de Paula Julien, da Silva Luise A B, Wayar Mariane A S, Campagnoli Eduardo B, Dos Santos Fábio A
Department of Dentistry, Universidade Estadual de Ponta Grossa, Ponta Grossa, Brazil.
Clin Adv Periodontics. 2024 Dec;14(4):290-299. doi: 10.1002/cap.10284. Epub 2024 Mar 2.
Various surgical approaches have been employed to manage gingival recession, including subepithelial connective tissue grafting, which has yielded favorable outcomes.
We present the case of a 17-year-old patient who developed gingival recession on tooth #6 following an esthetic crown lengthening procedure. The recession was treated with a subepithelial connective tissue graft; however, this case details the occurrence of two epithelial cysts adjacent to the region subjected to the surgical procedure, 6 months after surgery. The treatment involved periodontal surgical intervention, during which the lesions were completely excised and the associated osseous defect was filled using an inorganic bovine bone matrix along with a collagen membrane. The healing progressed without any complications. Histopathological analysis revealed the presence of cystic lesions, which were characterized by a cystic cavity lined with stratified orthokeratinized epithelium with cuboidal cells in some areas surrounded by fibrous connective tissue. The patient's progress was monitored through tomography performed 6 months, 1 year, and 5 years post-procedure, all of which demonstrated the absence of any signs of lesion recurrence.
This case study emphasizes the effectiveness and predictability of subepithelial connective tissue grafting in the treatment of gingival recession. However, dental professionals should be cautious about the potential risk of gingival recession following esthetic crown lengthening procedures and recognize the potential complications associated with subepithelial connective tissue grafting, such as the observed development of epithelial cysts in this specific case.
Why is this case new information? We present a case of an epithelial cyst following a subepithelial connective tissue graft, which resulted in buccal cortical bone resorption. The treatment involved excisional biopsy and the use of an inorganic bovine bone matrix with a collagen membrane. What are the keys to the successful management of this case? Successful treatment included periodontal surgery, bone defect filling using an inorganic bovine bone matrix and a collagen membrane, and regular monitoring with CT scans at 6 months, 1 year, and 5 years post-surgery; all showed no recurrence. Success factors included careful surgery, appropriate biomaterial usage, and ongoing follow-up. What are the primary limitations to success in this case? The limitations involve potential complications from subepithelial connective tissue grafting such as cyst development. This report stresses the importance of meticulous patient selection and periodontal phenotype evaluation to minimize risks. Continuous follow-up is critical to detect recurrence and other issues.
The subepithelial connective tissue graft effectively treats gingival recession, but clinicians must remain vigilant for potential complications such as epithelial cyst development, highlighting the importance of post-operative monitoring for long-term treatment success and patient satisfaction.
已采用多种手术方法来处理牙龈退缩，包括上皮下结缔组织移植术，该方法已取得了良好的效果。
我们报告了一例17岁患者的病例，该患者在进行美学牙冠延长术后，6号牙出现了牙龈退缩。采用上皮下结缔组织移植术对退缩进行了治疗；然而，本病例详细描述了术后6个月在手术区域附近出现了两个上皮囊肿。治疗包括牙周手术干预，术中将病变完全切除，并使用无机牛骨基质和胶原膜填充相关的骨缺损。愈合过程顺利，未出现任何并发症。组织病理学分析显示存在囊性病变，其特征为囊腔内衬有分层的正角化上皮，某些区域有立方体细胞，周围为纤维结缔组织。在术后6个月、1年和5年通过断层扫描对患者的病情进展进行监测，所有扫描结果均显示无病变复发迹象。
本病例研究强调了上皮下结缔组织移植术在治疗牙龈退缩方面的有效性和可预测性。然而，牙科专业人员应谨慎对待美学牙冠延长术后牙龈退缩的潜在风险，并认识到与上皮下结缔组织移植术相关的潜在并发症，如本特定病例中观察到的上皮囊肿形成。
为什么这个病例是新信息？我们报告了一例上皮下结缔组织移植术后出现上皮囊肿并导致颊侧皮质骨吸收的病例。治疗包括切除活检以及使用无机牛骨基质和胶原膜。成功处理该病例的关键是什么？成功的治疗包括牙周手术、使用无机牛骨基质和胶原膜填充骨缺损，以及在术后6个月、1年和5年定期进行CT扫描监测；所有结果均显示无复发。成功因素包括仔细的手术操作、合适的生物材料使用以及持续的随访。该病例成功的主要限制因素是什么？限制因素包括上皮下结缔组织移植术的潜在并发症，如囊肿形成。本报告强调了精心选择患者和评估牙周表型以最小化风险的重要性。持续随访对于检测复发和其他问题至关重要。
上皮下结缔组织移植术能有效治疗牙龈退缩，但临床医生必须警惕潜在并发症，如上皮囊肿形成，这突出了术后监测对于长期治疗成功和患者满意度的重要性。
