Esthetic treatment of peripheral giant cell granuloma using a subepithelial connective tissue graft and a split-thickness pouch technique

Background: Peripheral giant cell granuloma (PGCG) is a reactive hyperplastic lesion involving the gingiva or alveolar mucosa consisting of proliferating endothelial cells, a rich capillary bed, chronic inflammatory cells, fibroblasts, and giant cells.After complete clinical removal of PGCG recurrence occurs in about 10% of cases, and may result in an esthetic and functional soft tissue defect. This report describes a surgical procedure involving complete removal of a gingival PGCG in the maxillary esthetic zone and immediate tissue restoration achieving complete gingival augmentation. Methods: A 15-year-old female presented with a red, nodular, asymptomatic lesion, approximately 3.5 mm in diameter, located above the maxillary left lateral incisor. The lesion was excised down to the underlying root resulting in a 6 × 5-mmmucogingival dehiscence defect. Corrective surgery included a subepithelial connective tissue graft peripherally covered by the surrounding gingiva and stabilized by 5/0 resorbable sutures. Results: Healing was uneventful, resulting in healthy and esthetic gingiva. Microscopic examination of the biopsy specimen was consistent with the diagnosis of PGCG. Conclusions: PGCG may follow an aggressive course, sometimes requiring preemptive surgical intervention. Grafting a subepithelial connective tissue graft peripherally covered by the surrounding gingiva, without raising a gingival flap, successfully eliminated the gingival defect. The free gingival margin of the neighboring teeth and the mucogingival junction remained unchanged.