Mucogingival loss secondary to oral tuberculosis and its management using periodontal plastic surgery: A case report

BACKGROUND: Tuberculosis is widely recognized for its pulmonary manifestations; however, the oral cavity may serve as an early and overlooked site of disease. Although the tongue is the most affected region, gingival involvement is not rare and may cause severe mucogingival destruction. The nonspecific nature of these lesions frequently leads to diagnostic delay. METHODS: A 25-year-old female presented with a persistent gingival ulcer in the maxillary anterior region associated with progressive recession and soft-tissue loss. Histopathologic examination demonstrated necrotizing granulomatous inflammation with multinucleated giant cells. Although Ziehl-Neelsen staining was negative, chest radiography, sputum testing, and GeneXpert polymerase chain reaction confirmed tuberculosis with pulmonary involvement. Following 9 months of systemic anti-tubercular therapy, residual severe mucogingival defects were managed using a modified split-full-split coronally advanced flap combined with a subepithelial connective tissue graft and periosteal compartment stabilization. RESULTS: Healing was uneventful. At 2-year follow-up, complete root coverage was achieved in the incisors and premolars, with approximately 95% root coverage at the maxillary canine. Increased gingival thickness, stable soft-tissue margins, and resolution of hypersensitivity were observed. CONCLUSIONS: This case highlights the importance of considering tuberculosis in the differential diagnosis of persistent gingival lesions and demonstrates that advanced periodontal plastic surgery can successfully rehabilitate extensive mucogingival defects following medical stabilization. KEY POINTS: Severe mucogingival destruction can occur as a rare manifestation of oral tuberculosis and may persist despite resolution of infection. Accurate diagnosis relies on combining histopathologic findings with systemic and molecular investigations. Modified periodontal plastic surgery techniques can achieve predictable root coverage and long-term soft-tissue stability in complex defects. PLAIN LANGUAGE SUMMARY: Tuberculosis (TB) usually affects the lungs, but in rare cases, it can also involve the oral cavity. This report describes a young patient whose first sign of TB was a painful gum lesion that caused severe gingival recession and loss of tissue around several teeth. After medical treatment for TB, the infection resolved, but the significant mucosal damage did not resolve. To restore the lost tissue, the patient underwent advanced periodontal plastic surgery using a connective tissue graft and a specialized flap technique. The procedure restored most of the lost gum and improved both comfort and appearance.