Surgical management of persistent gingival recession after sepsis‐associated gingival necrosis in a patient with systemic lupus erythematosus: A case report

BACKGROUND: Sepsis-associated gingival necrosis is an uncommon oral manifestation that may result in extensive gingival recession after the resolution of the acute phase. METHODS: This report presents the 2-year follow-up of periodontal management in a 38-year-old woman with systemic lupus erythematosus, who developed septic shock accompanied by extensive gingival purpura and necrosis that resulted in widespread gingival necrosis during septic shock and subsequently underwent periodontal plastic surgery for persistent gingival recession. After recovery from the acute systemic condition, marked gingival recession persisted. Although pronounced spontaneous coronal migration of the gingival margin was observed during the first 6 months of follow-up, an esthetically unfavorable recession corresponding to Cairo recession type 1 persisted after 1 year. RESULTS: Connective tissue grafting was performed in the maxillary anterior region using a minimally invasive approach to minimize postoperative risk. Healing was uneventful, with no postoperative infection or adverse events despite the patient's immunosuppressed status. Satisfactory esthetic root coverage was achieved. CONCLUSION: This case suggests that periodontal plastic surgery may be a safe and effective treatment option for sepsis-associated gingival necrosis, even in patients with an immunocompromised status, when careful interdisciplinary collaboration and appropriate perioperative management are required. KEY POINTS: Sepsis-associated gingival necrosis can lead to severe recession that may not fully resolve spontaneously, especially in esthetic zones. A year of observation may reveal spontaneous coronal migration of the gingival margin, but surgical intervention should be considered when esthetic demands and functional stability persist. Well-timed periodontal plastic surgery can achieve stable and esthetic root coverage even in medically compromised patients with careful interdisciplinary management. PLAIN LANGUAGE SUMMARY: This case report describes the treatment and recovery of severe gum damage in a woman with systemic lupus erythematosus, an autoimmune disease. The patient developed septic shock, which was accompanied by extensive gum tissue damage. Although the acute condition improved, significant gum recession remained. Over the following months, the gum tissue showed gradual natural healing, but visible recession on the front surfaces persisted. After 1 year, periodontal plastic surgery was performed to restore the gum line, resulting in complete root coverage and satisfactory esthetic outcomes. This case highlights that some degree of gum recovery may occur naturally after severe tissue damage, particularly within the first year. However, surgical treatment may still be necessary to achieve optimal results. The findings also emphasize the importance of careful monitoring and preventive oral care in medically compromised patients, such as those receiving immunosuppressive therapy.