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Table of Contents   
SHORT COMMUNICATION  
Year : 2013  |  Volume : 24  |  Issue : 1  |  Page : 139-141
A rare case of isolated idiopathic gingival fibromatosis


1 Department of Periodontics, College of Dental Sciences, Babu Banarasi Das University, Lucknow, Uttar Pradesh, India
2 Department of Pedodontics and Preventive Dentistry, Ahmedabad Dental College and Hospital, Ahmedabad, Gujrat, India
3 Department of Periodontics, Career Institute of Dental Sciences and Hospital, Lucknow, Uttar Pradesh, India

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Date of Submission13-Jan-2011
Date of Decision22-Feb-2011
Date of Acceptance12-Dec-2012
Date of Web Publication12-Jul-2013
 

   Abstract 

Idiopathic gingival fibromatosis (IGF) is a rare condition. It is genetically heterogeneous and is usually part of a syndrome or, rarely, an isolated disorder. This study presents a rare case of 13 year old boy who was diagnosed with isolated IGF. This diagnosis has been based on clinical examination and after ruling out family, drug, and medical histories. External bevel gingivectomy has been done to remove excess gingival tissues. Excised tissue has been examined histologically. The patient has been followed up for a period of two and half years. No recurrence has been observed.

Keywords: Gingival enlargement, gingivectomy, idiopathic gingival fibromatosis

How to cite this article:
Saini A, Singh M, Singh SC. A rare case of isolated idiopathic gingival fibromatosis. Indian J Dent Res 2013;24:139-41

How to cite this URL:
Saini A, Singh M, Singh SC. A rare case of isolated idiopathic gingival fibromatosis. Indian J Dent Res [serial online] 2013 [cited 2020 Oct 29];24:139-41. Available from: https://www.ijdr.in/text.asp?2013/24/1/139/114925
Gingival fibromatosis (GF) is a slowly progressive gingival enlargement caused by collagenous overgrowth of the gingival fibrous connective tissue. GF can either be hereditary gingival fibromatosis (HGF) or idiopathic gingival fibromatosis (IGF). HGF is a rare condition affecting only 1 in 750,000 people. [1] Literature on the prevalence of IGF is scanty.


   Case Report Top


A 13-year-old boy reported in the outpatient department of Periodontics, Chhatrapati Shahuji Maharaj Medical University (C.S.M.M.U.), in May 2008 with the complaints of inability to eat and poor esthetics. Intraoral examination showed thick black swollen gums. The gingival enlargement started with the eruption of permanent teeth. There was no history of fever, medications, weight loss, deleterious oral habits, and allergies. Family history was also negative. The patient was also referred to Departments of Pediatrics and Otorhinolaryngology, C.S.M.M.U, to rule out any physical and mental disorder or syndrome.

On examination, patient had incompetent lips, convex profile, and bimaxillary protrusion. Intraoral examination revealed generalized bulbous gingival enlargement in both arches [Figure 1]. Gingiva was firm and fibrous in consistency and had physiologic melanin pigmentation. Teeth were submerged in gingiva. Bleeding on probing was present only in few sites. Based on the above findings, the case was diagnosed as isolated IGF.
Figure 1: Preoperative intraoral view of facial aspect of maxillary and mandibular arches

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Prior to surgery, the patient was subjected to oral prophylactic procedures. Oral hygiene status was reviewed till it was maintainable at a satisfactory level. All the parameters in hematological investigations were within normal limits. Panaromic radiograph revealed no abnormality in size, number, and structure of teeth.


   Surgical Procedure Top


A consent form was signed by the patient and his guardian prior to surgery. The facial skin all around oral cavity was scrubbed with povidone iodine solution and patient was asked to rinse with 0.2% chlorhexidine. Patient was operated under local anesthesia. Quadrant wise surgery was done. Gingival pockets were explored with periodontal probe and marked with pocket marker. External bevel gingivectomy was performed using Kirkland and Orban's periodontal knives. Periodontal pack was adapted.

Patient was prescribed one capsule amoxycillin 500 mg thrice daily, 1 tablet Ibuprofen 400 mg thrice daily, 1 capsule B-complex once daily for 5 days, and 0.2% chlorhexidine oral rinses twice daily for 2 weeks after each surgery. Seven days after surgery, dressings were removed and the site was cleaned. Interval of 2 weeks was given between successive surgeries. The patient returned periodically for follow-up visits during a two and half year span. Scaling was performed every 6 months. No recurrence of gingival enlargement occurred during this follow-up period. Patient was pleased with the treatment outcome [Figure 2], [Figure 3] and [Figure 4]. Since his chief complaint had been addressed, he was not willing for orthodontic treatment.
Figure 2: Postoperative intraoral view of facial aspect of maxillary and mandibular arches

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Figure 3: Postoperative intraoral view of maxillary arch

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Figure 4: Postoperative intraoral view of mandibular arch

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The gingiva excised during surgery [Figure 5] was immediately fixed with 10% buffered formaldehyde solution and sent for histopathologic examination. The specimen was processed and then embedded in paraffin wax. Multiple 5-mm serial sections were prepared stained with hematoxylin and eosin and viewed under trinocular light microscope with flat field objective lenses at ×100 and ×400 magnifications. The excised tissue showed parakeratinized epithelium and underlying connective tissue. Epithelial layer revealed hyperplasia and elongated rete ridges deeply penetrating into the connective tissue stroma. The connective tissue stroma showed abundance of collagen fibre bundles, increased number of fibroblasts, reduced vascularity, and few inflammatory cells infiltrate. These findings were suggestive of GF. [Figure 6].
Figure 5: Excised tissue mass

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Figure 6: Histopathologic examination

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   Discussion Top


GF can occur as an isolated disorder or be part of a syndrome. GF is classified as: [2]

  • Isolated HGF (generalized or localized);
  • Isolated IGF (generalized or localized);
  • GF with hypertrichosis;
  • GF with hypertrichosis and mental retardation and/or epilepsy;
  • GF with mental retardation and/or epilepsy and;
  • GF associated with other diseases as part of a syndrome.


In HGF, members of the family across generations are affected and a positive family history is always present. In IGF no causative agent can be identified and a family history is always lacking. [3]

Syndromes with varying inheritance patterns are associated with GF. These include Murray-Puretic-Drescher syndrome, Rutherford syndrome, Zimmermann-Laband syndrome, Jones' syndrome, Cross syndrome. [2],[4]

In this case, family, prenatal, medical, and drug histories were non contributory. Possibility of any syndrome was also ruled out as no such clinical features were observed. Thus, the patient was diagnosed as a case of isolated IGF.

Maximal gingival enlargement occurs either during the loss of deciduous teeth or in the early stages of the eruption of permanent teeth. It progresses rapidly during ''active'' eruption and decreases with the end of this stage. [1] This correlates positively to the present case.

The precise mechanism of idiopathic gingival fibromatosis is unknown, but it appears to confine to the fibroblasts which harbour in the gingivae. The hyperplastic response does not involve the periodontal ligament and occurs peripheral to the alveolar bone within attached and marginal gingival. [5]

Also, it has been reported that increased proliferation and elevated production of extracellular matrix molecules, fibronectin, and type I collagen could lead to an increase bulk of gingiva. [6]

The surgical and post surgical management of the present patient is identical to that reported by Ramer et al., [4] with HGF. They did a post surgical follow up for 2 years and no recurrence was observed.

Various other techniques like carbon dioxide laser and electrocautery can also be employed to remove such tissues. The goal of any treatment procedure should be to restore function and esthetics of the patient.

Emerson [7] has stated that the eruption of complete set of permanent teeth is the recommended time for surgery. The present patient had eruption of permanent teeth, hence the timing of surgery was considered appropriate.

Histopathologic findings in this case report were similar to those found in previous literature. [8]

Many authors have reported recurrence of hyperplastic tissue following gingivectomy, necessitating a repeat of treatment procedures. [7] The present case was followed up for a period of two and half years. No recurrence was observed during this period.

A patient with GF usually undergoes many surgeries. Therefore, counselling of a paediatric patient and parents is of paramount importance. Education and motivation of patient are also essential for maintenance of proper oral hygiene and regular recall visits.


   Conclusion Top


The present case was isolated IGF. The patient's esthetics and masticatory functions were significantly improved after surgery.


   Acknowledgment Top


The study was self funded by authors and their institution.

 
   References Top

1.Fletcher JP. Gingival abnormalities of genetic origin: Preliminary communication with special reference to hereditary gingival fibromatosis. J Dent Res 1966;45:597-612.  Back to cited text no. 1
    
2.Takagi M, Yamamoto H, Mega H, Hsieh KJ, Shioda S, Enomoto S. Heterogeneity in the gingival fibromatoses. Cancer 1991;68:2202-12.  Back to cited text no. 2
[PUBMED]    
3.Anegundi RT, Sudha P, Nayak UA, Peter J. Idiopathic gingival fibromatosis: A case report. Hong Kong Dent J 2006;3:53-7.  Back to cited text no. 3
    
4.Ramer M, Marrone J, Stahl B, Burakoff R. Hereditary gingival fibromatosis: Identification, treatment, control. J Am Dent Assoc1996;127:493-5.  Back to cited text no. 4
[PUBMED]    
5.Sapp JP, Eversole LR, Wysocki GP. Connective tissue lessions. Contemporary oral and maxillofacial pathology. 2 nd ed. London, UK: Mosby; 2004. p. 294-7.  Back to cited text no. 5
    
6.Tipton DA, Howell KJ, Dabbous ML. Increased proliferation, collagen and fibronectin production by heriditary gingival fibromatosis. J Periodontol 1997;68:524-30.  Back to cited text no. 6
    
7.Emerson TG. Hereditary gingival hyperplasia. A family pedigree of four generations. Oral Surg Oral Med Oral Pathol 1965;19:1-9.  Back to cited text no. 7
[PUBMED]    
8.Carranza FA, Hogan EL. Gingival enlargement. In: Newman MG, Takei HH, Klokkevold PP, Carranza FA, editors. Carranza's Clinical Periodontology, 10 th ed. New Delhi: Elsevier; 2007. p. 373-90.  Back to cited text no. 8
    

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Correspondence Address:
Ashish Saini
Department of Periodontics, College of Dental Sciences, Babu Banarasi Das University, Lucknow, Uttar Pradesh
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0970-9290.114925

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    Figures

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

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    Abstract
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   Surgical Procedure
   Discussion
   Conclusion
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    References
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