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 Table of Contents  
CASE REPORT
Year : 2016  |  Volume : 5  |  Issue : 7  |  Page : 13-15

Gingival fibromatosis with unknown etiology: An unusual clinical case presentation


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

Date of Web Publication28-Jul-2016

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


DOI: 10.4103/2250-9658.187182

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  Abstract 

Gingival fibromatosis is a heterogeneous group of enlargement characterized by progressive increase in gingival connective tissue elements. Most of the cases are iatrogenic, and some are inherited or idiopathic. Here, we present an unusual clinical presentation of nonsyndromic idiopathic gingival fibromatosis with unknown etiology in a 20-year-old female. The diagnosis was made based on history, clinical examination, radiographic findings, and histopathology.

Keywords: Gingival fibromatosis, gingivectomy, idiopathic gingival fibromatosis, syndrome


How to cite this article:
Khan MA, Tripathi AK, Gupta S, Chandra D. Gingival fibromatosis with unknown etiology: An unusual clinical case presentation. N Niger J Clin Res 2016;5:13-5

How to cite this URL:
Khan MA, Tripathi AK, Gupta S, Chandra D. Gingival fibromatosis with unknown etiology: An unusual clinical case presentation. N Niger J Clin Res [serial online] 2016 [cited 2021 Apr 18];5:13-5. Available from: https://www.mdcan-uath.org/text.asp?2016/5/7/13/187182


  Introduction Top


Gingival fibromatosis represents the fibrous hyperplasia of the gingival tissue.

Many forms of gingival fibromatosis are of unknown etiology and termed as idiopathic gingival fibromatosis (IGF).

IGF is a slowly progressive benign lesion caused by collagenous overgrowth of the gingival connective tissue that affects the interdental papilla, marginal gingiva, and attached gingiva. [1]

Gingival fibromatosis may potentially cover the considerable portion of crown, causing esthetic and functional problems such as difficulty in eating, speaking, mastication, and inadequate lip closure. The gingival tissues are usually present with pink, nonhemorrhagic, firm with fibrotic consistency. [2],[3]

Histopathologically, idiopathic gingival enlargement is characterized by the bulbous increased connective tissue is relatively avascular and has densely arranged collagen fiber bundles, numerous fibroblasts, and mild chronic inflammatory cells. [4]

Here, we report an unusual case of a nonsyndromic, idiopathic gingival enlargement with unknown etiology.


  Case Report Top


In the present case, a 20-year-old female reported to the Department of Periodontology at Career Postgraduate Institute of Dental Sciences and Hospital, Lucknow, Uttar Pradesh, with a complaint of swollen gums since last 2 years with poor esthetics and functional problems. There was no history of drug treatment.

Her current health condition and mental status were normal. She revealed that none of her family members were affected with any form of gingival enlargement. Intraoral examination revealed massive, generalized diffuse type of gingival enlargement involving both the arches [Figure 1]. Gingiva was pale pink, non-hemorrhagic, fibrotic with firm consistency. Severity of gingival enlargement was not related with the amount of local factors present, and the presence of local factors might be secondary to gingival enlargement because a massive gingival enlargement interferes to maintain proper oral hygiene by the patient. Intraoral panoramic radiograph revealed no alveolar bone loss [Figure 2]. Considering the severity of the enlargement, a quadrant-by-quadrant external bevel gingivectomy was chosen as the preferred surgical technique after scaling and root planing [Figure 3]. Histopathological investigations of the excised tissue [Figure 4] revealed densely arranged collagen fiber bundles, numerous fibroblasts, and chronic inflammatory cells [Figure 5]. Postoperative healing was satisfactory, and desired crown lengthening was achieved. Esthetics and functional problems were significantly improved in terms of gingival appearance after surgical excision of enlarged gingival tissue. There was no recurrence of the disease even after 2- years follow-up [Figure 6] and [Figure 7].
Figure 1: Preoperative view

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Figure 2: O.P.G.

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Figure 3: Intra - operative view

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Figure 4: Excised tissue

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Figure 5: Histopathological view

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Figure 6: Post - operative; Front view After 2 - years

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Figure 7: Post - operative; Side view; After 2 - years

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  Discussion Top


Gingival fibromatosis may appear as an isolated entity or may sometimes associated with other condition such as drugs, syndromes such as Cowden syndrome, Ramon syndrome, Zimmermann-Laband syndrome, Jones syndrome, and Cross syndrome. [5] However, several authors' use various terms such as gingivostomatitis, elephantiasis gingivae, hereditary gingival hyperplasia, idiopathic fibromatosis, and hypertrophied gingivae, to describe these lesions. [6],[7]

The similar clinical appearance of these lesions to hereditary gingival fibromatosis (HGF) might have led to misdiagnosis. These complications in the clinical diagnosis necessitate a detailed examination of the patients. Past medical history can eliminate the probability of drug-induced gingival enlargements. Histopathological investigation may also help in clarifying the existence of neoplastic leukocytes, which are abundant in leukemic gingival hyperplasia. As to our consideration, the most difficult part in the differential diagnosis could be the presence of HGF, which is frequently associated with hypertrichosis, mental retardation, epilepsy, and familial disturbances. [7] Syndromic gingival fibromatosis has been associated with ancillary features such as hypertrichosis, epilepsy, mental retardation, progressive sensorineural hearing loss, and abnormalities of the extremities, particularly of the fingers and toes. [2],[5]

However, clinically and histopathologically, it is difficult to differentiate the enlargement may be due to drugs, hereditary, or it is idiopathic. [1] In this case report, we established the diagnosis of IGF through patient history, clinical, radiographical, and histopathological findings.

Although a progressive fibrous enlargement of the gingiva is a feature of Idiopathic fibrous hyperplasia of the gingiva. [8]

Royer et al. [9] revise the hypothesis of gingival fibromatosis which include:

  • Direct stimulation of fibroblast, production of an altered less easily degraded collagen, and increased activity of enzyme prolyl hydroxylase which is important for polymerization of collagen [10],[11]
  • Direct fibroblast stimulation hypothesis is in question. Recent studies suggested that fibroblasts from fibrotic tissues remain activated, even in the absence of continuous stimulation. [12]
Histologic features of gingival fibromatosis have been based on the connective tissue alterations, which showed an increased amount of collagen fiber bundles associated with fibroblasts and the epithelium showing elongated rete pegs. [13] This histologic feature was found in the present case.

There are various treatment modalities available for removal of gingival enlargement including surgery, electrocautery although the most effective method for removing large quantities of gingival tissue is external bevel gingivectomy, especially when there is the presence of pseudopocket and no attachment loss. [14]

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 was observed.

Financial support and sponsorship


Nil.

Conflicts of interest

There are no conflicts of interest.

 
  References Top

1.
Neville B, Damm D, Allen C, Bouquot J. Periodontal Diseases, Oral and Maxillofacial Pathology. 2 nd ed.. Elsevier Saunders; 2004. p. 148-506.  Back to cited text no. 1
    
2.
Coletta RD, Graner E. Hereditary gingival fibromatosis: A systematic review. J Periodontol 2006;77:753-64.  Back to cited text no. 2
    
3.
Baptista IP. Hereditary gingival fibromatosis: A case report. J Clin Periodontol 2002;29:871-4.  Back to cited text no. 3
    
4.
Casavecchia P, Uzel MI, Kantarci A, Hasturk H, Dibart S, Hart TC, et al. Hereditary gingival fibromatosis associated with generalized aggressive periodontitis: A case report. J Periodontol 2004;75:770-8.  Back to cited text no. 4
    
5.
Gorlin RJ, Cohen MM, Levin LS. Syndromes of the Head and Neck. 3 rd ed. New York: Oxford Press (Oxford Monographs on Medical Genetics); 1990. p. 847-52.  Back to cited text no. 5
    
6.
Giansanti JS, McKenzie WT, Owens FC. Gingival fibromatosis, hypertelorism, anti-mongoloid obliquity, multiple telangiectases and cafe au lait pigmentation; a unique combination of developmental anomalies. J Periodontol 1973;44:299-302.  Back to cited text no. 6
[PUBMED]    
7.
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. 7
    
8.
Cekmez F, Pirgon O, Tanju IA. Idiopathic gingival hyperplasia. Int J Biomed Sci 2009;5:198-200.  Back to cited text no. 8
    
9.
Royer JE, Hendrickson DA, Scharpf HO. Phenytoin-induced hyperplasia of the pre-eruptive stage. Report of a case. Oral Surg Oral Med Oral Pathol 1983;56:365-7.  Back to cited text no. 9
[PUBMED]    
10.
Huang JS, Ho KY, Chen CC, Wu YM, Wang CC, Ho YP, et al. Collagen synthesis in idiopathic and dilantin-induced gingival fibromatosis. Kaohsiung J Med Sci 1997;13:141-8.  Back to cited text no. 10
    
11.
Meng L, Huang M, Ye X, Fan M, Bian Z. Increased expression of collagen prolyl 4-hydroxylases in Chinese patients with hereditary gingival fibromatosis. Arch Oral Biol 2007;52:1209-14.  Back to cited text no. 11
    
12.
Hassell TM, Page RC, Narayanan AS, Cooper CG. Diphenylhydantoin (dilantin) gingival hyperplasia: Drug-induced abnormality of connective tissue. Proc Natl Acad Sci U S A 1976;73:2909-12.  Back to cited text no. 12
[PUBMED]    
13.
Tipton DA, Woodard ES 3 rd , Baber MA, Dabbous MK. Role of the c-myc proto-oncogene in the proliferation of hereditary gingival fibromatosis fibroblasts. J Periodontol 2004;75:360-9.  Back to cited text no. 13
    
14.
Tipton DA, Howell KJ, Dabbous MK. Increased proliferation, collagen, and fibronectin production by hereditary gingival fibromatosis fibroblasts. J Periodontol 1997;68:524-30.  Back to cited text no. 14
    


    Figures

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



 

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