Epithelial cyst following subepithelial connective tissue graft: A case report
Authors: de Paula Julien , da Silva Luise A. B. , Wayar Mariane A. S. , Campagnoli Eduardo B. , dos Santos Fábio A. 
Published: March 2024

AbstractBackgroundVarious surgical approaches have been employed to manage gingival recession, including subepithelial connective tissue grafting, which has yielded favorable outcomes.Methods and ResultsWe present the case of a 17‐year‐old patient who developed gingival recession on tooth #6 following an esthetic crown lengthening procedure. The recession was treated with a subepithelial connective tissue graft; however, this case details the occurrence of two epithelial cysts adjacent to the region subjected to the surgical procedure, 6 months after surgery. The treatment involved periodontal surgical intervention, during which the lesions were completely excised and the associated osseous defect was filled using an inorganic bovine bone matrix along with a collagen membrane. The healing progressed without any complications. Histopathological analysis revealed the presence of cystic lesions, which were characterized by a cystic cavity lined with stratified orthokeratinized epithelium with cuboidal cells in some areas surrounded by fibrous connective tissue. The patient's progress was monitored through tomography performed 6 months, 1 year, and 5 years post‐procedure, all of which demonstrated the absence of any signs of lesion recurrence.ConclusionThis case study emphasizes the effectiveness and predictability of subepithelial connective tissue grafting in the treatment of gingival recession. However, dental professionals should be cautious about the potential risk of gingival recession following esthetic crown lengthening procedures and recognize the potential complications associated with subepithelial connective tissue grafting, such as the observed development of epithelial cysts in this specific case.Key pointsWhy is this case new information?
We present a case of an epithelial cyst following a subepithelial connective tissue graft, which resulted in buccal cortical bone resorption. The treatment involved excisional biopsy and the use of an inorganic bovine bone matrix with a collagen membrane.

What are the keys to the successful management of this case?
Successful treatment included periodontal surgery, bone defect filling using an inorganic bovine bone matrix and a collagen membrane, and regular monitoring with CT scans at 6 months, 1 year, and 5 years post‐surgery; all showed no recurrence. Success factors included careful surgery, appropriate biomaterial usage, and ongoing follow‐up.

What are the primary limitations to success in this case?
The limitations involve potential complications from subepithelial connective tissue grafting such as cyst development. This report stresses the importance of meticulous patient selection and periodontal phenotype evaluation to minimize risks. Continuous follow‐up is critical to detect recurrence and other issues.
Key findingsThe subepithelial connective tissue graft effectively treats gingival recession, but clinicians must remain vigilant for potential complications such as epithelial cyst development, highlighting the importance of post‐operative monitoring for long‐term treatment success and patient satisfaction.