Esthetic Consideration for Drug-induced Gingival Hyperplasia with True Pockets: A Case Report

<p> Objective: Periodontal surgery for drug-induced gingival hyperplasia resulting in pseudopockets is generally performed by gingivectomy through an external oblique incision, but in the present case the patient also presented with true pockets due to extensive chronic periodontitis, so modified Widmann flap surgery was performed while also considering esthetic aspects. However, a slight fibrotic gingival swelling remained on the labial aspect of the maxillary anterior teeth after the operation, so we used a CO₂ laser as a corrective treatment and report good results.</p><p> Case: The patient, a 57-year-old woman, presented to the clinic with a chief complaint of severe periodontal disease, of which she had been informed by a local doctor. She had a history of hypertension and had been taking amlodipine tablets 5 mg for 8 years. She had been aware of gingival swelling since the beginning of taking the medication, and visited a nearby doctor because the gingiva of her upper right bicuspid had swollen since one month ago, and after removal of a ceramic-fired metal crown and scaling, no improvement was observed, so she was referred to our clinic. At the initial examination, redness and fibrotic swelling of the gingiva were observed in the whole jaw, especially, fibrotic swelling in the anterior teeth of the upper and lower jaws was remarkable. Radiographs showed mild to moderate horizontal bone resorption in both jaws. Based on the above, a diagnosis of extensive chronic periodontitis and drug-induced gingival hyperplasia was made.</p><p> After basic periodontal treatment and re-evaluation, modified Widmann flap surgery was performed on both jaws due to residual true pockets. Subsequently, significant improvement of the true pockets was observed, but fibrotic gingival swelling remained on the labial aspect of the maxillary anterior teeth, so gingivectomy with a CO₂ laser was performed as a corrective treatment for esthetic and cleanability reasons, and after follow-up, a final restoration was placed.</p><p> Conclusion: In this case, periodontal surgery was performed for drug-induced gingival hyperplasia with true pockets, while taking esthetic considerations into account, and the prognosis is good. It is suggested that the use of a laser may expand the treatment options in the future.</p>