Idiopathic gingival hyperplasia and orthodontic treatment: a case report

Surgical treatment of hereditary gingival fibromatosis by diode laser: Report of five rare cases in the same family

The pathogenesis of hereditary gingival fibromatosis (HGF) is largely unknown; however, the removal of excess tissue may often be necessary as it often causes aesthetic and functional problems. Gingivectomy is usually a treatment option that can be performed using a scalpel, cryotherapy, electrosurgery, or laser. This paper aims to evaluate the results of HGF treatments using a diode laser of five people from the same family. Three members of a family of five (two females and three males; 9-36 years old) underwent gingivectomy with a 3 W 300-micron fiber-tipped diode laser (Doctor Smile, Vicenza, Italy) at 810 nm wavelength. While all teeth of one member were extracted, the other member refused treatment. Relapse occurred in three members due to poor oral hygiene. The diode laser was reapplied and oral hygiene instructions were repeated. Patients were followed during the postoperative period for up to two years. HGF is a rare condition that clinicians should pay attention to in the diagnosis, treatment, and follow-ups. Since recurrences are due to dental plaque, oral hygiene instructions are essential and compliance is mandatory. Although there are many treatment approaches, the diode laser is the most indicated method due to many advantages such as providing a bloodless and more sterile operation field, performing an atraumatic surgery, ensuring earlier and ideal recovery, and minimizing postoperative pain.

Seven-year follow-up of a patient with hereditary gingival fibromatosis treated with a multidisciplinary approach: case report

BACKGROUND

Hereditary gingival fibromatosis (HGF) is rare in clinical practice, and the long-term results of the combined orthodontic-periodontal treatment of HGF are rarely reported.

CASE PRESENTATION

This study reports for the first time the results of seven years of follow-up in a seven-year-old girl with HGF. The diagnosis was confirmed by clinical signs, family history and histopathological examination. First, periodontal scaling and oral hygiene reinforcement were performed regularly in the mixed dentition stage. Next, gingivoplasty was performed on the permanent dentition. Two months after the surgery, treatment with fixed orthodontic appliances was conducted. The teeth were polished on a monthly basis, and oral hygiene was reinforced to control gingival enlargement. Gingival hypertrophy recurred slightly, and gingivectomies were performed in the months following the start of orthodontic treatment. Follow-up was performed for 24 months with orthodontic retention, and gingival enlargement remained stable after the combined treatment.

CONCLUSIONS

The risk of gingival hyperplasia recurrence during and after orthodontic treatment is high, but satisfying long-term outcomes can be achieved with gingivectomy, malocclusion correction, and regular follow-up maintenance.

Nonsyndromic with Recurrent Idiopathic Gingival Fibromatosis: A Rare Case Report

Idiopathic gingival fibromatosis is a genetic rare disorder, which is characterized by a progressive enlargement of the gingiva. Gingival enlargement is an overgrowth of the gingiva, which can be caused by various etiological factors such as poor oral hygiene, plaque accumulation, inadequate nutrition, hormonal stimulation, several blood dyscrasias, or long-term intake of certain drugs like phenytoin, nifedipine, or cyclosporine. A 14-year-old female patient reported to the Department of Periodontology, Mahatma Gandhi Dental College and Hospital, Jaipur, Rajasthan with her chief complaint of swollen gums in both upper and lower arches since 3 years, which was gradual in onset and increased in size since 4 months which covered almost half of the surface of each tooth. Also reported that 3 years ago, there was similar swelling for which surgical intervention in form of gingivectomy was carried out. The treatment plan for this case was followed by phase 1 therapy (scaling and root planing) and after completion of phase 1 therapy, the labial tissue from the mandibular anterior region was excised and sent for histopathological examination. Histopathological appearance revealed idiopathic gingival fibromatosis. Thereafter, the conventional gingivectomy under local anesthesia was performed to remove excess gingival overgrowth.

How to cite this article: Kumari A, Bansal MB, Asrani KH, et al. Non-syndromic with Recurrent Idiopathic Gingival Fibromatosis: A Rare Case Report. Int J Clin Pediatr Dent 2021;14(1):158–160.

Hereditary gingival fibromatosis in children: a systematic review of the literature

OBJECTIVES

Hereditary gingival fibromatosis (HGF) is an uncommon, inherited condition with slow and progressive fibrous hyperplasia of the gingiva. Due to its association with mastication, speech, and occlusion problems, early diagnosis is important. We sought to summarize the available data regarding the epidemiology, clinical characteristics, and outcomes of children with HGF (< 18 years).

METHODS

A systematic literature review of the MEDLINE and Cochrane Library databases was conducted with respect to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement (end-of-search date: March 1, 2019).

RESULTS

A total of 99 articles reporting on 146 patients were included. The mean age was 10.82 ± 3.93 years, and generalized gingival enlargement was seen in 97.16% (95% CI 92.69 to 99.14). Jaw, gingival, and teeth abnormalities; poor oral hygiene; eating; or speech difficulties were typical HGF-induced, while 60.90% had extraoral manifestations (95% CI 52.41 to 68.78). The disease was most commonly inherited in an autosomal dominant manner (88.41%, 95% CI 78.5 to 94.26), and about one-third of the patients had syndromic HGF (33.85%, 95% CI 23.50 to 46.00). Gingivectomy was performed in the majority of cases (91.15%, 95% CI 84.31 to 95.29), and recurrence was seen in 33.85% (95% CI 23.50 to 46.00).

CONCLUSION

HGF should be suspected in children with nodularity and gingival fibrosis, teeth abnormalities, or jaw distortion. Family history can help to establish the diagnosis.

CLINICAL RELEVANCE

More cases should focus on longer-term follow-up after gingivectomy as disease recurrence is not uncommon.

The Periodontium as a Potential Cause of Orofacial Pain: A Comprehensive Review

Introduction:

Orofacial pain of periodontal origin has a wide range of causes, and its high prevalence and negative effect on patients' quality of life make intervention mandatory. This review provides a periodontological overview of the field of orofacial pain, focusing on the entities which involve the periodontal tissues and may be the cause of this pain or discomfort.

Methods:

The study comprised a literature search of these pathologies conducted in the MEDLINE/PubMed Database. Acute infectious entities such as gingival and periodontal abscesses are emergencies that require a rapid response. Periodontitis associated with endodontic processes, necrotizing periodontal disorders, desquamative gingivitis, gingival recession, and mucogingival herpetic lesions, cause mild to severe pain due to tissue destruction and loss. Other lesions that lead to periodontal discomfort include gingival enlargement and periodontal ligament strains associated with occlusal trauma, parafunctional habit and the impaction of food or foreign bodies.

Conclusion:

A range of therapeutic, pharmacological and surgical alternatives are available for the management of these injuries. However, the wide variety of causes of orofacial pain or periodontal discomfort may confuse the clinician during diagnosis and may lead to the wrong choice of treatment.

"Whisking of ugly tissue"… A surgical management of gingival fibromatosis in a 15-year-old girl: A rare case report

Gingival fibromatosis is a condition characterized by a slow, progressive increase in the gingival tissue that develops as either an isolated disorder or as part of the clinical characteristics of diverse syndrome. The present case report describes a rare case of gingival fibromatosis and its management using scalpel in combination with electrosurgery. A 15-year-old girl patient presented with a chief complaint of gingival overgrowth covering all the surfaces upper and lower teeth. The growth was excised with periodontal knife in combination with electrosurgery under local anesthesia. After 1-year of follow-up, healing was uneventful with no recurrence. Combined technique for the removal of gingival overgrowth represents a unique treatment approach where minimal postoperative bleeding and discomfort were observed.

Gingival Fibromatosis with Distinctive Facies - A Three Generation Case Report

Hereditary gingival fibromatosis (HGF) is a rare disorder characterized by progressive and varying degrees of gingival overgrowth. Oral manifestations may vary from minimal involvement of only tuberosity area and the buccal gingiva around the lower molars to a generalized gingival enlargement. It can occur as an isolated disorder but can be one feature of a syndrome. Although the clinical and histopathological characteristics of HGF are well known and described, the pathogenic mechanism remains unknown. The goal of this article is to describe a family with three generations afflicted with a syndromic form of HGF known as gingival fibromatosis with distinctive facies, and discuss the diagnosis and treatment of the disease.

Nonsurgical Management of Phenytoin-induced Gingival Hyperplasia

INTRODUCTION

The aim of this report is to present a severe case of phenytoin (PHT)-induced gingival hyperplasia in a Saudi patient.

MATERIALS AND METHODS

A 12-year-old male epileptic patient, undergoing PHT therapy, was diagnosed clinically with severe gingival hyperplasia. His treatment consisted meticulous oral care and weekly professional prophylaxis. The patient was advised oral folic acid supplementation (0.5 mg/day) and was also recommended 0.2% chlorhexidine gluconate mouthwash twice daily.

RESULTS

There was significant reduction in the hyperplastic tissue within 4 weeks of treatment.

CONCLUSION

It is possible to treat PHT-induced gingival hyperplasia non-surgically with intensive dental care, correct oral hygiene and oral folic acid supplements.

Hereditary gingivo-alveolar hyperplasia: a report of two siblings

Gingival hyperplasia is characterized by fibrotic gingival overgrowth. The lesion may bury all the crown of the teeth and lead to impairment in masticatory functions and aesthetic disfigurement. This inherited disease is considered rare. We presented two cases of gingival hyperplasia in two siblings: an 11-year-old girl and an 8-year-old boy, whose mother had also suffered from the disease. The two siblings presented with generalized gingival overgrowth involving the maxillary and mandibular arches and covering almost all of the teeth. We performed surgery to reduce the excessive gingivo-alveolar tissue and disclosed most of the teeth. The patients showed functional and aesthetic improvement. The last follow-up through a phone call, which was conducted 12 months after the surgery, revealed no recurrent hyperplasia.

A Papilloma-like Atypical Gingival Enlargement Treated Using Nd:YAG Laser Surgery: Report of a Case

Gingival overgrowths can occur due to various factors, such as inflammation, or rarely without a reason and are significant in periodontology. Here, we describe the diagnosis and treatment of a 33-year old female with a papilloma-like atypical enlargement of the gingiva attached to the molar vestibular region of her lower jaw. After the patient's medical history was taken and the clinical examination done, the enlargement was surgically removed with a Nd:YAG laser and evaluated histopathologically. There was an inflamed, oedematous and vascularized stroma with a thick spongy squamous epithelium layer. After six months, there were no problems at the surgical area and recurrence was not observed.

Unusual presentation of localized gingival enlargement associated with a slow-growing odontogenic myxoma

Unusual presentation of localized gingival enlargement associated with a subjacent tumoural pathology is reported. The patient was a 55-year-old black male, whose chief complaint was a progressive gingival overgrowth for more than ten years, in the buccal area of the anterior left mandible. According to the clinical features and the radiological diagnosis of odontogenic keratocyst, a conservative surgery with enucleation and curettage was performed. Tissue submitted for histopathological analysis rendered the diagnosis of odontogenic myxoma. After 12-month of follow-up, no evidence of recurrence was found. Clinicians should be cautious when facing any gingival enlargement to avoid diagnostic pitfalls and to indicate the appropriate treatment.

Report of a case of Zimmermann-Laband syndrome with new manifestations

Zimmermann-Laband syndrome is a rare disorder characterized by gingival fibromatosis, abnormalities of the nose and/or ears, absence and/or hyperplasia of the nails or terminal phalanges of the hands and feet, hyperextensibility of joints, hepatosplenomegaly, mild hirsutism and mental retardation. The syndromic characteristics of Zimmermann-Laband syndrome are highly variable and complicated. This paper described a patient with Zimmermann-Laband syndrome with new manifestations and discusses the possible underlying genetic mechanisms.

The effects of fixed orthodontic appliances on saliva flow rate and saliva electrolyte concentrations

Fixed appliance orthodontic treatment may affect local saliva secretion; however, there is limited information available about this respect in the literature. Understanding how fixed appliance orthodontic treatment affects local saliva secretion could provide insight on possible contributions of salivary changes towards decalcification. In this study, we found that during the first month of fixed orthodontic treatment, the whole saliva flow rate, upper labial saliva flow rate and concentrations of whole saliva sodium and chlorine increased significantly, while the concentrations of calcium, phosphorous and potassium in whole saliva decreased. However, all these were in normal levels after 3 months. This study demonstrated that saliva flow rate was increased and saliva electrolytes were changed at early stage when placing fixed orthodontic appliances, which was considered due to increased mechanosensation.

Hereditary Gingival Fibromatosis

INTRODUCTION

Hereditary gingival fibromatosis (HGF) is a rare condition characterized by progressive enlargement of the gingiva. Most cases follow autosomal dominant genetics, with a reported incidence of 1 in 750,000. In addition to cosmetic concerns, the compromised oral cavity may cause difficulty with eating, speech, hygiene, and oral competence. In addition, social consequences can be dramatic, forcing patients to lead isolated, reclusive lives. Traditional therapy uses serial gingival resections ("quadrantectomies") with primary closure. However, this method is associated with frequent recurrence and additional resections. We report on a family of 12 siblings, 8 of whom, including monozygotic twins, are affected with HGF. We describe corrective surgery for 3 siblings, as well as their long-term follow-up.

METHODS

Three sisters suffered from severe maxillary and mandibular gingival hyperplasia. All complained similarly of weight loss, difficulty with articulation, and social isolation. Physical examination revealed massive overgrowth of both maxillary and mandibular gingiva, as well as multiple ectopic teeth. Following diagnostic biopsy, all 3 patients underwent staged resections. The first stage involved resection of the maxillary component, followed by a planned second-stage resection of the mandibular component. All resections included gingivectomies, odontectomies, and alveolar ridge ostectomies. The oral cavity was allowed to heal by secondary intention.

RESULTS

All 3 patients were female, and ages ranged from 34-48 years (mean: 43). Follow-up on the 3 patients ranged from 3-18 months (mean: 11 months). There has been no evidence of recurrence to date. The gingiva remucosalized uneventfully within several weeks, and all patients are tolerating solid food. All patients report dramatically improved speech, oral hygiene, and self-confidence.

CONCLUSIONS

In an effort to address the high recurrence rate, we describe our aggressive surgical approach, including resection of the hypertrophied gingiva and alveolar processes. Two-staged gingival resection, as opposed to the more traditional 4-stage quadrantectomy approach, has resulted in no recurrence to date, suggesting an improved outcome over the traditional techniques.

Hereditary Gingival Fibromatosis: A Systematic Review

Generalized gingival enlargement can be caused by a variety of etiological factors. It can be inherited (hereditary gingival fibromatosis [HGF]); associated with other diseases characterizing a syndrome; or induced as a side effect of systemic drugs, such as phenytoin, cyclosporin, or nifedipine. HGF, previously known as elephantiasis gingivae, hereditary gingival hyperplasia, and hypertrophic gingiva, is a genetic disorder characterized by a progressive enlargement of the gingiva. This review will focus on diagnosis, treatment, and control of HGF. The pattern of inheritance, the histopathologic characteristics, and the known biologic and genetic features associated with HGF are also emphasized.

Gingival fibromatosis and significant tooth eruption delay in an 11-year-old male: a 30-month follow-up

This case report describes the dental management of an unusual case of idiopathic gingival fibromatosis with multiple impacted primary teeth, and the absence of eruption of permanent teeth, in an 11-year-old boy and at the 30-month follow-up. The patient presented with severely enlarged gingival tissues affecting both arches and multiple retained and non-erupted primary teeth. He had already been subjected to localized gingivectomies at the ages of 7 and 9 years. He had no known syndrome and there was no family history of any similar disorder. The patient was treated under general anaesthesia to remove the excessive gingival tissues using apically positioned flaps. During the surgical procedure, over-retained and unerupted impacted primary teeth were extracted in order to facilitate the eruption of the permanent successors. Two years postoperatively, there was no recurrence of the gingival enlargement. Overdentures were then constructed because none of the permanent teeth had yet erupted. Furthermore, pre-eruptive coronal resorption was detected radiographically affecting the crown of the unerupted 36. Thirty months postoperatively, no recurrence of gingival enlargement was seen, but the permanent teeth had still not erupted.