Gingivectomy Ciclosporin — ORE Part 1 MCQ

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HardPeriodontologyGingivectomy CiclosporinORE Part 1

A patient on ciclosporin following heart transplant presents with severe gingival overgrowth obscuring the crowns of the teeth. The transplant physician confirms the medication cannot be changed. What is the most definitive surgical approach?

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Correct answer: A — Internal bevel gingivectomy with meticulous post-operative oral hygiene maintenance

Internal bevel gingivectomy with meticulous post-operative oral hygiene is the definitive surgical approach when ciclosporin cannot be discontinued. Severe gingival overgrowth that obscures tooth crowns requires surgical tissue removal because inflammation-reducing measures and plaque control alone are insufficient. The internal bevel technique provides proper recontouring and esthetics. Critically, strict post-operative plaque control is essential: evidence shows that plaque-induced inflammation modulates drug-gingival tissue interaction and is pivotal to preventing rapid recurrence (which occurs within 2 months if hygiene is neglected). Option E (laser alone) lacks the tissue recontouring necessary for severe cases and omits the hygiene component. Option B (steroids) is not definitive for severe overgrowth. Option D (antibiotics) may reduce inflammation but is not a surgical approach. Option C (scaling alone) addresses only plaque-driven inflammation, not the hyperplastic tissue itself.

Reference: Malek R, El Houari B, Kissa J. Periodontal Management of Cyclosporin A-Induced Gingival Overgrowth: A Nonsurgical Approach. Hindawi. 2019. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6487135/ ; supported by consensus in PubMed-indexed reviews (Tomar & Ashrafi 1998; Thomason et al. 2008).