PMC4506913_01
Clinical images. (a) Initial presentation; note Miller Class I recession defect on facial of the mandibular left canine; (b) pouch prepared; (c) SCTG surgery completed; (d) postoperative week 1 presentation.
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Clinical examination revealed approximately 3 mm of gingival recession (Miller Class I) and less than 1 mm of attached gingiva on the tooth (Figure 1(a)). Under local anesthesia, and following thorough root planing of the exposed root surface, a full thickness envelope flap (pouch) was elevated on the affected area (Figure 1(b)). The graft was partially covered with the overlaying flap, and the flap was secured to the undisturbed interproximal papillae with 4-0 PGA simple interrupted sutures (Figure 1(c)). Clinical presentation at the first postoperative visit (1 week) was within normal limits and the patient reported no pain or swelling (Figure 1(d)).
Clinical images. (a) Postoperative week 3 presentation; note lesion on mesial aspect of treated recession defect (arrow); (b-d) postoperative week 6 presentation; lesion (arrow) evident from direct (b), occlusal (c), and profile (d) view.
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At the 3-week postoperative visit, an asymptomatic, slightly indurated, 5 mm swelling was noted on the mesioapical corner of the recipient site (Figure 2(a)). At the 6-week postoperative visit, the asymptomatic lesion was still evident and appeared slightly enlarged from the previous visit (Figures 2(b)-2(d)).
Clinical images. (a) Excisional biopsy completed; (b-d) postoperative appearance: 1 week (b), 3 months (c), and 12 months (d).
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The biopsy site was sutured using nonabsorbable sutures (Figure 3(a)), to eliminate any possible local irritation from the degradation of absorbable suture material. One week after the biopsy, the patient reported no symptoms and the site was healing within normal limits; sutures were removed (Figure 3(b)). At the 3-month follow-up the patient was still asymptomatic and clinical examination revealed no recurrence of the lesion and complete root coverage (Figure 3(c)). Clinically, complete root coverage with normal appearing tissues was evident (Figure 3(d)).
Routine histology of lesion: low-power (a) and higher power (b) photomicrographs. Note the stratified squamous nonkeratinized cystic epithelium lining the lesion and the surrounding subacutely inflamed fibrous connective tissue (hematoxylin and eosin, original magnification: (a) x40; (b) x100).
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