Periodontal plastic surgery in a dystrophic epidermolysis bullosa patient: Review and case report

Epidermolysis bullosa (EB) is a group of genetic disorders in which patients frequently present with fragile skin and mucosal surfaces that blister following minor trauma; 23 subtypes have been recognized, but their precise pathogenesis and etiology remain obscure, There is no treatment for EB, only palliative therapy. Oral bullae are the most common oral finding and affect all surfaces, Patients with EB present a unique challenge in terms of periodontal therapy. The following article reviews this disorder and describes the complications encountered when providing periodontal plastic surgery to a patient exhibiting this condition. A 36-year-old female with dystrophic EB presented for treatment of a 3 mm recession area with minimal attached gingiva on the facial of #24 and 25. Oral evaluation revealed multiple ulcers. The treatment consisted of a subepithelial connective tissue graft in conjunction with a coronally positioned flap and buccal frenectomy. Most of the epithelium associated with the surgical area and buccal vestibule sloughed. During the postoperative course, the frenum had regenerated at a more coronal level and was applying tension on the gingival tissues. It appeared that a connective tissue union had formed between the de-epithelialized surface of the facial flap and the buccal mucosa of the vestibule. A second frenectomy was performed, and a clear acrylic stent was fabricated to prevent the union of the connective tissue of the facial flap to the buccal mucosa. The stent prevented the fusion of both connective tissue layers and allowed time for epithelium migration.