Evaluation of Free Gingival Grafts as a Treatment for Gingival Involvement of Mucous Membrane Pemphigoid: Periodontal Considerations and a Study of Six Cases

Simon Jean, Geneviève Payne, Julien E. Ghannoum


Background: Mucous membrane pemphigoid is a chronic autoimmune blistering disease of unknown aetiology. The attached gingiva in dentulous areas is one of the primary affected sites. Oral mucous membrane pemphigoid is often treated with hygiene measures in association with topical corticosteroids and/or immunosuppressive agents. Lesions can be temporarily controlled by medication but there is no definitive cure. Treatment is focused on treating active lesions and alleviating symptoms. Aims and Objectives: To assess free gingival grafts as a novel approach in the treatment of recalcitrant for oral mucous membrane pemphigoid lesions. Materials and Methods: Inflammation was subjectively graded using a visual analog scale preoperatively and three months after the free gingival grafts were performed. Patients were also re-evaluated six months postoperatively. Results: All patients displayed complete, albeit localized, permanent remission of lesions in the treated areas, despite discontinuation of topical treatment. Slight radial improvement around the gingival grafts was noted. Conclusion: Free gingival grafts could be useful in treating refractory gingival lesions due to mucous membrane pemphigoid. These results may help to shed deeper insight on the pathogenesis of this disease and help developing more specific therapies.


Desquamative Gingivitis; Free Gingival Graft; Mucous Membrane Pemphigoid; Vesicullobullous Disease.

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Foster CS. Cicatricial pemphigoid. Trans Am OphtalmolSoc 1986;84:527-663.

Neville B, Damm D, Allen C, Bouquot J. Oral and Maxillofacial Pathology. St. Louis: Elsevier, 2009: P. 771-5.

Thorne JE, Anhalt GJ, Jabs DA. Mucous membrane pemphigoid and pseudopemphigoid. Ophthalmology 2004;111:45-52.

Goldstein AT, Anhalt GJ, Klingman D, Burrows LJ. Mucous membrane pemphigoid of the vulva. ObstetGynecol 2005;105:1188-90.

Scully C, Carrozzo M, Gandolfo S, Puiatti P, Monteil R. Update on mucous membrane pemphigoid: a heterogeneous immune-mediated subepithelial blistering entity. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 1999;88:56-68.

Chan IS. Mucous membrane pemphigoid. Clin Dermatol 2001;19:703-11.

Agbo-Godeau S, De Lima Soares P, Szpirglas H. Pemphigoïdecicatricielle: prise en charge en stomatologie. Rev StomatolChir Maxillofac 2004;105:206-10.

De Las Heras ME, Moreno R, Núñez M, Gómez Mi, Ledo A. Angina bullosahemorrhagica. J Dermatol 1996;23:507-9.

Oliveira SC, Slot DE, Van Der Weijden GA. What is the cause of palate lesions? A case report. Int JDent Hyg 2013;11:306-9.

Chan LS, Ahmed AR, Anhalt GJ, Bernauer W, Cooper KD, Elder MJ.The first international consensus on mucous membrane pemphigoid: definition, diagnostic criteria, pathogenic factors, medical treatment, and prognostic indicators. Arch Dermatol 2002;138:370-9.

Egan CA, Lazarova Z, Darling TN, Yee C, Yancey KB. Anti-epiligrin cicatricial pemphigoid: clinical findings, immunopathogenesis, and significant associations. Medicine (Baltimore) 2003;82:177-86.

Rashid KA, Gürcan HM, Ahmed AR. Antigen specificity in subsets of mucous membrane pemphigoid. J Invest Dermatol 2006;126:2631-6.

Dainichi T, Takeshita H, Moroi Y, et al. Cicatricial pemphigoid with autoantibodies against the laminin 5 gamma 2 subunit. EurJDermatol 2005;15:189 93.

LazarovaZ, Hsu R, Briggaman RA, Yancey KB. Fab fragments directed against laminin 5 induce subepidermal blisters in neonatal mice. Clin Immunol 2000;95:26 32.

McgowanKA, MarinkovichMP. Laminins and human disease. MicroscRes Tech 2000;51:262 79.

DabelsteenE. Molecular biological aspects of acquired bullous diseases. CriRev Oral Biol Med 1998;9:162 78.

Darling MR, Daley T. Blistering mucocutaneous diseases of the oral mucosa--a review: part 1. Mucous membrane pemphigoid. J Can Dent Assoc 2005;71:851 4.

BholKC, Rojas AI, Khan IU, Ahmed AR. Presence of interleukin 10 in the serum and blister fluid of patients with pemphigus vulgaris and pemphigoid. Cytokine 2000;12:1076 83.

Elder MJ, Lightman S. The immunological features and pathophysiology of ocular cicatricial pemphigoid. Eye (lond) 1994;8:196 9.

KarpouzisA, Vamvassakis E, Stavrianeas N, Koumantaki-Mathioudaki E, Karpouzi M, Vareltzides A.Ultra structural immunocytochemistry of autoimmune bullous diseases. AustraliaJDermatol 2002;43:113 9.

CalabresiV, Carrozzo M, Cozzani E, et al. Oral pemphigoid autoantibodies preferentially target bp180 ectodomain. Clin Immunol 2007;122:207-13.

AndreadisD, Lorenzini G, Drakoulakos D, et al. Detection of pemphigus desmoglein 1 and desmoglein 3 autoantibodies and pemphigoid bp180 autoantibodies in saliva and comparison with serum values. Eur J Oral Sci 2006;114:374-80.

MignognaM, Lanza A, Rossiello L, Ruocco V, Ahmed AR.Comparison of reactivity and epitope recognition between sera from American and Italian patients with oral pemphigoid. ClinExpImmunol 2006;145:28 35.

Colón JE, Bhol KC, Razzaque MS, Ahmed AR. In vitro organ culture model for mucous membrane pemphigoid. Clin Immunol 2001;98:229 34.

Kumari S, Bhol KC, Simmons RK, et al. Identification of ocular cicatricial pemphigoid antibody binding site(s) in human beta4 integrin. Invest Ophthalmol Vis Sci 2001;42:379–85.

Balding SD, Prost C, Diaz LA, et al. Cicatricial pemphigoid autoantibodies react with multiple sites on the bp180 extracellular domain. J Invest Dermatol 1996;106:141–6.

Bernard P, Prost C, Lecerf V, Intrator L, Combemale P, Bedane C. Studies of cicatricial pemphigoid autoantibodies using direct immunoelectron microscopy and immunoblot analysis. J Invest Dermatol 1990;94:630-5.

Di Zenzo G, Carrozzo M, Chan LS. Urban legend series: mucous membrane pemphigoid. Oral Dis 2014;20:35-54.

Graziano A, Cirillo N, Pallotti S, Cricenti L, Romano F, Aimetti M. Unexpected resilience to experimental gingivitis of subepithelial connective tissue grafts in gingival recession defects: a clinical-molecular evaluation. J Periodontal Res 2013 (in press).

Silverman S Jr, Gorsky M, Lozada-Nur F, Liu A. Oral mucous membrane pemphigoid. A study of sixty-five patients. Oral Surg Oral Med Oral Pathol 1986;61:233-7.

Hardy KM, Perry HO, Pingree GC, Kirby TJ Jr. Benign mucous membrane pemphigoid. Arch dermatol 1971;104:467-75.

Damoulis PD, GagariE. Combined treatment of periodontal disease and benign mucous membrane pemphigoid. Case report with 8 years maintenance. J Periodontol 2000;71:1620-9.

HeiligenhausA, Shore JW, Rubin PA, Foster CS. Long-term results of mucous membrane grafting in ocular cicatricial pemphigoid. Implications for patient selection and surgical considerations. Ophthalmology 1993;100:1283-8.

Sotozono C, Inatomi T, Nakamura T, et al. Visual improvement after cultivated oral mucosal epithelial transplantation. Ophtalmology 2013;120:193-200.

Axéll T, Henriksen BM. Treatment of gingival lichen with free palatal grafts. J Oral Pathol Med 2007;36:105-9.

HoexterDL. The sutureless free gingival graft. J Periodontol 1979;50:75-8.

GrisdaleJ. The use of cyanoacrylates in periodontal therapy. J Can Dent Assoc 1998;64:632-3.

Arduino PG, Lopetuso E, Carcieri P, et al. Professional oral hygiene treatment and detailed oral hygiene instructions in patients affected by mucous membrane pemphigoid with specific gingival localization: a pilot study in 12 patients. Int J Dent Hyg 2012;10:138-41.

Foster CS, Ahmed AR. Intravenous immunoglobulin therapy for ocular cicatricial pemphigoid: a preliminary study. Ophtalmology 1999;106:2136-43.

Canivares MJ, Smith DI, Conners MS, Hefferman KJ. Successful treatment of mucous membrane pemphigoid with etanercept in 3 patients. Arch Dermatol 2006;142:1457-61.

Carbone M, Carrozzo M, Castellano S, Conrotto D, Broccoletti R, Gandolfo S. Systemic corticosteroid therapy or oral vesiculoerosive diseases. An open trial. Minerva Stomatol 1998;47:479-87.

Lee Hy, Blazek C, Beltraminnelli H, Borradori L. Oral mucous membrane pemphigoid: complete response to tacrolimus. ActaDermVenereol 2011;91:604-5.

Karring T, Ostergaard E, Löe H. Conservation of tissue specificity after heterotopic transplantation of gingiva and alveolar mucosa. J Periodontal Res 1971;6:282-93.


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