(78) Treatment of a recurrent gingival lesion in the esthetic zone

Introduction: One of the underappreciated aspects of clinical periodontics is the diagnosis and management of oral lesions. Although not a major component of daily periodontal practice, it is critical that periodontists are able to distinguish between lesions they can treat themselves and those that necessitate referral to the appropriate specialist. Alternatively, in recognition of their skill at managing soft tissue anomalies, patients are referred by dental/medical colleagues to periodontists for removal of benign lesions appearing within the esthetic zone of the mouth. When confronted with this scenario, the periodontist must be able to: 1) inform the patient of potential esthetic ramifications resulting from removal of the lesion and 2) utilize a surgical approach that allows complete removal of the lesion yet minimizes esthetic complications. In this report we describe the treatment of a 76-year old male presenting with a recurrent pyogenic granuloma (PG) appearing between the maxillary central incisors.

Methods: Patient JD is a 76-year-old Caucasian male who presented with a recurrent pyogenic granuloma (PG). Patient JD underwent two procedures and was ultimately treated without recurrence of the lesions via an aggressive resective procedure that involved removal of the lesion along with adjacent gingiva, alveolar bone and periodontal ligament. The rationale for this approach is explained stressing the potential periodontal and esthetic ramifications that were taken into consideration.

Results: At the five-month post-surgical follow-up visit, the gingiva adjacent to #’s 8 and 9 was firm, coral pink and stippled. There appeared to be rebound of the gingival margin although the facial interproximal space between #’s 8 and 9 was deficient. Most importantly, there was no evidence of recurrence of the lesion. The patient was advised to return in six to nine months for a follow-up exam and urged to contact us immediately if the lesion appeared to be recurring.

Conclusions: The efficacious surgical treatment of recurrent gingival lesions, such as a PG, requires an aggressive approach involving removal of the lesion as well as a 1.0 to 2.0 mm margin of normal tissue, underlying alveolar bone, and associated periodontal ligament. In situations where the lesion is localized to the anterior part of the mouth, the surgical procedure should be modified to minimize the extent of gingival recession and other potential esthetic issues.

Lead Author's Contributions to the Research Project. : The Lead Author was responsible for treating the case and for the composition of the abstract.