Subepithelial connective tissue graft for root coverage: a case report of an unusual late complication of epithelial origin.
BACKGROUND
The subepithelial connective tissue graft (SCTG) is one of the most used and predictable periodontal plastic surgery procedures; reports of late complications are very rare. This article presents an SCTG case with a previously unreported late complication of epithelial origin, and we suggest a potential link between the patient's dermatologic condition and this complication. Late SCTG complications also are reviewed.


METHODS
A 19-year-old female presented with a 3-mm deep Miller Class I recession defect on the mandibular right central incisor. An SCTG procedure was performed for root coverage, with uneventful initial postoperative healing that resulted in complete root coverage. At 4 months, an asymptomatic solid white discharge was observed at sites along the original graft margin without evidence of inflammation. A month later, the somewhat reduced but still evident discharge was collected and submitted for microscopic examination.


RESULTS
Cytologic examination revealed the discharge to be normal epithelial cells, suggesting a proliferative epithelial response. Follow-up indicated that the discharge was self-limiting and was no longer present at 9 months after surgery. This unusual late SCTG complication is consistent with reported epithelial invaginations and projections between graft and overlying flap. The patient had acne, a disease whose pathogenesis includes host predisposition to epithelial hyperproliferation; therefore, a possible association of this SCTG complication with the patient's systemic health is proposed.


CONCLUSIONS
Epithelial cell discharge is a hitherto unreported, self-limiting, late complication of the SCTG procedure, and a potential association between this complication and the patient's dermatologic condition is suggested.
Parashis
Andreas O
AO
Section of Periodontology, College of Dentistry, The Ohio State University Health Sciences Center, Columbus, OH 43218-2357, USA.
Tatakis
Dimitris N
DN
D000152:Acne Vulgaris / Q000150:complications; D000328:Adult; D003238:Connective Tissue / Q000637:transplantation*; D004847:Epithelial Cells / Q000473:pathology*; D005260:Female; D005881:Gingiva / Q000637:transplantation; D005889:Gingival Recession / Q000150:complications / Q000601:surgery*; D005893:Gingivoplasty; D006801:Humans; D007180:Incisor; D008334:Mandible; D011183:Postoperative Complications