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Altered Healing Following Mucogingival Surgery in a Patient with Crohn's Disease: A Literature Review and Case Report
Author(s) -
Andersen KariM.,
Selvig Knut A.,
Leknes Knut N.
Publication year - 2003
Publication title -
journal of periodontology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 2.036
H-Index - 156
eISSN - 1943-3670
pISSN - 0022-3492
DOI - 10.1902/jop.2003.74.4.537
Subject(s) - medicine , dentistry , crohn's disease , enamel matrix derivative , oral hygiene , wound healing , gingival recession , chlorhexidine , adverse effect , buccal administration , root caries , surgery , disease , regeneration (biology) , biology , microbiology and biotechnology
Background: Crohn's disease is a chronic inflammatory bowel disease characterized by uncertainty in etiology and pathogenesis occasionally with manifestations in oral mucous membranes. This report reviews the literature on Crohn's disease and presents a patient with Crohn's disease on continuous antiinflammatory and immunosuppressive medication who showed adverse healing response following surgical treatment of gingival recession type defects.Methods: A 28‐year‐old male in generally good health apart from his bowel disease requested treatment of multiple maxillary gingival recessions due to esthetic concerns and root sensitivity. Following oral hygiene instruction, 3 coronally advanced flap procedures were performed in the maxillary anterior region to cover the defects. In 2 of the surgical areas, the exposed root surfaces were treated by etylenediaminetetraacetic acid (EDTA) in combination with enamel matrix derivative (EMD) before coronally positioning the buccal flap. Postoperatively, chlorhexidine gluconate was used for oral hygiene control.Results: The first surgical procedure, performed as a coronally advanced flap, showed delayed and altered healing. Two weeks postoperatively, the flapped tissue remained intensely red and swollen. In the following 2 surgical sites where EDTA and EMD were applied the healing was uneventful. Differences in immediate tissue response, however, did not influence the 3‐month treatment outcome with respect to root coverage Conclusions: Patients with Crohn's disease on recommended systemic medications may show a delayed and altered wound healing indicating that periodontal surgery must be closely monitored. Treatment planning should take into account the potential wound healing promoting effects of enamel matrix derivative as well as adverse healing effects of chlorhexidine gluconate administration. J Periodontol 2003;74:537‐546.