JICDRO is a UGC approved journal (Journal no. 63927)

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CASE REPORT
Year : 2010  |  Volume : 2  |  Issue : 2  |  Page : 82-85

Peripheral ossifying fibroma


1 Department of Periodontics and Oral Implantology, Pravara Institute of Medical Sciences, Rural Dental College, Loni, Ahmednagar, Maharashtra, India
2 Department of Orthodontics, Pravara Institute of Medical Sciences, Rural Dental College, Loni, Ahmednagar, Maharashtra, India
3 Department of Prosthodontics, Pravara Institute of Medical Sciences, Rural Dental College, Loni, Ahmednagar, Maharashtra, India
4 Department of Oral Pathology Pravara Institute of Medical Sciences, Rural Dental College, Loni, Ahmednagar, Maharashtra, India

Date of Web Publication20-Apr-2012

Correspondence Address:
Ameet Mani
Department of Periodontics & Oral Implantology, Pravara Institute of Medical Sciences, Rural Dental College, Loni - 413736, Ahmednagar, Maharashtra
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/2231-0754.95267

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   Abstract 

The peripheral ossifying fibroma (POF) is an exophytic gingival mass of fibrous connective tissue covered with a surface epithelium associated with the formation of randomly dispersed foci of a mineralized product consisting of bone, cementum-like tissue, or dystrophic calcifications having a recurrent rate of nearly 20%. It is one of the most common reactive gingival lesions, which have often been called by the generic term "epulis." This case report describes the clinical and histopathological findings of POF, its differential diagnosis, and treatment.

Keywords: Ossifying fibroma, gingival mass, bone


How to cite this article:
Mani A, Mhaske S, Marawar P P, Lagdive S, Kalburge JV. Peripheral ossifying fibroma. J Int Clin Dent Res Organ 2010;2:82-5

How to cite this URL:
Mani A, Mhaske S, Marawar P P, Lagdive S, Kalburge JV. Peripheral ossifying fibroma. J Int Clin Dent Res Organ [serial online] 2010 [cited 2019 Apr 18];2:82-5. Available from: http://www.jicdro.org/text.asp?2010/2/2/82/95267


   Introduction Top


Peripheral ossifying fibroma (POF) is an oral pathologic condition that appears in the mouth as an overgrowth of gingival tissue due to irritation or trauma. A gingival fibroma is derived from cells of the periodontal ligament and usually developing in response to local irritants such as plaque and calculus on associated teeth. It may be mistaken for other more common exophytic gingival lesions such as fibrous hyperplasia or pyogenic granuloma. [1] POF is localized reactive enlargement of the gingiva that typically measures less than 1.5 cm at its greatest dimension. [2] It is relatively common, accounting for 9.6% of all biopsied gingival lesions. [3] The POF may be pedunculated or sessile and does not blanch upon palpation; it mostly occurs between the ages of 25 and 35 years. [4],[5] It may appear ulcerated and erythematous or exhibit a color similar to adjacent gingiva. As it occurs exclusively on the gingival, its occurrence is correlated with the presence of periodontal ligament. [6]

The following case describes POF of the maxillary posterior attached gingiva and its treatment.


   Case Report Top


A female patient aged 32 years reported to the Department of Periodontics, Rural Dental College, Loni, with the chief complaint of bleeding and swelling in the buccal and palatal aspect of 25 and 26 regions since 6 months. The swelling started as a small growth and grew to the present size. It posed no other problems other than interfering with food intake. Bleeding was noticed with slight ulceration due to indentation of lower teeth on occlusal side which caused discomfort during mastication to the patient.

Intraoral examination revealed a single, unilateral growth on buccal and palatal aspect of 25 and 26 measuring about 3.0 × 2 cm in diameters, reddish pink in color, somewhat oval in shape, firm in consistency with pedunculated base, and painless. The growth extended horizontally from distal line angle of 24 to mesial line angle of 26 and vertically from mucogingival junction, involving marginal gingiva and extending palatally to involve palatal mucosa as shown in [Figure 1] and [Figure 2]. The origin was seen primarily from interdental papilla with 24 and 25 regions. Evidence of erythema, ulceration, and intermittent bleeding was seen due to palatal indentation due to antagonist teeth. Color was slight reddish compared with adjacent gingiva. There was no pertinent medical history and further head and neck examination was unremarkable. A periapical radiograph revealed osseous defect with 24 and 25 regions.
Figure 1: Preoperative lesion associated with 24, 25, and 26 regions

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Figure 2: Preoperative palatal view

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Differential diagnosis included pyogenic granuloma, irritational fibroma, aneurismal bone cyst, gingival cyst of adult, peripheral odontogenic fibroma, peripheral giant cell granuloma, and POF. Investigations ordered were intraoral periapical radiograph in relation to 24, 25, and 26 regions and complete hemogram.

The radiographic findings showed mild angular bone loss, and hemogram revealed normal values. Thorough scaling and root planing was done and patient was put on maintenance phase. After 1 week, the growth was surgically excised under local anesthesia. A wide excision of the mass was performed, and the adjacent gingival tissues were plastied to create symmetrical postoperative gingival contours as shown in [Figure 3] and [Figure 4]. The biopsy was transported to the Department of Oral Pathology in 10% formalin for histological report.
Figure 3: Intraoperative view

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Figure 4: Excised lesion

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Histopathological findings

Section shows a parakeratinized stratified squamous epithelium with proliferation. There was forking and arcading of rete ridges. The connective tissues just below the epithelium were fibrocellular, made up of proliferating fibroblasts arranged in strands and whorls with areas of globular calcified masses resembling cementum-like material and osteoid tissue. Rest of the connective tissue was fibrocellular with blood vessels and chronic inflammatory cell infiltrate suggestive of POF as shown in [Figure 5].
Figure 5: Histological photograph

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   Discussion Top


POF can occur at any age, although it appears to be somewhat more common in children and young adults. [7] The present clinical case report concerns a relatively common gingival lesion. In 1982, Gardner described the nature of the POF which had been considered the extraosseous counterpart of the central ossifying fibroma. [8] Most reported series of cases show a predilection for occurrence in females by a ratio ranging from 2:1 to 3:2. Plaque, calculus, rough restorations, illfitting dentures, microorganisms, masticatory forces, minor trauma, trapped food and debris, and iatrogenic factors all influence the development of these lesions. In most instances (<5%), a POF lesion is associated with radiographic signs and tooth migration. [9] For this reason, POF is considered not to be neoplastic, but rather to be a hyperplastic reaction due to inflammation. [10] POFs may exhibit diffuse radio-opaque calcifications, but not all lesions exhibit these radiographic features. Majority of these lesions are not associated with radiographic destruction of bone. [11]

The POF must be differentiated histologically from the peripheral odontogenic fibroma. The main histological differences are the presence of odontogenic epithelium in the peripheral odontogenic fibroma and the presence of displastic dentin in the POF. [12]

The treatment requires proper surgical intervention that ensures deep excision of the lesion including periosteum and affected PDL. Thorough root scaling of adjacent teeth and/or removal of other sources of irritation should be accomplished. [13]

Cundiff found a recurrence rate following excision of 16%, and Eversole and Rovin found a recurrence rate of 20% in 50 cases. [7] Most probably, the incomplete removal of the tumor at the initial surgical procedure and failure to eliminate local irritants are responsible for its recurrence. In this case, recurrence was not observed after 1 year of period as shown in [Figure 6]. However, recurrences are easily managed with additional surgery.
Figure 6: 1 year postoperatively (no recurrence observed)

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   Conclusion Top


The POF is a well-defined pathologic entity among reactive gingival lesions. They are most common in females, found most often in the maxillary incisor-cuspid region, but may occur at any gingival site. As of the POF behavior pattern, a proper treatment protocol is warranted with close follow-up.

 
   References Top

1.Michaelides PL. Recurrent peripheral odontogenic fibroma of the attached gingiva: A case report. J Periodontol 1992;12:645-7.  Back to cited text no. 1
    
2.Kfir Y, Buchner A, Hansen LS. Reactive lesions of the gingiva: A clinicopathologic study of 741 cases. J Periodontol 1980;51:655-61.  Back to cited text no. 2
[PUBMED]    
3.Layfield LL, Shopper TT, Weir JC. A diagnostic survey of biopsied gingival lesions. J Dent Hyg 1995;69:175-9.  Back to cited text no. 3
    
4.Bhaskar SN, Jacoway JR. Peripheral fibroma and peripheral fibroma with calcification: Report of 376 cases. J Am Dent Assoc 1966;73:1312-20.  Back to cited text no. 4
[PUBMED]    
5.Zain RB, Fei YJ, Fibrous lesion of the gingiva: A histological analysis of 204 cases. Oral Surg Oral Med Oral Pathol 1990;70:466-70.  Back to cited text no. 5
    
6.Kenny JN, Kaugars GE, Abbeu LM. Comparision between peripheral ossifying fibroma and peripheral odontogenic fibroma. J Oral Maxillofac Surg 1989;47:378-82.  Back to cited text no. 6
    
7.Shafer's Textbook of Oral Pathology. 5 th Ed.   Back to cited text no. 7
    
8.Gardner DG. Peripheral odontogenic fibroma: An attempt of classification. Oral Surg Oral Med Oral Pathol 1982;54:40-8.  Back to cited text no. 8
[PUBMED]    
9.Silva CO, Sallum AW, do Couto-Filho CE, Costa Pereira AA, Hanemann JA, Tatakis DN. Localized gingival enlargement associated with alveolar process expansion: Peripheral ossifying fibroma coincident with central odontogenic fibroma. J Periodontol 2007;78:1354-9.  Back to cited text no. 9
[PUBMED]  [FULLTEXT]  
10.Eversole LR, Rovin S. Reactive lesions of the gingiva. J Oral Pathol 1972;1:30-8.  Back to cited text no. 10
[PUBMED]    
11.Abitbol TE, Santi E. Peripheral ossifying fibroma - Literature update and clinical case. Periodontal Clin Investig 1997 Spring;19:36-7.  Back to cited text no. 11
    
12.Buchner A. Peripheral odontogenic fibroma: Report of 5 cases. J Craniomaxillfac Surg 1989;17:134-8.  Back to cited text no. 12
    
13.Walters JD, Will JK, Hatfield RD, Cacchillo DA, Raabe DA. Excision and repair of the peripheral ossifying fibroma: A report of 3 cases. J Periodontol 2001;72:939-44.  Back to cited text no. 13
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    Figures

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



 

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