Development of an exostosis following a free gingival graft: Case report
The author describes a free gingival graft placed on the buccal of #20 and #21 to increase the width of the attached gingiva prior to crown fabrication (1977). In 1994 the patient presented with a chief clinical complaint that the graft had increased in thickness and was acting as a food trap. The patient had no noticeable palatal or mandibular tori. The free gingival graft in the area of #20 was firm to palpation. A full-thickness mucoperiosteal flap was elevated, revealing a small bifid bony exostosis approximately 3 mm in length. Biopsy of the site revealed dense, viable cortical bone. The etiology of exostosis remains unknown. A genetic or ethnic background has been suggested as well as environmental factors (excessive masticatory forces).
This case report demonstrates an uncommon sequela of free gingival graft. It is possible that its occurrence was coincidental, although the exact cause of this exostosis is unknown. The author speculated that it may have arisen secondary to trauma of the periosteum, which induced an inflammatory response with liberation of osteoprogenitor cells from the periosteum, therefore inducing osteogenesis. [I.S.]
Czuzak, C.A., G.E. Tolson IV, V.L. Kudryk, B.S. Hanson, and M.A. Billman, J Periodont, 67:250,1996