case_images: PMC11217575_01
case_images: (a) Graphite tattoo was caused by sticking gum with pencil. (b) Push-back method, which removes all soft tissue above alveolar bone, was established as treatment planning in order to prevent recurrence. (c) PRF membrane over exposed alveolar bone can provide extracellular matrix and growth factors to facilitate migration of gingival fibroblasts from adjacent keratinized gingiva.
case_images: CRID2024-5559986.001.jpg
case_images: PMC11217575_01_CRID2024-5559986.001.jpg
case_images: fig1
case_images: He had a habit of sticking his gum with a pencil when he was young (Figure 1(a)). In order to prevent recurrence, we planned to use the push-back method to remove the entire mucosa above the alveolar bone (Figure 1(b)) and then to cover the exposed alveolar bone with a PRF membrane to induce migration of gingival fibroblasts from adjacent keratinized gingiva (Figure 1(c)).
case_images: (a) Graphite tattoo extending to the interdental papilla and marginal gingiva of the maxillary left central incisor and lateral incisor. (b) Incision design to remove the graphite tattoo and surrounding gingival tissue. (c) Excisional procedure with a full thickness flap. (d) Hidden root recession and traumatic bone injury caused by the patient's habit of sticking his gum with a pencil. (e) Excised gingival tissue including the graphite tattoo. (f) Inner surface of excisional gingiva. The graphite tattoo approached the periosteum. (g) PRF after centrifuge. (h) PRF membranes formed by squeezing the PRF clot with a couple of 2 x 2 gauze. (i) Positioning the inner PRF membrane and suturing the outer PRF membrane with 5-0 braded black silk (Ailee Co. Ltd.). (j) Fixation of PRF membranes on alveolar bone with direct loop and cross mattress sutures.
case_images: CRID2024-5559986.002.jpg
case_images: PMC11217575_01_CRID2024-5559986.002.jpg
case_images: fig2
case_images: Upon clinical observation, grayish black macules were observed, extending from the interdental papilla and marginal gingiva to the apex of the maxillary left central incisor and lateral incisor (Figure 2(a)).