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Gingival recession is defined as the apical migration of the gingival margin from the amelocemental junction. This condition may be associated with symptoms such as tooth hypersensitivity, root decay, and cosmetic complaints from patients. Many treatments have been used to treat gingival recession and the gold standard is the autogenous connective tissue gingival graft because of its predictability. This type of gingival graft is performed by harvesting connective tissue from patients' hard palate. Periodontists and general dentists frequently perform these gingival grafts. Occasionally, some patients develop postoperative complications that need to be addressed in an hospital setting. An uncommon but concerning complication of an autogenous connective tissue gingival graft is a donor site pseudoaneurysm of the greater palatine artery. No description of this complication following a gingival graft has been identified in the current literature. One case report mentioned that pseudoaneurysm of the greater palatine artery looks like a pulsatile nodule associated or not with pain on palpation. From the experience of the investigators, patients may consult an hospital setting having a complaint of major oral bleeding. Local hemostatic agents can palliate this type of bleeding, but angiographic embolization is often required. Several cases were treated in the investigators' hospital. Thus, the investigators believe it is relevant to share this experience with the scientific community. The primary objective of this case series is to inform dental professionals of the existence and the management of postoperative pseudoaneurysm of the greater palatine artery following autogenous gingival graft. The secondary objective is to find potential solutions to minimize the incidence of this morbid complication.
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| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| Postoperative pseudoaneurysm of the greater palatine artery | Procedure | Patients had an autogenous connective tissue gingival graft. |
| Measure | Description | Time Frame |
|---|---|---|
| Postoperative oral bleeding | Complication following autogenous connective tissue gingival graft | One month following autogenous connective tissue gingival graft |
| Measure | Description | Time Frame |
|---|---|---|
| Use of local hemostatic agents | Palliative method before definitive care | Six months |
| Secondary effects following angiographic intervention | Postoperative infection, bone or gum necrosis, extrusion of embolization material, loss of tooth, tooth devitalization following angiographic intervention |
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Patients having a diagnostic of pseudoaneurysm of the greater palatine artery who had an autogenous connective tissue gingival graft
| Name | Role | Phone | Extension | |
|---|---|---|---|---|
| Simon Jean, DMD | Contact | 1-418-649-0252 | 63972 | simon.jean.4@ulaval.ca |
| Marianne Bouchard-Asselin, DMD | Contact | 1-418-649-0252 | 63972 | marianne.bouchard-asselin.1@ulaval.ca |
| Name | Affiliation | Role |
|---|---|---|
| Melinda Paris, DMD, FRCD | Hopital de l'Enfant-Jesus, CHU de Quebec, Laval University | Study Director |
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| PubMed Identifier | Type | Citation | Retractions |
|---|---|---|---|
| 29424485 | Background | Yadav AP, Kulloli A, Shetty S, Ligade SS, Martande SS, Gholkar MJ. Sub-epithelial connective tissue graft for the management of Miller's class I and class II isolated gingival recession defect: A systematic review of the factors influencing the outcome. J Investig Clin Dent. 2018 Aug;9(3):e12325. doi: 10.1111/jicd.12325. Epub 2018 Feb 9. | |
| 16274302 |
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| ID | Term |
|---|---|
| D017541 | Aneurysm, False |
| D011183 | Postoperative Complications |
| ID | Term |
|---|---|
| D014652 | Vascular Diseases |
| D002318 | Cardiovascular Diseases |
| D010335 | Pathologic Processes |
| D013568 | Pathological Conditions, Signs and Symptoms |
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| Six months |
| Number of followups required | Secondary effects following angiographic intervention | Six months |
| Tozum TF, Keceli HG, Guncu GN, Hatipoglu H, Sengun D. Treatment of gingival recession: comparison of two techniques of subepithelial connective tissue graft. J Periodontol. 2005 Nov;76(11):1842-8. doi: 10.1902/jop.2005.76.11.1842. |
| 19485822 | Background | Byun HY, Oh TJ, Abuhussein HM, Yamashita J, Soehren SE, Wang HL. Significance of the epithelial collar on the subepithelial connective tissue graft. J Periodontol. 2009 Jun;80(6):924-32. doi: 10.1902/jop.2009.080673. |
| 23375075 | Background | Thomas J, Patel NS, Viroslav A, Sheykholeslami K. Greater palatine artery pseudoaneurysm presenting as a slow-growing palatal mass. J Oral Maxillofac Surg. 2013 Apr;71(4):e164-7. doi: 10.1016/j.joms.2012.11.017. Epub 2013 Jan 29. No abstract available. |