Gingival Hyperplasia with Bone Resorption as a Chronic Trauma associated with an Occlusal Defect

Abstract

Aim: To report a clinical presentation, diagnosis and treatment of a particular case of traumatic fibroma associated an occlusal defect. Background: Fibroma is benign neoplasm, whose causative agent is represented by a chronic or a traumatic stimulus. Case report: A 52-year-old healthy woman, came to our observation with a condition of an increased volume of the gingival tissue in the region between the back of the upper central incisors and the palatine wrinkles. In the middle of the exophytic lesion, could be noted invaginations that corresponded to the incisal edges of the lower incisors. An orthopantomoghraph and Dental Scan was performed that showed a reduction of the bone tissue and the thinning of the corresponding gingival cortex, to the area of incisal traumatism. The hystological examination confirmed the presence of an inflammatory hyperplasia, with traumatic etiology. Conclusion: The patient was advised to the use of a soft resin bite to reduce occlusal trauma and was sent to a gnathologist for an appropriate treatment plan. (Int J Biomed Sci 2018; 14 (2): 74-77)

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December 2018 Vol. 14 No. 2 Int J Biomed Sci www.ijbs.org
74
INTERNATIONAL JOURNAL of BIOMEDICAL SCIENCE
Gingival Hyperplasia with Bone Resorption as a Chronic
Trauma associated with an Occlusal Defect
Cinzia Casu1, Maria Giulia Nosotti2, Luca Viganò3
1Private Dental Practice, Cagliari, Italy; 2Freelancer in Piacenza, Italy;
3University of Milano, Departement of Oral Radiology, Milano, Italy
ABSTR AC T
Aim: To report a clinical presentation, diagnosis and treatment of a particular case of traumatic broma
associated an occlusal defect. Background: Fibroma is benign neoplasm, whose causative agent is represented
by a chronic or a traumatic stimulus. Case report: A 52-year-old healthy woman, came to our observation with
a condition of an increased volume of the gingival tissue in the region between the back of the upper central
incisors and the palatine wrinkles. In the middle of the exophytic lesion, could be noted invaginations that cor-
responded to the incisal edges of the lower incisors. An orthopantomoghraph and Dental Scan was performed
that showed a reduction of the bone tissue and the thinning of the corresponding gingival cortex, to the area
of incisal traumatism. The hystological examination conrmed the presence of an inammatory hyperplasia,
with traumatic etiology. Conclusion: The patient was advised to the use of a soft resin bite to reduce occlusal
trauma and was sent to a gnathologist for an appropriate treatment plan. (Int J Biomed Sci 2018; 14 (2): 74-77)
Keywords: Traumatic broma; Focal brous hyperplasia; pyogenic granuloma; peripheral giant-cell granuloma;
peripheral ossifying broma; mucocele
Corresponding author: Cinzia Casu, Private Dental Practice, Cagliari,
Italy. E-mail: ginzia.85@hotmail.it .
Received July 11, 2018; Accepted November 1, 2018
Copyright: © 2018 Cinzia Casu et al. This is an open-access ar ticle dis-
tributed under the terms of the Creative Commons Attribution License
(http://creativecommons.org/licenses/by/2.5/), which permits unrestrict-
ed use, distribution, and reproduction in any medium, provided the origi-
nal author and source are credited.
INTRODUCTION
The oral tissues are exposed to continuous traumat-
ic and phlogistic insults, the most aected areas are the
tongue, palate, vestibular mucosa and periodontal tissues
(1). Reactive lesions are tumor-like hyperplasia which
show a response to a low-grade irritation or injury, such as
chewing food impaction, calculus, and iatrogenic injuries
(broken teeth, overhanging dental restorations and extend-
ed anges of denture) (2, 3).
The reactive lesions of the oral cavity are: irritation -
broma, pyogenic gr anuloma, pe r ipher al giant cell granu lo-
ma and cemento-ossifying broma. Other reactive lesions
are epulis ssuratum inammatory papillary hyperplasia
and inammatory brous hyperplasia (1).
In a retrospective study of Hamideh K. et al, the le-
sions were classied into two groups: brous lesions with
connective tissue predominantly consisting of collagen
(irritation broma, giant cell broma, epulis ssuratum,
CASE REPORT

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peripheral ossifying broma) and soft hemor rhagic le-
sions that are highly vascular (pyogenic granuloma,
epulis granulomatosum, peripheral giant cell granuloma
and pregnancy tumor). In this study the prevalence of re-
active lesions was 20.2% and the most common peripheral
lesion was pyogenic granuloma (4).
Most studies have found an increased presence of these
lesions in women than men. This dierence may be due to
the role of hormonal factors as predisponding factors in
the development of these lesions (5, 6).
The trau matic broma, also know as a focal brous hy-
perplasia (FFH), is considered the most common benign
tumor in the oral cavity (7), it consists in a reactive hyper-
plasia of connective tissue. It presents a supercial or deep
location and there are dierent types of broma, depend-
ing on its origin that can be odontogenic, not odontogenic
(8). It is observed with a higher frequency between 40 and
60 years of age. It presents itself clinically as a nodule of
variable dimensions and of rosy or white color, as result of
hyperkeratosis due to traumatism (1).
Fibroma can be sessile or pedunculated. The most com-
mon site is the vestibular mucosa, tongue, gingiva and pal-
ate, associated with the reaction of chronic trauma, such as
chewing on the cheeks, cheilophagia, amalgam fractured
or irritation by prothesis (9). In many cases broma has to
do with defective acrylic overlays or mistting dentures
that irritate the palate, inducing a pathological overgrowth
of the broblasts and the collagen produced by them,
which causes a submucosa mass evident on clinical ex-
amination (10). In most cases the lesion is asymptomatic
and the size can vary from a few millimeters to several
centimeters in diameter. Treatment of the broma involves
surgical excision using scalpel and laser, recurrences are
very infrequent (1).
Denitive diagnosis is based on histological analysis to
rule out the possibility of lesions that may have a similar
appearance, such as, pyogenic granuloma (PG), peripheral
giant- cell granuloma (PGCG) and peripheral ossifying -
broma (POF) and mucocele (11，12，13，14).
CASE REPORT
A 52-year-old woman patient came to our observation
for a dental check-up. The anamnesis repor ted a good gen-
eral state of health, while at the oral level emerged previ-
ous xed prosthetic rehabilitations on the upper central in-
cisors, outcomes of conservative and endodontic therapies
and the lack of some dental elements. Furthermore, the
patient presented a malocclusion with an increased overjet
and overbite. Observing the oral mucosa it was found the
presence of an increase in volume of the gingival tissue in
the region between the back of the upper central incisors
and the palatine wrinkles (Fig. 1).
Furthermore, in the middle of the exophytic lesion,
could be noted invaginations that corresponded to the in-
cisal edges of the lower incisors. Going to reevaluate the
patient’s occlusion, the lower incisors in occlusion went
to traumatize the front of the palate (Fig. 2). The dental
orthopantomography didn’t show any type of lesion, there-
fore a Dental Scan was performed to verify the presence of
a bone lesion (Fig. 3-4).
The three-dimensional examination showed a reduc-
tion of the bone tissue and the thinning of the correspond-
ing gingival cortex, to the area of incisal traumatism.
It was decided to subject the patient to an incisional
biopsy for a precise diagnosis. Histological examination
highlighted the presence of an inammatory hyperplasia,
with possible traumatic etiology. The patient was advised
Figure 1.
Figure 2.

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December 2018 Vol. 14 No. 2 Int J Biomed Sci www.ijbs.org
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to use a soft resin bite to reduce occlusal trauma and was
sent to a gnathologist for an appropriate treatment plan.
DISCUSSION
The term “inammatory hyperplasia” is used to de-
scribe a large range of commonly occurring nodular
growths of the oral mucosa that histologically represent
inamed brous and granulation tissue (11).
Reactive hyperplastic lesions are relatively common in
centers of oral pathology (4). In according to the study of
Kadeh et al., the prevalence of reactive lesions are 20.0%
and the most common lesions are pyogenic granuloma
and irritation broma. These lesions are more frequent in
women (60%) than men (40%) and the most common loca-
tions of involvement are the gingiva and alveolar mucosa
of the mandible (4).
The broma is a benign mesenchymal neoplasm that
appears very frequently in the cavity. Within these lesions,
a group of reactive hyperplasia that develop in response to
a chronic, recurring tissue injury stimulates an exuberant
or excessive tissue repair response (15).
Most bromas represent reactive focal brous hyper-
plasia due to trauma or local irritation, although this term
is more accurately describes the clinical appearance and
pathogenesis of this entity, it is not commonly used.
By histological examination it was possible to nd the
presence of a traumatic broma, marked by the presence
of the stratied squamous epithelium of variable thick-
ness, below which there may be dense brous connective
tissue with abundant collagen bers, interspersed with -
broblasts, brocytes and small vascular spaces.
The broma is the most common non-neoplastic
growth in the oral cavity. It has been know as irritation
broma, brous hyperplasia, traumatic broma, focal -
brous hyperplasia, localized hyperplasia, brous polyp
(16) and broepithelial polyp. The epidemiology of most
non-neoplastic growths in the oral cavity are similar and
the identication depends on histopathological dierentia-
tion.
The dierential diagnoses will depend on the size and
location of the lesion and they can be: papilloma, lipoma,
neurobromas, salivary gland tumor, giant cell peripheral
granulomas. If they reach to develop giant sizes, their dis-
tinction will be with large mucoceles, peripheral odonto-
genic bromas and spinocellular carcinomas (17).
Although conservative surgical excision and removal
of causative irritations (plaque, calculus, foreign materi-
als, source of trauma) are the usual treatments for gingival
lesions, the excision should extend down to the periosteum
and the adjacent teeth should be thoroughly scaled to re-
move the source of continuing irritation (11).
Excisional surgery is the treatment of choice for gin-
gival hyperplasia, but some new approches for treatment
such as cryosurgery, excision by Nd:YAG laser, ash lamp
pulsed dye laser, injection of ethanol or corticosteroid and
sodium tetradecyl sulfate sclerotherapy have been report-
ed as alternative therapies (11).
Focal brous hyperplasia is a slowly progressing le-
sion, the growth of which is generally limited, so due to
the lack of symptoms, patients will be treated long after
the injury has started.
It is important to perform a careful dierential diagno-
sis and a long-term follow-up of the case is necessary to
prevent any relapse.
CONFLICT OF INTEREST
The authors declare that no conicting interests exist.
Figure 3.
Figure 4.

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