Treatment outcome and postoperative complications of mucogingival surgery in a case of type I von Willebrand disease

The aim of this study is to describe the clinical outcomes and postoperative complications of the surgical treatment of gingival recession defects in a patient affected with type I von Willebrand Disease (vWD).MATERIALS AND METHODS. Two Miller's Class I gingival recession defects of traumatic origin at teeth 2.3 and 4.3 were treated with bilaminar techniques. At 2.3 site, a split-thickness envelope flap was prepared. An epithelial-connective tissue graft was harvested from the left hemipalate, fitted within the envelope and stabilized with 6/0 absorbable sutures. At 4.3 site a split-thickness flap was performed. An epithelial-connective tissue graft was obtained from the right hemipalate and fixed to the recipient site. The flap was then sutured in a coronally advanced position. The patient was unaware of his type I vWD at the time of surgery. RESULTS. Hemorrhagic complications occurred mainly at the palatal donor areas within the first 7 days post-surgery. At 7 and 15 days post-surgery, impaired healing was evident, particularly at palatal donor sites. Laboratory analyses were performed to investigate the presence of a hematologic disorder, and type I vWD was diagnosed. At 1-year follow-up, a partial to complete root coverage and an increase in keratinized tissue width was observed at surgerized sites. CONCLUSIONS. Mucogingival surgery can be successfully performed in patients affected with type I vWD. However, hemorrhagic events in the first postoperative period may represent a relevant complication.