{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,10]],"date-time":"2026-08-10T10:32:06Z","timestamp":1786357926166,"version":"build-2736575974"},"reference-count":24,"publisher":"MDPI AG","issue":"8","license":[{"start":{"date-parts":[[2026,8,10]],"date-time":"2026-08-10T00:00:00Z","timestamp":1786320000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Dent. J.","Dentistry Journal"],"abstract":"<jats:p>Background and Objectives: Achieving optimal soft-tissue aesthetics is a paramount challenge during an apicoectomy of the maxillary central incisors. This article presents a novel modification of the Eskici Vertical Flap, designed to minimize scar formation, preserve the architectural integrity of the sub-mucosal fibers, and eliminate the risk of marginal gingival recession. Methods: The Transfrenular-Single Incision (TrSI) flap is elevated via a precise two-step process. First, a sagittal incision is carried out through the mucosa along the midline of the maxillary labial frenulum. Blunt lateral tunnel preparation is then performed toward the targeted tooth apex, and a subsequent deep periosteal incision with bony contact provides localized access to the periapical lesion. Following Paraendodontic Surgical Intervention (PSI), a two-layer suturing technique is implemented: the deep layer utilizes resorbable sutures to restore periosteal integrity and reposition the basal fibers of the frenular connective tissue, while the superficial layer promotes accurate mucosal edge adaptation. Results: The surgical access provided by the TrSI flap provides clinically sufficient exposure to perform precise osteotomy, retrograde root-end preparation, and biocompatible sealing. The evaluated clinical cases demonstrated optimal healing kinetics, the complete absence of visible scar tissue, and zero marginal gingival recession. Conclusions: The TrSI flap modification constitutes a highly predictable and effective option for PSI in the aesthetically critical anterior maxilla. Although its application spectrum is primarily limited to the central incisors, its capacity to prevent aesthetic deformities warrants its consideration in selected surgical protocols.<\/jats:p>","DOI":"10.3390\/dj14080507","type":"journal-article","created":{"date-parts":[[2026,8,10]],"date-time":"2026-08-10T09:24:53Z","timestamp":1786353893000},"page":"507","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Transfrenular Single-Incision (TrSI) Flaps: A Modified Minimally Invasive Technique That Optimizes Aesthetic Outcomes in Maxillary Central Incisor Apicoectomy\u2014Technique Description and Case Report"],"prefix":"10.3390","volume":"14","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-3552-8836","authenticated-orcid":false,"given":"Ivan Hristov","family":"Arabadzhiev","sequence":"first","affiliation":[{"name":"Oral Surgeon, Private Practice, 66849 Landstuhl, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2762-3764","authenticated-orcid":false,"given":"Eber Luis Lima","family":"Steolo","sequence":"additional","affiliation":[{"name":"Oral and Maxillofacial Surgeon, Private Practice, Pato Branco 80501-054, PR, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Carsten","family":"Nix","sequence":"additional","affiliation":[{"name":"Oral Surgeon, Private Practice, 66849 Landstuhl, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,8,10]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"9552","DOI":"10.1038\/s41598-026-37936-7","article-title":"Effect of root canal filling techniques and materials on endodontic treatment outcomes: A systematic review and meta-analysis","volume":"16","author":"Mushtaq","year":"2026","journal-title":"Sci. Rep."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"1272","DOI":"10.1016\/j.joen.2021.04.024","article-title":"Root-end Surgery or Nonsurgical Retreatment: Are There Differences in Long-term Outcome?","volume":"47","author":"Haxhia","year":"2021","journal-title":"J. Endod."},{"key":"ref_3","first-page":"37","article-title":"The ratio in choosing access flap for surgical endodontics: A review","volume":"2","author":"Grandi","year":"2009","journal-title":"Oral Implantol."},{"key":"ref_4","first-page":"331","article-title":"Eine neue Schnittf\u00fchrung bei Wurzelspitzenresektionen: A new incision method in apicoectomy","volume":"26","author":"Eskici","year":"1971","journal-title":"Dtsch. Zahn\u00e4rztl. 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Pract."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"959","DOI":"10.1111\/j.1365-2591.2007.01306.x","article-title":"Changes of periodontal parameters following apical surgery: A prospective clinical study of three incision techniques","volume":"40","author":"Jensen","year":"2007","journal-title":"Int. Endod. J."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"186","DOI":"10.4103\/jisp.jisp_290_20","article-title":"Effect of full sulcular versus papilla-sparing flap on periodontal parameters in periradicular surgeries: A systematic review and meta-analysis","volume":"25","author":"Jamal","year":"2021","journal-title":"J. Indian Soc. Periodontol."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"4","DOI":"10.1097\/01.DON.000014532.08454.5c","article-title":"Soft tissue management in endodontic surgery","volume":"31","author":"Velvart","year":"2005","journal-title":"J. Endod."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"440","DOI":"10.1007\/s12663-012-0465-4","article-title":"Comparative Study Between Two Flaps-Trapezoidal flap (TZF) and Ocshenbein-Leubke Flap (OLF) in Periapical Surgeries","volume":"12","author":"Ahmed","year":"2013","journal-title":"J. Maxillofac. Oral Surg."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"178","DOI":"10.1111\/j.1752-248X.2008.00039.x","article-title":"Scarring of gingiva and alveolar mucosa following apical surgery: Visual assessment after one year","volume":"1","author":"Arx","year":"2008","journal-title":"Oral Surg."},{"key":"ref_13","first-page":"235","article-title":"Gingival Recession after Surgical Endodontic Treatment and Quality of Life: A Systematic Review and Meta-analysis","volume":"19","author":"Alamoudi","year":"2021","journal-title":"Oral Health Prev. Dent."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"4495","DOI":"10.1007\/s00784-020-03761-z","article-title":"Influence of incision on periodontal parameters after apical surgery: A meta-analysis","volume":"25","year":"2021","journal-title":"Clin. Oral Investig."},{"key":"ref_15","first-page":"365","article-title":"Papilla healing following sulcular full thickness flap in endodontic surgery","volume":"98","author":"Velvart","year":"2004","journal-title":"Oral Surg. Oral Med. Oral Pathol. Oral Radiol. Endod."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"687","DOI":"10.1111\/j.1365-2591.2004.00852.x","article-title":"Comparison of long-term papilla healing following sulcular full thickness flap and papilla base flap in endodontic surgery","volume":"37","author":"Velvart","year":"2004","journal-title":"Int. Endod. J."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"653","DOI":"10.1046\/j.1365-2591.2003.00693.x","article-title":"Comparison of papilla healing following sulcular full-thickness flap and papilla base flap in endodontic surgery","volume":"36","author":"Velvart","year":"2003","journal-title":"Int. Endod. J."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"1191","DOI":"10.1016\/j.joen.2016.05.003","article-title":"Does the Papilla Preservation Flap Technique Induce Soft Tissue Modifications over Time in Endodontic Surgery Procedures?","volume":"42","author":"Taschieri","year":"2016","journal-title":"J. Endod."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"1824","DOI":"10.1016\/j.joen.2020.08.024","article-title":"Soft and Hard Tissue Remodeling after Endodontic Microsurgery: A Cohort Study","volume":"46","author":"Albanyan","year":"2020","journal-title":"J. Endod."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"1898","DOI":"10.1016\/j.joms.2014.05.011","article-title":"Do gingival soft tissues benefit from the application of a papilla preservation flap technique in endodontic surgery?","volume":"72","author":"Taschieri","year":"2014","journal-title":"J. Oral Maxillofac. Surg."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"157","DOI":"10.1111\/j.1600-051X.2010.01658.x","article-title":"Bone loss after full-thickness and partial-thickness flap elevation","volume":"38","author":"Fickl","year":"2011","journal-title":"J. Clin. Periodontol."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"425","DOI":"10.1016\/S0099-2399(07)80131-2","article-title":"Wound healing in the tissues of the periodontium following periradicular surgery. I. The incisional wound","volume":"17","author":"Harrison","year":"1991","journal-title":"J. Endod."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"1799","DOI":"10.1111\/iej.70014","article-title":"Minimally Invasive Vertical Incision Subperiosteal Tunnelling Technique for Targeted Endodontic Surgery: Technical Overview and a Case Report","volume":"58","author":"Zbozen","year":"2025","journal-title":"Int. Endod. J."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"76","DOI":"10.1007\/s10006-025-01372-0","article-title":"Approaches in apical microsurgery: Conventional vs. guided. A systematic review","volume":"29","author":"Facchera","year":"2025","journal-title":"Oral Maxillofac. 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