. From 2018 to 2021, 16 patients diagnosed with SSc were treated with incisional release and fat grafting for the management of perioral fibrosis. Of the SSc patients, 8 presented with limited SSc, and 8 presented with diffuse SSc. The mean patient age was 54.31 years. All SSc patients presented with functional symptoms with the most common concern (n = 9) being "decreased mouth opening." Other common complaints were "difficulty eating" (n = 3) or "difficulty drinking" (n = 2). Some patients (n = 11) also presented with cosmetic concerns with "perioral rhytids" being the most common (n = 6). The mean number of systemic complications, at the time of presentation, was 3.06. The mean anesthetic risk assessment was 2.44. The average amount of fat grafted intraoperatively was 14.89 mL. Two patients with SSc required regrafting. For one patient, this was part of the original treatment plan and for the other due to fat resorption. Patients who followed up reported improved functionality and were pleased aesthetically. Patients with perioral fibrosis due to SSc can benefit from autologous fat grafting. Incisional release in combination with fat grafting can enhance procedure outcomes. This technique provides beneficial functional and aesthetic outcomes. Patients with both diffuse and limited disease are appropriate candidates for this procedure.

Articaine versus lidocaine inferior alveolar nerve block in posterior mandible implant surgeries: a randomized controlled trial.

The aim of this study is to compare the effects of %4 articaine and %2 lidocaine on inferior alveolar nerve block (IANB) for implant surgery in the posterior mandible. The patients who have inserted implants in the posterior mandible were divided into 2 groups for IANB: lidocaine and articaine. VAS = visual analog scale, pain during surgery and injection, lip numbness time, mandibular canal-implant apex distance, age, gender, bone density, implant number, release incision, adjacent teeth, and duration of surgery were analyzed using t-test, Mann-Whitney U test, Spearman's coefficient, and, Pearson's chi-squared test. This trial followed the recommendations of the Consort Statement for reporting randomized controlled trials. 577 patients were included and 1185 dental implants were analyzed. There was no significant difference between the two groups in terms of injection and surgery VAS values (p>0.05). The lip numbness time of lidocaine was 3.06±3.22min while articaine was found to be 2.96±3.09min (p>0.05). Mandibular canal-implant apex distance was found to be 2.28±0.75mm in the articaine and 2.45±0.86mm in the lidocaine group (p<0.05). Release incision was made more in the articaine group (51/252) than in the lidocaine group (40/325) (p<0.05). There was no difference between the %4 articaine and %2 lidocaine in terms of pain perception in posterior mandible implant applications. Both anesthetics provided adequate anesthesia for implant application.

Surgical Treatment for Trigger Thumb Using a Radial Approach

The anatomy of the thumb flexor pulley system and surrounding structures differs from the fingers. The hand's positioning during trigger thumb release is troublesome. Iatrogenic radial digital nerve injuries of the thumb following opened or percutaneous A1 pulley release have been reported. We present the radial approach using a transverse incision for surgical release of the trigger thumb. This surgical approach aimed to restore a familiar surgical hand position, prevent radial digital nerve injury and bowstringing of the flexor pollicis longus, and decrease postoperative pain to facilitate recovery of hand function.

The Tunnel Wall Approach and Enamel Matrix Derivative to Cover Exposed Roots and Improve Clinical Attachment Levels in Cairo Class III Defects Associated with an Intrabony Lesion in the Anterior Area: Three Cases.

These case reports present a surgical technique to improve the clinical attachment level and cover the exposed root surface in Cairo Class III situations associated with a one- to two-wall combined intrabony defect in the anterior area. The tunnel wall approach combined previously described concepts and placed a CTG into a modified tunnel-type flap through a vertical releasing incision. The CTG acted both as a buccal soft tissue wall to stabilize the blood clot and as a space maintainer to coronally move the tissue. The decontaminated root surfaces were treated with enamel matrix derivative, and a bone filler material was placed from the bottom of the intrabony defect up to the cementoenamel junction to support the proximal soft tissue architecture. Healing of the four presented sites was uneventful. Clinical measurements up to 12 months showed significant probing depth reduction, clinical attachment gain, and coverage of the buccal recession in each case. Papilla improvement was reported in three cases. Radiographic examinations confirmed intrabony defect healing and the presence of embedded bone filler material in the soft tissue above the bone crest. The tunnel wall approach seems to be a valuable option to safely enhance the clinical attachment level and cover the exposed root in Cairo Class III situations associated with a one- to two-wall combined intrabony defect in the anterior area.

Aesthetic Management of Peri-Implant Soft Tissue Dehiscence. A Case Report of a Combined Perio Restorative Approach

This case report designates a combined perio restorative technique in the management of peri-implant 3-dimensional soft tissue defects in an esthetic zone. A staged approach was implemented to treat this case; the first stage was planned to treat the horizontal defect around the implant, in which crown was removed, and coronally advanced flap with connective tissue graft were used to treat the soft tissue defect. At the second stage, a modified coronally advanced flap with connective tissue graft was used to augment the vertical defect, and no vertical releasing incision was made in this stage to maximize the blood supply to the advanced flap. De-epithelized free gingival graft was harvested from the palate to obtain better fibrous connective tissue graft . Graft was placed over the site to compensate for the vertical defect and flap was advanced to ensure primary closure without tension. Resin-bonded bridge was used as a provision after modification to avoid any soft tissue contact. Healing by primary intention was attained providing a clinically healthy soft tissue surrounding a well-functioning restoration, and periapical radiographs showed a stable crestal bone level without presence of mucositis or peri-implantitis. Within the limitations of this clinical case report, it revealed the possibility of fully restoring severe horizontal and vertical peri-implant soft tissue defects and at the same time attaining high level of patient satisfaction via a combined mucogingival and prosthetic approach; nevertheless, the long-term preservation of this successful outcome needs to be monitored.

Incisional Release and Autologous Fat Grafting for the Management of Perioral Fibrosis in Patients with Scleroderma and Dermatomyositis: A Single Center Experience

Incisional Release and Autologous Fat Grafting for the Management of Perioral Fibrosis in Patients with Scleroderma and Dermatomyositis: A Single Center Experience

718 Cryptogenic Stroke in a Patient with Firearm Injury - a Diagnostic Dilemma

Abstract Introduction Neurological deficit associated with firearm injury outside the head and neck region is a rare phenomenon. Multiple explanations, including pellet embolization, patent foramen ovale and carotid intimal tear, have been suggested. Case Report We present a case of an otherwise healthy 21-year-old male, who was received in the emergency with a firearm injury, unstable vitals, and GCS 14/15. Bullet entry wound was on the back of the chest, 3 cm medial to the spine of left scapula, with no exit wound, but bullet palpable superior to the medial 1/3rd of right clavicle. CT and X-ray imaging confirmed surgical emphysema and left sided haemopneumothorax. Two release incisions were given superior to the medial 1/3rd of both clavicles. Bullet was found below the right release incision and was retrieved. Chest tube was inserted bilaterally, and the patient was placed on mechanical ventilation. On the 5th day, upon resolution of emphysema and haemopneumothorax, the patient was extubated, and the chest tubes were removed. However, examination findings revealed left facial and abducens palsy along with left circumduction gait. MRI brain showed ischaemic changes in the right frontoparietal region. Carotid angiography and echocardiography were normal. Patient was then managed by neurology and neurosurgery. Conclusion In cases of firearm injury the physician should always look for neurological deficits, irrespective of the firearm injury pathway through the body. Stroke should be a concern in such cases even if the patient is otherwise healthy and young.

Surgical Treatment and Outcome of Acquired Midline Palate Defects in Cats.

Acquired midline palate defects (PDE) affect the hard palate and/or soft palate, and result from trauma, commonly falling from a height or being hit by a motor vehicle. Additional life-threating injuries and costs associated with the treatment may delay the surgical treatment. This retrospective study describes signalment, cause, and extent of the PDE, and treatment in 25 cats. In addition, the outcome of the surgical repair is described in 19 (76%) cats. All defects were repaired within 5 days of the injury. Twenty (80%) cats were 4 years of age or younger. The most common rostral extent of the PDE was to the level of the third premolar tooth (n = 8; 32%), incisor teeth (n = 7; 28%), and fourth premolar tooth (n = 5; 20%). The soft palate laceration was present in all cases. Surgical therapy was successful in all cases with follow-up. The most common techniques used for the closure of the hard palate defect were bilateral pedicle flaps with lateral releasing incisions (n = 8; 32%), direct apposition of the oral mucosa (n = 7; 28%), bilateral pedicle flaps with lateral releasing incisions and interquadrant splinting (n = 5; 20%), and unilateral pedicle flap with one lateral releasing incision (n = 4; 16%). A tension-free closure by direct apposition of the edges was possible for the soft palate laceration. No oronasal fistulae were identified at follow-up. The only complication was malocclusion. The interquadrant splinting was most often used for PDE extending to the rostral portion of the hard palate (p < 0.05). The cats that suffered postoperative malocclusion were significantly more likely to have sustained temporomandibular joint injury, underwent CT scan, or had a feeding tube placed before discharge. The results of this retrospective study indicate that the early treatment (within 5 days) of the acquired longitudinal defects in the midline of the hard and soft palates is highly successful.

Postoperative Salvage Decompressive Craniotomy: Usefulness of The Simple Posteriorly Directed Release Incision in Adequately Expanding Frontotemporal Flaps.

Salvage decompressive craniotomies performed following complications after initial planned craniotomies may be inadequate if they are only restricted to removal of the small previously replaced bone flap with some additional nibbling of bone from the surrounding craniotomy margins by retracting the skin. To achieve the aim of adequately decreasing intracranial pressure without affecting wound healing, fresh incisions need to be placed to expand the craniotomy adequately while not compromising vascularity of the scalp. The rationale and safety of the simple posteriorly placed release incision to expand frontotemporal flaps is described.

Comparative Assessment of Flap-Advancing Techniques in an Ex Vivo Cadaverous Porcine Model.

Since flap advancement is a prerequisite for tension-free primary closure and successful regenerative procedures, the aim of this study was to test the efficacy of six surgical approaches for flap advancement in an ex vivo porcine model. A total of 60 fresh mandibles from pigs were randomized into one of six groups: (1) trapezoidal full-thickness flap design with two vertical releasing incisions (control), (2) trapezoidal flap with linear periosteal scoring, (3) mucosal detachment technique, (4) mucosal detachment with horizontal extension, (5) mucosal detachment with horizontal and vertical extension, and (6) mucosal detachment with horizontal vertical and cutback extension. Coronal advancement of the flap was recorded as the primary variable; the surface area of exposed mucosa and the tear strength were recorded as secondary variables. Homogeneity existed among groups for preoperative keratinized tissue width and tissue thickness. Mucosal detachment with horizontal, vertical, and, cutback extensions achieved the highest amount of advancement. All remaining groups achieved a statistically higher advancement compared with the trapezoidal full-thickness flap (control). Pairwise comparison demonstrated statistical significance between any two groups (P < .001). A positive correlation was noted between exposed mucosa and flap advancement; the advancement increased 0.62 mm for each 10 mm2 of increase in the exposed mucosal surface. Strength at tear stress was the highest in the trapezoidal full-thickness flap (control) and mucosal detachment with horizontal-vertical-cutback incisions (P < .001). Coronal flap advancement was maximized in the mucosal detachment techniques and positively correlated with the area of exposed mucosa.

Posteromedial Accessory Incision for Posterior Capsular Release and Retractor Placement in a Total Ankle Replacement.

The standard approach for performing a total ankle replacement (TAR) is the anterior approach as this offers good direct visualization of the tibiotalar joint. Irrespective of implant system used, most commonly, bone cuts are made in the anterior to posterior direction and may potentially injure the posterior neurovascular structures and tendons running close to the ankle joint. Careful consideration must be taken to ensure these structures are protected. We introduce a new intraoperative technique of protection for the posteromedial soft tissues and neurovascular structures and include the early results of 60 consecutive patients where the described technique was employed. There were no technique-related complications, or evidence of injury to the PTT, FHL, flexor digitorum longus (FDL), or neurovascular bundles.

Long-term evaluation (7 years) of coronally advanced flap with (CAF) and without (e-CAF) vertical release incisions using a subepithelial connective tissue graft in the treatment of multiple recession-type defects.

The objective of this retrospective study was to compare the 7-year outcomes of coronally advanced flap with vertical incisions (CAF) and the envelope type of flap (e-CAF), using a subepithelial connective tissue graft (SCTG) in the treatment of multiple recession defects. Twenty-two patients (13 CAF and 9 e-CAF) with at least two adjacent recession defects in the esthetic zone contributed to a total of 50 sites (29 CAF and 21 e-CAF). Complete root coverage (CRC), mean root coverage (MRC), and keratinized tissue (KT) width were recorded over the course of the study. In the short term (8 months), CRC, MRC, and KT outcomes were similar between the groups (P > .05). However, at the 3-year follow-up, the e-CAF group displayed significantly higher KT, MRC (100%), and CRC (100% at both tooth- and patient-levels) than the CAF group (MRC 91.43%; CRC 79.31% at tooth-level and 69.23% at patient-level). Similarly, at the 7-year follow-up, statistically significantly superior KT, MRC (94.24%), and CRC (87.71% at tooth-level and 77.78% at patient-level) values were recorded for the e-CAF group compared to the CAF group (MRC 68.98%; CRC 31.03% at tooth-level and 15.38% at patient-level). Despite similar treatment outcomes recorded by both surgical procedures in the short term, sites treated with e-CAF showed better stability of the gingival margin and superior KT width in the medium (3 years) and long term (7 years).

A conservative approach to a mesiodens removal via frenectomy incision. A case report

Hyperdontia is a condition when patient presents one or more supernumerary teeth in maxilla or mandible. When the supernumerary tooth is in the midline, above the upper incisors, it is called mesiodens. The aim of this paper is to report a case of a mesiodens extraction by means of a minimally invasive technique using an incision in the labial frenulum, avoiding releasing incisions and using platelet-rich fibrin (PRF) to fill the surgical site. A 13 year-old patient was referred to our clinic to extract a supernumerary tooth located above maxillary central incisor. After anesthesia and removal of the labial frenulum, a mucoperiosteal flap was raised bilaterally via tunneling. A careful osteotomy was performed and the tooth was cautiously removed with an apexo elevator. This technique provides a predictable and conservative approach and reduction in the procedure morbidity, also absence of scar in the anterior maxilla, not impacting aesthetics.