Cyst in Alveolar Mucosa Adjacent to a Dental Implant Following Connective Tissue Grafting for Ridge Augmentation

Introduction: When the soft tissue around an implant is inadequate or poorly contoured, soft tissue augmentation techniques such as connective tissue grafts are used to enhance the gingiva and gingival contour around an implant-supported restoration. There have been some case reports of cystic lesions occurring after a connective tissue graft, but this appears to be the first case report of a cyst in alveolar mucosa adjacent to an implant. Case Presentation: Following the placement of implants in the #6 and #7 positions, a cosmetic soft tissue deficiency was visible and inadequate papilla height was evident interproximally. The #7 implant was subsequently submerged, and multiple connective tissue grafts were placed to reconstruct the soft tissue on the buccal aspect of #5 to #7. Four years later the patient returned for evaluation of a 6 x 3 mm raised, fluid-filled vesicle on the alveolar mucosa, buccal to the submerged #7 implant. A submarginal incision with a semilunar design was placed from #6 to #8. A 6 x 3.5 mm cystic-appearing lesion was enucleated from the inner aspect of the flap opposite the submerged #7 implant and sent for biopsy. Histologic evaluation showed the lesion to be a gingival cyst of the buccal mucosa. Conclusion: While subepithelial connective tissue grafting is highly predictable, complications can occur. What causes the epithelium to proliferate and subsequently develop into a cyst is still unknown.