A Novel Zinc-Containing Palatal Stent and Topical Oxygen Therapy for Wound Protection and Healing Following Mucoperiosteal Flap Surgery in the Hard Palate: A Case Report

Abstract

In oral surgery, common surgical procedures such as the removal of impacted teeth, the treatment of intraosseous cysts and tumors, and endodontic surgery often require access through a palatal approach. Full-thickness flap surgery in the hard palate region can result in significant post-operative pain, swelling, and hematoma, adversely affecting the patient's function and well-being for several days. Moreover, post-operative infection can delay or compromise healing. Post-surgical traditional palatal stents have been shown to effectively reduce discomfort by minimizing swelling and pain during the early healing phases. Recent advances in materials with the incorporation of bioactive agents have led to the fabrication of a new generation of wound dressings that provide improved conditions for effective wound protection and healing. This case report illustrates the use of a novel, zinc-embedded, thermoplastic surgical polymer for the chairside fabrication of post-operative palatal stents. A 33-year-old female patient, who underwent mucoperiosteal flap surgery for the management of a nasopalatine duct cyst, was provided immediately post-surgery with a customized zinc-containing palatal stent. The bone defect was grafted using a fully resorbable synthetic bone substitute, and an oxygen and lactoferrin-releasing oral gel was provided post-operatively as an adjunct therapy. The innovative stent helped the patient maintain low levels of pain and minimal swelling during the initial post-operative period, resulting in uneventful healing, as documented during the one-week follow-up appointment. Further reviews at four weeks and six months post-surgery revealed successful healing and sensory recovery in the anterior palatal region. As emphasized in this report, the chairside fabrication of zinc-containing palatal stents for post-operative wound protection seems to constitute a valid, simple, time-saving, and cost-effective clinical solution. Moreover, the incorporation of zinc nanoparticles into the stent is of great clinical importance, potentially offering significant benefits in post-operative bacterial control and enhancement of the early-phase palatal soft-tissue healing.

Keywords: alloplastic bone graft; nasopalatine duct cyst; oxygen therapy; palatal stent; palatal surgery; wound healing; zinc-embedded polymer.

Figure 1. Initial clinical (A) and radiological (B-D) views

Figure 2. Surgical debridement of the cystic lesion

A: A full-thickness palatal flap was raised B: The cystic lesion was enucleated C: Radiological view of the associated periapical lesion (arrow) D: The apex of #22 was resected, followed by periradicular curettage (arrow)

Figure 3. Decontamination and grafting of the bone defect

A: Oxygen and lactoferrin-releasing blue®m gel B: Hemostatic collagen placed at the entrance of the incisive canal C: The silicate-substituted β-TCP bone graft (Powerbone Dental Putty). The bone graft is preloaded in a sterile syringe and ready to use. No mixing with sterile saline is required D: The surgical site immediately after bone grafting

Figure 4. Clinical views immediately post-surgery

A: Tension-free primary closure B: Topical application of oxygen and lactoferrin-releasing blue®m oral gel

Figure 5. Chairside preparation of the Elemental palatal stent, composed of the zinc-containing thermoplastic surgical polymer

A, B: The Elemental granules were placed in hot sterile saline C, D: A soft pliable polymer was formed

Figure 6. Intra-oral adaptation (A,B) and final shape (C-E) of the zinc-containing Elemental palatal stent. If needed, the stent can be further contoured using surgical scissors

Figure 7. The histopathological evaluation of the lesion established the diagnosis of a nasopalatine duct cyst

A: The surgical specimen B, C: Histological pictures

Figure 8. Clinical views at the follow-up appointments

A, B: One week post-surgery C: Four weeks post-surgery D: Six months post-surgery

Figure 9. Corresponding radiological views before and six months post-surgery revealing the shrinkage of the cyst

A: Axial view pre-operative B: Axial view six months post-surgery C: Coronal view pre-operative D: Coronal view six months post-surgery