Esthetic management of mucogingival defects after total excision in a case of pyogenic granuloma.

Purpose: Pyogenic granuloma is a relatively rare hyperplastic lesion of the oral tissues. Clinically it is heterogeneous and can be similar to malignant epithelial and mesenchymal neoplasms. The treatment of choice is the surgical excision of the lesion. This approach often results in unpleasant gingival defects, especially when the pyogenic granuloma is located in the esthetic zone.

Materials and methods: This report describes the clinical and histological findings of pyogenic granuloma diagnosed in the maxilla of a 24-year-old female, as well as the successful treatment of the mucogingival defect that occurred following excision of the lesion, by placement of a subepithelial free connective tissue graft with the envelope-technique concurrently with the biopsy procedure.

Results: One-year postoperative complete root coverage of tooth 11 was achieved with a harmonious gingival contour, and no further recurrence was noted.

Conclusion: Early diagnosis of pyogenic granuloma, and consequent therapy with adequate excision in a safe distance of at least 1 mm, is essential for prevention of neighboring structures and minimizing the risk of a relapse. Histopathological evaluation is obligatory to confirm the tentative clinical diagnosis and to exclude malignant neoplasms. The immediate esthetic rehabilitation with free connective tissue grafts presents a complementary procedure in the treatment of mucogingival defects after total excision of oralmucosal diseases.