Subepithelial Connective Tissue Graft for Root Coverage: A Case Report of an Unusual Late Complication of Epithelial Origin

Abstract

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. 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. 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. 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.