Esthetic treatment of peripheral giant cell granuloma using a subepithelial connective tissue graft and a split-thickness pouch technique.
BACKGROUND
Peripheral giant cell granuloma (PGCG) is a reactive hyperplastic lesion involving the gingiva or alveolar mucosa consisting of proliferating endothelial cells, a rich capillary bed, chronic inflammatory cells, fibroblasts, and giant cells. After complete clinical removal of PGCG recurrence occurs in about 10% of cases, and may result in an esthetic and functional soft tissue defect. This report describes a surgical procedure involving complete removal of a gingival PGCG in the maxillary esthetic zone and immediate tissue restoration achieving complete gingival augmentation.


METHODS
A 15-year-old female presented with a red, nodular, asymptomatic lesion, approximately 3.5 mm in diameter, located above the maxillary left lateral incisor. The lesion was excised down to the underlying root resulting in a 6 x 5-mm mucogingival dehiscence defect. Corrective surgery included a subepithelial connective tissue graft peripherally covered by the surrounding gingiva and stabilized by 5/0 resorbable sutures.


RESULTS
Healing was uneventful, resulting in healthy and esthetic gingiva. Microscopic examination of the biopsy specimen was consistent with the diagnosis of PGCG.


CONCLUSIONS
PGCG may follow an aggressive course, sometimes requiring preemptive surgical intervention. Grafting a subepithelial connective tissue graft peripherally covered by the surrounding gingiva, without raising a gingival flap, successfully eliminated the gingival defect. The free gingival margin of the neighboring teeth and the mucogingival junction remained unchanged.
Lev
Ron
R
Department of Periodontology, School of Dental Medicine, Tel Aviv University, Ramat Aviv, Israel.
Moses
Ofer
O
Holtzclaw
Dan
D
Tal
Haim
H
D000293:Adolescent; D003238:Connective Tissue / Q000637:transplantation; D004955:Esthetics, Dental; D005260:Female; D005500:Follow-Up Studies; D005881:Gingiva / Q000637:transplantation*; D005882:Gingival Diseases / Q000601:surgery*; D005890:Gingivectomy; D005893:Gingivoplasty / Q000379:methods*; D006101:Granuloma, Giant Cell / Q000601:surgery*; D006801:Humans; D008437:Maxilla / Q000601:surgery; D019651:Plastic Surgery Procedures / Q000379:methods; D014945:Wound Healing / Q000502:physiology