Gingival fibromatosis with significant de novo formation of fibrotic tissue and a high rate of recurrence (original) (raw)

Gingival fibromatosis: clinical, molecular and therapeutic issues

Orphanet Journal of Rare Diseases, 2016

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.

Treatment and long-term follow-up of a patient with hereditary gingival fibromatosis: a case report

2002

This report addresses the complex nature of oral diagnosis, treatment and long-term case management in the hereditary form of recurrent gingival fibromatosis. Case management is discussed in relation to a 13-year-old girl who presented with recurrent, progressive gingival enlargement requiring consecutive periodontal and orthodontic treatment. The initial course of treatment included 4-quadrant gingivectomy with reverse bevel incisions, followed by orthodontics. Microscopic examination of the gingivectomy specimens supported the clinical diagnosis. Three years later, recurrence of the condition was observed in all quadrants. To facilitate orthodontic tooth movement and to achieve optimal esthetics, another full-mouth gingivectomy was performed. There was no recurrence of the condition a year later. It is recommended that patients with this condition be monitored closely after gingivectomy, so that the treatment requirements of localized areas can be addressed as needed.

Study About Hereditary Gingival Fibromatosis and Its Impact on Dental Treatment

2019

Clinical and histomorphometric characteristics of three different families with hereditary gingival fibromatosis

Oral Surgery Oral Medicine Oral Pathology Oral Radiology and Endodontology, 2008

Objective. To examine the histomorphologic and histomorphometric features of tissue from 3 unrelated families with hereditary gingival fibromatosis (HGF). Study design. Twelve affected individuals from 3 HGF families and 3 control subjects were evaluated. Gingival samples were fixed in formalin and embedded in paraffin for hematoxylin and eosin stain to count the number of fibroblast and inflammatory cells. Sirius red staining was performed to quantitate the amount of collagen present. Results. Histomorphologic analysis of HGF showed extension of epithelial rete ridges into the underlying lamina propria and the presence of collagen bundles in the connective tissue. Analysis of the mean area fraction of collagen showed that there were significant increases in the collagen fraction for all HGF types compared with control subjects (P Ͻ .05). There were significant increases in the number of fibroblasts for HGFa and HGFb compared with control subjects (P Ͻ .05). The number of fibroblasts for HGFc were similar to that for control subjects. Conclusions. The collagen fraction was significantly greater in all HGF types compared with controls. The number of fibroblasts was significantly increased in 2 of the 3 HGF types compared with controls. These data indicate that different mechanisms may be responsible for tissue enlargement in different forms

Long-term uncontrolled hereditary gingival fibromatosis: a case report

The journal of contemporary dental practice, 2007

Hereditary gingival fibromatosis (HGF) is a rare condition characterized by varying degrees of gingival hyperplasia. Gingival fibromatosis usually occurs as an isolated disorder or can be associated with a variety of other syndromes. A 33-year-old male patient who had a generalized severe gingival overgrowth covering two thirds of almost all maxillary and mandibular teeth is reported. A mucoperiosteal flap was performed using interdental and crevicular incisions to remove excess gingival tissues and an internal bevel incision to reflect flaps. The patient was treated 15 years ago in the same clinical facility using the same treatment strategy. There was no recurrence one year following the most recent surgery.

Surgical Management of a Severe Case of Gingival Fibromatosis

oral health and dental management, 2016

Gingival fibromatosis (GF) is a fibrous overgrowth of gingiva that maybe idiopathic or may have an inheritance pattern wherein it is known as hereditary gingival fibromatosis (HGF). This case report describes a 16-year old female patient who presented generalized extensive gingival overgrowth, involving the maxillary and mandibular arches. Diagnosis of GF was substantiated by the patient’s clinical features and histopathological examination. Excision of the gingival tissue was done by gingivectomy with manual instrumentation and electrosurgery. The postoperative course was uneventful and the patient’s aesthetic concerns were addressed. Thus, in severe cases of GF, the use of multiple modalities of surgery is warranted to achieve favorable esthetic and functional results.

Idiopathic gingival fibromatosis – case report

Idiopathic gingival enlargement is a type of gingival fibromatosis characterized by progressive overgrowth of the gingival tissues.This case report presented the clinical features of a typical idiopathic gingival enlargement which was treated with external bevel gingivactomy. The patient presented with generalized diffuse gingival enlargement involving the maxillary and mandibular arches extending on buccal and lingual/palatal surfaces and covering incisal/occlusal third of the tooth resulting in difficulty in speech and mastication since last three years. Gingivectomy was carried outto improve patient's quality of life. Since removal of hyperplastic gingival tissue eliminates difficulties in eating and speaking. Therefore, this surgical intervention improves access for plaque control, and leads to psychological benefits due to esthetic improvement. In this case, even after one year from following-up, no recurrence of gingival overgrowth was observed. Keyword: Gingival Overgrowt...

Study About Hereditary Gengival Fibromatosis and Its Impact on Dental Treatment

2019

Introduction: Gingival Fibromatosis or Gingival Hyperplasia is a rare disorder with slow and progressive growth and is characterized by being a neoplasm in the gingival tissue, where it can be found in a localized manner. This study aims to elucidate the characteristics and possible manifestations, aiming to facilitate its identifi cation, treatment and control. Methodology: This is a literature review. Forty-two articles and theses with languages in English, Spanish, French, and Portuguese were researched, whose sources are Scielo and Pubmed, and 25 articles were included for their relevance to the topic. Literature review: Gingival fi bromatosis is a clinical manifestation present in several genetic syndromes that can lead to a craniofacial involvement that is characterized by the expansion and accumulation of connective tissue with increased number of cells and collagen fi bers. Fibromatosis has a proliferation of well-diff erentiated fi broblasts with varying amounts of collagen between proliferating cells and can be classifi ed as: drug-induced and hereditary. Through histopathology, the stratifi ed squamous epithelium is obese with prominent and elongated ridges, dense connective tissue and disorganized cells with slow but progressive growth. It is also a rare disorder of non-neoplastic gingival tissue (1 case/750,000 people) that presents normal coloration, fi rm consistency and absence of infl ammatory signs. Conclusion: The expression of Gingival Fibromatosis has several origins, making it necessary to know the causative factor in the patient to prepare the treatment plan according to their needs, so the conversation with the patient through the anamnesis is so important at the beginning of treatment. Oral manifestations are important clinical fi ndings to assist in the diagnosis of genetic syndromes, allowing the dentist to guide their patients and clarify doubts about dental impairment.

Idiopathic gingival fibromatosis rehabilitation: a case report with two-year followup

Case reports in dentistry, 2013

Gingival enlargements are quite common and may be either inflammatory, noninflammatory, or a combination of both. Gingival hyperplasia is a bizarre condition causing esthetic, functional, psychological, and masticatory disturbances of the oral cavity. Causes of gingival enlargement can be due to plaque accumulation, due to poor oral hygiene, inadequate nutrition, or systemic hormonal stimulation (Bakaeen and Scully, 1998). It can occur as an isolated disease or as part of a syndrome or chromosomal abnormality. A progressive fibrous enlargement of the gingiva is a facet of idiopathic fibrous hyperplasia of the gingiva (Carranza and Hogan, 2002; Gorlin et al., 1976). It is described variously as fibromatosis gingivae, gingivostomatitis, hereditary gingival fibromatosis, idiopathic fibromatosis, familial elephantiasis, and diffuse fibroma. We present a case of idiopathic gingival fibromatosis with its multidisciplinary approach of management.

Gingival fibromatosis with significant de novo formation of fibrotic tissue and a high rate of recurrence (original) (raw)

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