Figure 5 - uploaded by Ramachandra SS
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Photomicrograph showing epithelial hyperplasia with inflammatory cell infiltration in the connective tissue (H and E 40X).
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This case report describes the management of an 18-year-old female who presented with generalized aggressive periodontitis, gingival enlargement and a mesiodens. Diagnosis for aggressive periodontitis was determined based on history, clinical findings and radiographic examination. Treatment included oral prophylaxis, extraction of the...
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... 2 therapy involved periodontal surgery under local anaesthesia in all four quadrants with internal bevel gingivectomy combined with open- flap debridement. Excised gingiva was submitted for histopathologic examination, which revealed epithelial hyperplasia with an abundance of fibroblasts and inflammatory cells in June 2012 the connective tissue ( Figure 5). The patient continues to be followed-up and has had no recurrence of the gingival enlargement (Figures 6-8). ...
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Enlargement of the gingiva can be due to various causes. Most prevalent are the inflammatory type and drug-induced type of gingival hyperplasia. However, sever enlargement associated with an aggressive type of periodontitis is an infrequent finding. Reported here is a case of a female patient aged 18 years who presented with severe enlargement of t...
Citations
... [2] A few cases of aggressive periodontitis associated with gingival enlargement have been reported in past. [3][4][5][6] The uniqueness of this case report lies on the observation that none of the earlier case reports managed to prosthetically rehabilitate the dentition, which was a major goal in this case. Hence, our case report highlights a case of generalized aggressive periodontitis (GAP) with generalized gingival fibrous hyperplasia and reports its interdisciplinarity management. ...
... In the past, very few case reports had shown complete management of GAP patients with gingival enlargement. [3][4][5][6] The fact that this was rarely reported made us to document and presents this particular case. ...
... A similar case of GF was recently reported by Ramachandra et al. 27 reported a case of gingival enlargement associated with generalized AP and the presence of mesiodens. The common features of GF and localized AP are their onset around puberty, female predilection, hereditary back-ground, and progression in the presence of minimal local factors, although secondary involvement can aggravate the preexisting condition. ...
Idiopathic gingival fibromatosis (IGF) is a hereditary condition with esthetic, functional, and periodontal impairment in patients. It is slowly progressive in nature. The enlargement might be nodular or localized and symmetrical in nature all along the dentition in both the arches and similar gender prediction uniformly. The present case report of IGF in a 21-year-old female patient covering three-fourths of crowns in posterior areas. The gingival enlargement was excised by external bevel gingivectomy along with the use of electrocautery. The gingival fibromatosis can be genetic, hereditary, or drug-influenced covering marginal, papillary or in severe, long-standing cases, it might cover crown of teeth, thus hampering mastication henceforth, functional impairment. The prognosis is uncertain, and the recurrence of risk is high.
... The first report was published by Mahajan et al. [70], followed by reports by Jadwat et al. [71], Chaturvedi [93], Sandhu et al. [94], and Vishnoi and Phadnaik [72]. Recently, Ramachandra et al. [95] reported a case of gingival enlargement associated with generalized AP and the presence of mesiodens. The common features of GF and localized AP are their onset around puberty, female predilection, hereditary background, and progression in the presence of minimal local factors, although secondary involvement can aggravate the pre-existing condition [96]. ...
... Regenerative techniques include the use of bone grafts, barrier membranes, wound healing agents and enamel matrix protein. Local drug delivery, full mouth disinfection and host immune response modulation are other modes of treatment [38,72,76,95,[156][157][158]. ...
Gingival fibromatosis is a rare and heterogeneous group of disorders that develop as slowly progressive, local or diffuse enlargements within marginal and attached gingiva or interdental papilla. In severe cases, the excess tissue may cover the crowns of the teeth, thus causing functional, esthetic, and periodontal problems, such as bone loss and bleeding, due to the presence of pseudopockets and plaque accumulation. It affects both genders equally. Hereditary, drug-induced, and idiopathic gingival overgrowth have been reported. Hereditary gingival fibromatosis can occur as an isolated condition or as part of a genetic syndrome. The pathologic manifestation of gingival fibromatosis comprises excessive accumulation of extracellular matrix proteins, of which collagen type I is the most prominent example. Mutation in the Son-of-Sevenless-1 gene has been suggested as one possible etiological cause of isolated (non-syndromic) hereditary gingival fibromatosis, but mutations in other genes are also likely to be involved, given the heterogeneity of this condition. The most attractive concept of mechanism for drug-induced gingival overgrowth is epithelial-to-mesenchymal transition, a process in which interactions between gingival cells and the extracellular matrix are weakened as epithelial cells transdifferentiate into fibrogenic fibroblast-like cells. The diagnosis is mainly made on the basis of the patient’s history and clinical features, and on histopathological evaluation of affected gingiva. Early diagnosis is important, mostly to exclude oral malignancy. Differential diagnosis comprises all pathologies in the mouth with excessive gingival overgrowth. Hereditary gingival fibromatosis may present as an autosomal-dominant or less commonly autosomal-recessive mode of inheritance. If a systemic disease or syndrome is suspected, the patient is directed to a geneticist for additional clinical examination and specialized diagnostic tests. Treatments vary according to the type of overgrowth and the extent of disease progression, thus, scaling of teeth is sufficient in mild cases, while in severe cases surgical intervention is required. Prognosis is precarious and the risk of recurrence exists.
... [7] In 2008 such another case was reported by Jadwat et al., [8] followed in 2010, by Vishnoi and Phadnaik. [9] Recently, Ramachandra [10] Isolated cases of gingival overgrowth have been reported since ages, but in association with aggressive periodontitis are rarely found. It is difficult to ascertain, which occurred first, localized aggressive periodontitis or gingival overgrowth since the patient gave a history of noticing the enlargement 1 year back, around upper molars of the left side and aggressive periodontitis progresses without any warning symptoms. ...
This case reports a unique presentation of two different clinical entities amidst few similarities and differences. Usually, aggressive periodontitis and gingival fibromatosis occur independently. Their simultaneous occurrence is rarely found. This report deals with the clinical features and management aspect of such a case.
