PMC5116516_01
(a) Intraoral physical examination showed an injury inserted in the interproximal gum; ((b), (d), and (e)) excision of the lesion; (c) radiographic examination with no changes observed. (g) Histological diagnosis of peripheral ossifying fibroma.
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A 36-year-old female leucoderma patient sought treatment complaining of a lesion located between teeth 21 and 22, painless and compromising the aesthetics of her smile (Figure 1(a)). The radiographic examination showed no related changes (Figure 1(c)). The graft was taken from the palate and its format was similar to the open area of the receiving tissue (Figure 1(f)). The graft was sutured along its entire length (Figure 1(f)). Histologically, the lesion showed an intact squamous epithelium and in the lamina propria a highly cellular component of fibroblasts was observed with central area of calcification, setting the diagnosis for peripheral ossifying fibroma (Figure 1(g)).
(a) After three months of the procedure; ((b), (c), (d), and (e)) a second surgical stage was performed in order to cover the exposed root of tooth 22; (f) root coverage of 100% after 6 months and (g) 5-year follow-up.
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Three months after the procedure (Figure 2(a)), a second surgical procedure was performed in order to cover the exposed root of tooth 22. The biomechanical preparation of the surface of the root was accomplished with scaling and root planing (Figure 2(b)) and application of EDTA 24% neutral pH (Pref-Gel , Straumann). The coronally advanced flap technique, described by de Sanctis and Zucchelli (2007), was the selected technique: two horizontal beveled incisions were performed, mesial and distal to the recession, located at one end of the anatomical papillae and equal to the height of the recession plus 1 mm; two oblique incisions, slightly divergent, starting at the end of the two horizontal incisions and extending to the alveolar mucosa (Figure 2(c)). The coronal portion of the flap is partially divided, while the portion apical to the recession is a full thickness flap, exposing 3-4 mm of bone (Figure 2(d)). At this time simple sutures are performed throughout the flap (Figure 2(e)). After the initial results were achieved, root coverage of 100% was obtained after 6 months (Figure 2(f)), and suitable gingival contour was promoted which prevented the development of a mucogingival defect or root exposure with its functional and aesthetic consequences. After five years (Figure 2(g)) the margin remained at its initial position, with no relapse in the exhibition of the cementum-enamel junction; and tissues were stable and characterized by color harmony, demonstrating the success of the chosen techniques.