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 Table of Contents  
CASE REPORT
Year : 2015  |  Volume : 7  |  Issue : 2  |  Page : 62-64

Unilateral fibrotic enlargement of gingiva with unknown etiology: A rare findings


Department of Periodontology, Career Post Graduate Institute of Dental Sciences and Hospital, Lucknow, Uttar Pradesh, India

Date of Web Publication22-Dec-2015

Correspondence Address:
Mohammad Arif Khan
Department of Periodontology, Career Post Graduate Institute of Dental Sciences and Hospital, Lucknow, Uttar Pradesh
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/2249-4987.172497

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  Abstract 

Idiopathic gingival enlargement is a rare condition characterized by massive enlargement of the gingiva. It can be an isolated entity or may be associated with syndrome. In this case report, A 15-year-old female reported with a chief complaint of swollen gums which was slowly progressive since last 2 years that affects the esthetic appearance and functional movement such as mastication. On her intraoral examination revealed that there was unilateral, generalized, diffuse fibrotic gingival enlargement with pseudopockets. The lesion was surgically removed. Postoperative healing was satisfactory with significant improvement in esthetic appearance and mastication. There was no postoperative recurrence during 2 years of follow-up.

Keywords: Diffuse gingival enlargement, idiopathic, internal bevel gingivectomy


How to cite this article:
Khan MA, Tripathi AK, Jaishwal RK, Agrawal P. Unilateral fibrotic enlargement of gingiva with unknown etiology: A rare findings. J Oral Res Rev 2015;7:62-4

How to cite this URL:
Khan MA, Tripathi AK, Jaishwal RK, Agrawal P. Unilateral fibrotic enlargement of gingiva with unknown etiology: A rare findings. J Oral Res Rev [serial online] 2015 [cited 2019 Oct 15];7:62-4. Available from: http://www.jorr.org/text.asp?2015/7/2/62/172497


  Introduction Top


Idiopathic gingival enlargement (IGF) is a rare condition which is characterized by slowly, progressive, nonhemorrhagic fibrotic enlargement of the gingiva. [1] This condition may diagnose as an isolated disorder or as a part of syndromes such as Zimmermann-Laband syndrome, Jones syndrome, and Cross syndrome. [2],[3]

Enlarged gingiva is pink in color, firm in consistency with abundant surface stippling and affects the entire gingiva including marginal gingiva, attached gingiva, and interdental papilla. [4]

Gingival enlargement has potential of cosmetic implications and also provides a favorable environment for the growth of microorganisms which is a serious concern for both patients and clinician. Although gingival overgrowth also causes major problems such as the maintenance of oral hygiene, difficulty while mastication, unesthetic appearance, and impaired nutrition due to disfiguration of gingiva.

Nonsurgical periodontal therapy can reduce the size of the clinical lesions by up to 40%, mainly due to the elimination of bacteria. Hence, complete resolution of the lesion requires surgical intervention. [5]

Histopathological features of this condition are hyperplastic epithelium with elongated and thin papillae inserted in fibrous connective tissues along with a marked increase in the amount of connective tissue which is mostly avascular. [3]


  Case Report Top


In the present case, a 15-year-old female reported with her mother to outpatient Department of Periodontology at Career Post Graduate Institute of Dental Sciences and Hospital, Lucknow, Uttar Pradesh, with a chief complaint of swollen gums which was slowly and progressively enlarged since last 2-3 years. She did not reported of any positive drugs, and none of her family members were affected with any form of gingival enlargement. Her current health condition and mental status were normal.

On her intraoral examination revealed that there was unilateral (right side) fibrotic enlargement of the gingiva [Figure 1]. The gingiva was pink in color with superimposed melanin pigmentation and observed no bleeding on probing.
Figure 1: Preoperative affected side

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Enlargement was diffuse type and affected the right side of gingiva of both upper and lower jaws [Figure 2] and [Figure 3]. Biopsy sample was taken and send for histopathological examination showing stratified squamous epithelium with long slender rete-peg, abundant of connective tissues and dense collagen stoma [Figure 4] and [Figure 5].
Figure 2: Preoperative upper arch view

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Figure 3: Preoperative lower arch view

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Figure 4: Histopathological specimen showing stratifi ed squamous epithelium with long slender rete-pegs, connective tissue, and dense collagen stroma

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Figure 5: Orthopantomogram of patient showing normal alveolar bone architecture

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On the basis of clinical and histopathological examination, the diagnosis of IGF was made with no syndromic association.

In this case report, gingival enlargement was satisfactorily treated with nonsurgical periodontal therapy including oral hygiene instruction and oral prophylaxis. However, due to incomplete resolution of the enlargement, surgical excision of enlarged gingival tissue was done under local anesthesia by techniques of external bevel gingivectomy. Postoperative healing was satisfactory, and adequate exposer of crown length was achieved [Figure 6] and [Figure 7]. The patient was satisfied with the esthetic appearance and functional movement such as mastication. The patient was followed up regularly at 1, 3, and 6 months interval followed by after 1 and 2 years. There was no recurrence of the lesion at the end of 2 years.
Figure 6: Two-year postoperative upper arch view

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Figure 7: Two-year postoperative lower arch view

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  Discussion Top


Gingival enlargement is mostly due to various drugs, conditions, syndromes, and hereditary disorders. [6] Clinically and histopathologically, it is difficult to differentiate the enlargement may be due to drugs induced, hereditary disorders or it is idiopathic. [1] In this case report, diagnosis of IGF was made on the basis of patient history, clinical and histopathological examination.

Exact molecular and cellular mechanism which play important role in this condition is not clearly mentioned. [1] According to some recent studies, rapid proliferation rate of fibroblast cells, increase in collagen synthesis, and other extracellular matrix component such as fibronectin and glycosaminoglycans, [7],[8] decreased levels of matrix metalloproteinases (MMP-1 and MMP-2), may be associated with this condition. [9]

Treatment methods for gingival enlargement are depends on the severity of the lesion. [1] When the enlargement is minimal and possible to maintain by the patient, scaling and root planning along with proper maintenance of oral hygiene may be sufficient but when enlargement is massive, surgical intervention such as internal bevel or external bevel gingivectomy, electrocautery, and carbon dioxide lasers, is required to restore the functional and esthetic appearance. There is no any clear-cut evidence about recurrence, so the postoperative long-term benefit of periodontal surgery cannot be predicted. In this case report, there was no recurrence of the lesion even after 2 years of follow-up.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

 
  References Top

1.
Nagarale GP, Ravindra S, Thakur S, Setty S. Long term follow up of idiopathic gingival enlargement associated with chronic periodontitis: A case report and review. J Indian Soc Periodontol 2013;17:242-7.  Back to cited text no. 1
[PUBMED]  Medknow Journal  
2.
Holzhausen M, Ribeiro FS, Gonçalves D, Corrêa FO, Spolidorio LC, Orrico SR. Treatment of gingival fibromatosis associated with Zimmermann-Laband syndrome. J Periodontol 2005;76:1559-62.  Back to cited text no. 2
    
3.
Wynne SE, Aldred MJ, Bartold PM. Hereditary gingival fibromatosis associated with hearing loss and supernumerary teeth - A new syndrome. J Periodontol 1995;66:75-9.  Back to cited text no. 3
    
4.
Bozzo L, de Almedia OP, Scully C, Aldred MJ. Hereditary gingival fibromatosis. Report of an extensive four-generation pedigree. Oral Surg Oral Med Oral Pathol 1994;78:452-4.  Back to cited text no. 4
    
5.
Kantarci A, Cebeci I, Tuncer O, Carin M, Firatli E. Clinical effects of periodontal therapy on the severity of cyclosporin A-induced gingival hyperplasia. J Periodontol 1999;70:587-93.  Back to cited text no. 5
    
6.
Bittencourt LP, Campos V, Moliterno LF, Ribeiro DP, Sampaio RK. Hereditary gingival fibromatosis: Review of the literature and a case report. Quintessence Int 2000;31:415-8.  Back to cited text no. 6
    
7.
de Andrade CR, Cotrin P, Graner E, Almeida OP, Sauk JJ, Coletta RD. Transforming growth factor-beta1 autocrine stimulation regulates fibroblast proliferation in hereditary gingival fibromatosis. J Periodontol 2001;72:1726-33.  Back to cited text no. 7
    
8.
Shirasuna K, Okura M, Watatani K, Hayashido Y, Saka M, Matsuya T. Abnormal cellular property of fibroblasts from congenital gingival fibromatosis. J Oral Pathol 1988;17:381-5.  Back to cited text no. 8
    
9.
Coletta RD, Almeida OP, Reynolds MA, Sauk JJ. Alteration in expression of MMP-1 and MMP-2 but not TIMP-1 and TIMP-2 in hereditary gingival fibromatosis is mediated by TGF-beta 1 autocrine stimulation. J Periodontal Res 1999;34:457-63.  Back to cited text no. 9
    


    Figures

  [Figure 1], [Figure 2], [Figure 3], [Figure 4], [Figure 5], [Figure 6], [Figure 7]



 

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