Periodontal Regenerative Therapy with Recombinant Human Fibroblast Growth Factor (rhFGF) -2 for Stage III Grade C Periodontitis: A Case Report with 6-month Follow-up.

This report describes a case of generalized chronic periodontitis requiring periodontal regenerative therapy. The patient was a 56-year-old woman visiting the Tokyo Dental College Suidobashi Hospital with the chief complaint of swelling in the maxillary right gingiva. An initial examination revealed 34.0% of sites with a probing depth (PD) of ≥4 mm. The prevalence of sites with bleeding on probing was 32.7%. The plaque control record (PCR) score was 65.7%. Radiographic examination revealed angular bone resorption at #18 and 48. Horizontal absorption was also observed in other areas. The percent bone loss/age at #48 was 1.07. A clinical diagnosis of generalized chronic periodontitis (Stage III, Grade C) was made. Based on the clinical diagnosis of severe chronic periodontitis, initial periodontal therapy was performed. An improvement was observed in periodontal conditions at re-evaluation. The PCR score was 16.7%. Periodontal surgery was performed for teeth with a residual PD of ≥4 mm. Periodontal regenerative therapy using rhFGF-2 were performed on intrabony defects in #18 and 48. Open flap debridement was performed on #16, 26, and 27. Following evaluation, oral function was restored using all-ceramic crowns (#46). At 6 months postoperatively, the patient was transitioned to supportive periodontal therapy (SPT). During the 6-month SPT, stable periodontal conditions that facilitated a favourable level of plaque control were maintained.

A Case Report of Periodontal Regenerative Therapy Using Recombinant Human Fibroblast Growth Factor 2 and Deproteinized Bovine Bone Mineral with Non-incised Papillae Surgical Approach (NIPSA) for Angular Bone Defect in Patient with Stage III Grade C Periodontitis.

This report describes a case of Stage III Grade C periodontitis requiring periodontal regenerative therapy. The patient was a 19-year-old woman who presented with the chief complaint of gingival recession in the incisor region. An initial examination revealed that 45.3% of sites had a probing depth of ≥4 mm and 45.8% bleeding on probing. Radiographic examination showed angular bone resorption in #25, 26, 31, 36, and 46 and horizontal resorption in other regions. Initial periodontal therapy was implemented based on a clinical diagnosis of Stage III Grade C periodontitis (generalized aggressive periodontitis). Occlusal adjustment was also performed at sites showing premature contact (#26 and 36) after suppression of inflammation. Periodontal regenerative therapy using recombinant human fibroblast growth factor (rhFGF) -2 was performed on #25, 26, and 46. Combination therapy with rhFGF-2 and deproteinized bovine bone mineral (DBBM) was performed on #31 and 36. A non-incised papillae surgical approach (NIPSA) was used on #31. Periodontal conditions were then re-evaluated and the patient placed on supportive periodontal therapy. Regenerative therapy using rhFGF-2 and DBBM with NIPSA yielded an improvement in clinical parameters and bone resorption. This improvement has been adequately maintained over a 12-month period. Continued care is needed to maintain stable periodontal conditions.

Vitamin C mesotherapy versus diode laser for the esthetic management of physiologic gingival hyperpigmentation: a randomized clinical trial.

BACKGROUND: Physiologic gingival hyperpigmentation is a common esthetic concern that affects individuals of various ethnicities, and can have a significant impact on individual's self-confidence and overall quality of life. Thus, this study aimed to clinically assess the effectiveness of intra-mucosal injection of vitamin C versus 980 nm diode laser for the management of physiologic gingival hyperpigmentation. METHODS: Twenty-six healthy non-smoker individuals with physiologic gingival hyperpigmentation were randomly assigned to two groups. Group I received intra-mucosal injection of vitamin C (L-Ascorbic acid 1000 mg/5 ml), and group II was managed using diode laser (980 nm, 1.5 W, continuous wave mode). Clinical evaluation of pigmentation intensity and distribution was performed preoperatively, and at 1, 2 and 3 months postoperatively using two different color assessment indices; Dummett-Gupta Oral Pigmentation Index (DOPI), and Gingival Pigmentation Index (GPI). Additionally, the study assessed pain intensity and patients' satisfaction. RESULTS: Pigmentation scores decreased significantly between pre-operative visit and different follow-up visits for both treatment modalities (p < 0.0001*). When compared to the vitamin C mesotherapy group, the laser group demonstrated significantly lower gingival pigmentation scores (p < 0.0001*). However, both treatment modalities were equally satisfying for the patients. CONCLUSIONS: Vitamin C mesotherapy and diode laser are both effective in the management of physiologic gingival hyperpigmentation. While diode laser yields better and earlier results, vitamin C mesotherapy offers a cost-effective, safe and minimally invasive approach that is equally satisfying for the patients seeking esthetic enhancements. TRIAL REGISTRATION: The study was registered on ClinicalTrials.gov (NCT05608057) on (01/11/2022).

Intraoral healing type of pyogenic granuloma (A benign vascular tumor): A case report.

Pyogenic granulomas represent tumor-like lesions affecting the skin and the oral cavity. This classic definition can be somewhat misleading because such lesion is not associated with infection and lacks any clinical evidence of pus or histological evidence of actual granulation tissue. This case report describes a surgical excision of the growth to exclude angiomatous proliferation. The patient reported a chief complaint of localized gingival overgrowth since 4 months. Intraoral examination revealed an irregular, sessile exuberant growth in respect to labial aspect and interdental gingiva of 31, 32, and 33, measuring about 1.6 × 1.1 cm. Based on the clinical findings, the case was provisionally diagnosed as "pyogenic granuloma". A treatment was planned for the patient. A surgical excision was done irt 31, 32, 33, and the tissue was sent for histopathological examination, which was suggestive of a healing type of pyogenic granuloma.

Treatment of Stage III Grade C Periodontitis with Periodontal Regenerative Therapy including Guided Tissue Regeneration (GTR) and Recombinant Human Fibroblast Growth Factor (rhFGF)-2: A Case Report.

This report describes a case of periodontitis treated with periodontal surgery including guided tissue regeneration (GTR) and recombinant human fibroblast growth factor (rhFGF)-2. The patient was a 54-year-old woman who visited the Tokyo Dental College Suidobashi Hospital with the chief complaint of swelling in the maxillary right gingiva. An initial examination revealed 30.4% of sites with a probing depth (PD) of ≥4 mm. The prevalence of sites with bleeding on probing was 57.7%. The plaque control record (PCR) score was 66.1%. Radiographic examination revealed vertical bone defects in the molar region. Based on these findings, the clinical diagnosis was generalized chronic periodontitis (Stage III, Grade C). Initial periodontal therapy yielded an improvement in periodontal conditions, with the PCR score reducing to 13.8%. Periodontal surgery was performed for teeth with a residual PD ≥4 mm. Guided tissue regeneration was performed on #37 and 47. A series of periodontal regenerative treatments comprising application of rhFGF-2 was performed on angular bone defects in #14, 15, 25, and 27. Open flap debridement was performed on #16, 17, 26, 36, and 46. Following evaluation, oral function was restored by placing all-ceramic crowns on #21 and 26. The patient was then placed on supportive periodontal therapy. In the present case of generalized chronic periodontitis, periodontal regenerative therapy with GTR and rhFGF-2 yielded stable periodontal conditions.

Clinical and pathologic factors associated with the relapse of fibrous gingival hyperplasia.

BACKGROUND: The association between clinicopathologic characteristics and the relapse of fibrous gingival hyperplasia is unknown. METHODS: The records of 211 consecutive patients with a clinicopathologic diagnosis of fibrous gingival hyperplasia were retrieved. Patients who experienced relapse after surgical excision of the lesion were considered case patients (n = 30). All control patients were informed that there was no recurrence (n = 181). Logistic regression was used to evaluate the associations among different characteristics and the recurrence. Stratified analyses on sex was applied to identify the different associations. RESULTS: Binary logistic regression showed that patients with ulcer (odds ratio [OR], 3.23; 95% CI, 1.18 to 8.83) or mechanical stimulation (OR, 2.42; 95% CI, 1.03 to 5.68) had a higher risk of experiencing recurrence. Stratified analysis of sex identified significant association in females (ulcer: OR, 4.04; 95% CI, 1.14 to 14.34; mechanical stimulation: OR, 3.30; 95% CI, 1.15 to 9.42). No significant difference was observed in males (ulcer: OR, 2.44; 95% CI, 0.40 to 15.06; mechanical stimulation: OR, 1.62; 95% CI, 0.28 to 9.40). Male patients with larger epulides had fewer recurrence (OR, 0.13; 95% CI, 0.02 to 0.74). There was no significant difference in pathologic calcification between case and control patients (P > .05). CONCLUSIONS: Patients with ulcer and mechanical stimulation may have a high risk of experiencing recurrent epulis. PRACTICAL IMPLICATIONS: More attention should be paid to patients with ulcer and mechanical stimulation. Apart from complete surgical removal, it is important to remove local stimulation to prevent recurrence of these lesions.

Prosthetic and surgical management of a sizeable epulis fissuratum: a case report.

This case report describes the management of a large-sized Epulis Fissuratum (EF) in a 70-year-old female patient using an original prosthetic technique. It consists of a combination of a tissue conditioning and a resection surgery. The patient´s main concern was a mucogingival tissue growth located on the left mandibular area. The interesting clinical findings deriving from this technique are: tissue conditioning is an important phase prior to the surgical resection of a large EF and occlusal functions can be maintained during the procedures with patient´s corrected dentures. After clinical, radiological and pathological examinations, the diagnosis was of an EF induced by an ill fitted mandibular denture. The intervention carried out was a combination of a 2 weeks tissue conditioning period followed by a cold blade surgical resection. After a 3 months follow-up period, a completely healed vestibular sulcus was observed with no scar tissue. The present technique facilitates the resection surgery by removing the inflammatory component of the EF. It also guides the post-surgical tissue healing, allowing the obtention of a deep vestibular sulcus, thus creating a better bearing surface for subsequent renewed dentures. Not depriving the patient of her dentures during the healing process helped to improve her quality of life and her cooperation.

Novel flapless esthetic procedure for the elimination of extended gingival metal tattoos adjacent to prosthetic teeth: Er:YAG laser micro-keyhole surgery.

PURPOSE: This article describes a novel, minimally invasive procedure called Er:YAG laser micro-keyhole surgery (EL-MIKS) that removes metal or amalgam tattoos in the gingiva adjacent to prosthetic teeth without gingival deformity and recession. We aimed to evaluate the clinical efficacy of EL-MIKS for removing metal tattoos and present its long-term treatment outcomes. METHODS: The EL-MIKS procedure consists of several steps that are all performed under a microscope. First, a micro-keyhole (1-2 mm diameter) was prepared using an Er:YAG laser in the center of the metal pigmentation. The connective tissue was evaporated in the deep layer, where metal debris was deposited. Second, within the accessible range, the irradiation angle was changed in various directions to ablate the metal pieces and discolored connective tissue without enlarging the keyhole. Finally, after blood filled the space created by the tissue evaporation, the surface of the blood clot at the entrance of the micro-keyhole was thermally coagulated with defocus laser irradiation. Pigmentation that could not be successfully removed from a single micro-keyhole was treated by forming new micro-keyholes at a distance of 3 mm or more from each previously created hole. Depigmentation over an extended area was completed over a few sessions every 4 weeks without gingival recession after surgery. CONCLUSION: EL-MIKS, a novel depigmentation technique, was able to successfully remove an extended area of metal tattoos in the gingiva using a simpler, easier, and less invasive procedure than conventional periodontal plastic surgery. Esthetic restoration was successfully achieved without postoperative alteration of the gingival contour.

Granuloma piógeno oral. Serie de casos / Oral pyogenic granuloma. Case series

RESUMEN El granuloma piógeno es una lesión que se manifiesta en la piel y en la cavidad oral, relacionado con diversas causas, como irritación crónica, trauma y cambios hormonales. Clínicamente se muestra como una lesión hiperplásica altamente vascularizada, con un tamaño de 1-3 cm, de base pedunculada o sésil y de crecimiento lento. Predomina en el sexo femenino y tiende a aparecer, sobre todo, en la encía, con muy pocos casos reportados en zonas edentes, motivo por el que se realizó el reporte de tres casos de granuloma piógeno oral en pacientes femeninas, comprendidas entre 30 y 40 años de edad. Se presentaron lesiones que diferían en cuanto a su localización y apariencia clínica (AU).

ABSTRACT Pyogenic granuloma is a lesion that arises in the skin and oral cavity, related to various causes, such as chronic irritation, trauma and hormonal changes. Clinically it looks like a highly vascularized hyperplastic lesion, sized 1-3 cm, with a pedunculated or sessile base and slow growing. It predominates in the female sex and tends to appear, above all, in the gum, with very few cases reported in edentulous areas; that is why the authors reported three cases of oral pyogenic granuloma in female patients, aged between 30 and 40 years. The lesions differed in their location and clinical appearance (AU).

Comparison of Bur Abrasion and CO2 Laser in Treatment of Gingival Pigmentation: 6 Months Follow-Up.

PURPOSE: Pigmentation of gingiva is an aesthetic problem. Until now, various methods have been introduced for removal of gingival pigmentation. The purpose of this study was to compare bur abrasion and CO2 laser methods in removing gingival pigmentation. MATERIALS AND METHODS: Twelve patients aged 20-40 years old with the chief complaint of physiologic gingival pigmentation participated in this study. For these patients, gingival depigmentation was performed using two treatment modalities including bur abrasion and CO2 laser in a split-mouth design. Gingival depigmentation was performed in the right half of the anterior maxillary and mandibular sextants using bur abrasion method by means of diamond bur on a high-speed headpiece with vigorous water irrigation and the left half of the anterior maxillary and mandibular sextants using a CO2 laser. CO2 laser was set at: peak power 252 watts, repeat time 20 ms and pulse duration 200 microsecond which was used in a non-contact position. The area of pigmentation was calculated via gridlines in the Microsoft Paint software 1 and 6 months after the procedure. Gingival recession was also determined before, and at 1 and 6 months after the procedure. RESULTS: The area of gingival pigmentation was not statistically significantly different between the two treatment modalities before the procedure (p = 0.452), 1 month (p = 0.443) and 6 months after the procedure (p = 0.202). There was no statistically significant difference in the variance of pigmented area at different times in the two methods. In both CO2 laser and bur abrasion methods, the mean area of pigmentation was statistically significantly different in the follow-up period (p < 0/001), in a way that the change in the area of pigmentation was statistically significant 1 month after treatment (p <0.001) and also 6 months after treatment (p < 0.001) compared to before. The change in the area of pigmentation between 1 and 6 months after treatment was not statistically significant in both CO2 laser (p = 0.157) and bur abrasion method (p = 0.150). No increase in gingival recession was observed in any of the patients. CONCLUSION: Both treatment modalities can effectively treat gingival pigmentation. No increase in gingival recession was observed. Conventional method and CO2 laser were not statistically significantly different during a follow-up period of 1 and 6 months.

Efficacy of 980 nm diode laser and 2940 nm Er: YAG laser in gingival depigmentation: A comparative study.

BACKGROUND: Gingival hyper-pigmentation is an esthetics problem in patients with excessive gingival display. Laser ablation has been suggested recently as the most effective, pleasant, and reliable technique for gingival depigmentation compared to blade surgery. AIM: The present study aimed to identify and compare the effectiveness of two types of lasers, Er:YAG laser-2940 nm and Diode laser-980 nm, in gingival depigmentation in the maxilla and mandible. PATIENTS/METHODS: 20 participants, 16 males, and 4 females, whose ages ranged between 18 and 35 years, were recruited using simplified random sampling. Oral pigmentation was measured at pre- and two postoperative follow-ups, 1 month, and 6 months, according to the oral pigmentation index. Furthermore, the study assessed postoperative intensity of pain using the Visual Analogue Scale, bleeding and healing process in both groups. RESULTS: There was a significant decrease in the oral pigmentation index scores, 1 month (0.90 ± 0.64) and 6 months (1.55 ± 0.60) after the operation (P < .001). No significant differences were detected between the two study groups regarding the mean ranking on the oral pigmentation index pre-operatively (P = .547), 1 month after the operation (P = .154), and 6 months after the operation (P = .831). CONCLUSIONS: The Er:YAG laser and Diode laser both significantly reduced gingival pigmentation with no significant differences between the effectiveness of the two types of laser in treating gingival hyper-pigmentation.

Gingival Plasma Cell Granuloma: A case Report of Multiple Lesions.

BACKGROUND: Plasma cell granuloma (PCG) is a rare benign pseudotumorous proliferation of unclear etiology that is mainly situated in the lungs. Gingival PCG is an even more peculiar lesion that usually occurs in middle-aged or elderly individuals and clinically manifests as a solitary entity. CASE REPORT: A 15-year-old male with no underlying medical conditions presented with multiple gingival masses in the right maxilla, which were initially thought to be epulis. The lesions were resected completely and the excisional biopsies sent for histological examination. Immunohistochemical (IHC) stain revealed dense polyclonal plasma cell infiltration with positive expression of both kappa and lambda light chains, confirming a diagnosis of gingival PCG. Subsequently, the affected gingiva healed uneventfully, with no sign of recurrence over 2 years of follow-up. CONCLUSIONS: The present report depicts an extremely unusual case of gingival PCG occurring in a juvenile with multiple lesions, which is worth attention in clinical pediatric dentistry. Excisional-biopsy and histological investigations are imperative for a confirmative diagnosis and to exclude potential aggressive conditions. Complete resection of lesions seems to be a valid treatment, while long-term clinical follow-up is still needed.

Utilización de láser diodo en tejidos blandos: reporte de 3 casos / Use of diode laser in soft tissue: report of 3 cases

Existen diversas condiciones anatómicas o alteraciones mucogingivales que pueden afectar tanto el normal funcionamiento como la estética gingival de piezas dentarias e implantes dentales. Si bien los tratamientos de estas condiciones se han realizado tradicionalmente con bisturí, el desarrollo tecnológico ha permitido que actualmente se pueden realizar con láser. Existen diferentes tipos de láser, siendo el diodo uno de los más utilizados debido a su menor tamaño, portabilidad, fácil configuración y menor costo. El láser ha adquirido mayor popularidad en cirugías de tejido blando dado sus múltiples beneficios: menor tiempo operatorio, control del sangrado y de la hemostasia, reducción de la cantidad de anestesia, posibilidad de no requerir suturas y minimización del dolor e inflamación postquirúrgica. El propósito de este trabajo es presentar la resolución de tres casos clínicos a los cuales se les realizaron los procedimientos de frenectomía labial, remoción de melanosis gingival y resección de fibroma irritativo mediante el uso de láser diodo. Para desarrollar todos los procedimientos se utilizó un equipo de láser diodo de 940 nm (Biolase®, USA) con una potencia que varió entre 2 y 2.5 W en modo continuo utilizando una pieza quirúrgica con una punta de 300 µm (E 3-4), la que fue activada antes de empezar. Posterior a la cirugía se bioestimuló para disminuir el dolor y edema postoperatorio utilizando la punta de dolor a 4 W por 30 segundos a una distancia de 1 cm directo en la zona intervenida a todos los casos. La conclusión arroja que en todos los casos, el láser de diodo permitió un resultado exitoso. El procedimiento fue seguro, la técnica fue sencilla y de tiempo clínico reducido. El postoperatorio ocurrió con ausencia de dolor o molestias, generando una mayor satisfacción del paciente. Cabe señalar que la técnica depende de la habilidad del profesional que la realiza.

There are various anatomical conditions or mucogingival alterations that can affect the normal functioning and the gingival aesthetics of teeth and dental implants. Although the treatments of these conditions have been traditionally performed with a scalpel, technological development has allowed that they can be now performed with lasers. There are different types of lasers, being the diode one of the most used due to its smaller size, portability, easy configuration, and lower cost. The laser has become more popular in soft tissue surgeries due to its multiple benefits: shorter operating time, control of bleeding and hemostasis, reduction in the amount of anesthesia, possibility of not requiring sutures, and minimization of post-surgical pain and inflammation. The purpose of this work is to present the resolution of three clinical cases which underwent labial frenectomy procedures, removal of gingival melanosis and resection of irritative fibroma using diode laser. To develop all the procedures, a 940 nm diode laser equipment (Biolase®, USA) was used with a power that varied between 2 and 2.5 W in continuous mode, using a 300 µm tip (E 3-4), which was activated before starting. After surgery, biostimulation was carried out to reduce postoperative pain and edema using the pain tip at 4 W for 30 seconds at a distance of 1 cm directly in the operated area in all cases. In all cases, the diode laser allowed a successful result. The procedure was safe, the technique was simple, and the clinical time was short. The postoperative period occurred with the absence of pain or discomfort, generating greater patient satisfaction. It should be noted that the technique depends on the skill of the professional who performs it.

Long-Term Results (24 Years) of the Treatment of Amalgam Tattoo in the Anterior Maxillary Region: A Histologic and Clinical Case Report.

Amalgam tattoos are a serious cosmetic problem for patients. A 35-year-old woman came to a private periodontal practice complaining of black pigmentation (amalgam tattoo) above temporary crowns on the lateral and central maxillary incisors and asked that the cosmetic problem be solved before the new permanent crowns were cemented into place. A full-thickness coronoapical incision was made to raise a thick flap; another incision parallel to the surface of the alveolar mucosa made it possible to remove the pigmented connective tissue, which was sent for histologic examination. Due to the fact that the pigmentation extended into the gingival epithelium, the gingiva of the lateral and central incisors was completely removed, with a horizontal incision in the alveolar mucosa from the ends of the distal releasing incisions. Therefore, partially denuded alveolar bone was used as the recipient site for a free gingival graft (FGG). The histologic analysis revealed the presence of amalgam fragments of different sizes in both connective tissue and epithelium. At 6 months, 3 years, and 24 years postoperatively, the periodontal tissues appeared healthy, and the treated area was pink, without pigmentation or scarring, and was perfectly integrated with the adjacent tissues. The patient was very pleased with her appearance. A one-stage procedure, namely an FGG, should be considered an effective treatment of amalgam tattoo providing positive morphologic and cosmetic outcomes over a 24-year follow-up period.

An unusually large peripheral giant cell granuloma: a case report / Granuloma periférico de células gigantes inusualmente grande: reporte de un caso

Peripheral giant cell granuloma (PGCG) is a benign reactive lesion of the oral cavity. Although PGCG is classified as a tumor-like lesion, it does not represent a true neoplasm, however it is often associated with a response of local irritation and trauma. Clinically, it appears as an exophytic growth with either sessile or pedunculated base, it can be located in gingiva or edentulous alveolar mucosa and usually does not exceed two cm in diameter. The following report describes the case of a 64-year-old female diagnosed with a PGCG of a particularly large size and rapidly evolving, located in the upper jaw area. The lesion was completely excised, and the diagnosis was confirmed by histopathology, there is no apparent recurrence in the area after 12 months of follow-up. A few cases of PGCG greater than 5 cm in diameter have been reported. Furthermore, exceptional cases might present an abnormal rapid growth as well. An opportune diagnosis based on clinical examination, radiographic and histopathological study are fundamental for a prompt and efficient treatment

El granuloma periférico de células gigantes (GPCG) es una lesión reactiva benigna de la cavidad oral en respuesta a una irritación local o a un traumatismo crónico. Si bien es una lesión de aspecto tumoral, no constituye una verdadera neoplasia. Se manifiesta como un crecimiento exofítico de base sésil o pediculada, localizado en encía o procesos alveolares edéntulos y no suele sobrepasar los 2 cm de diámetro. El presente reporte describe el caso de un GPCG de tamaño anormalmente grande y rápida evolución localizado en la zona del maxilar superior en un paciente femenino de 64 años. La biopsia escisional de la lesión confirmó el diagnóstico de GPCG y a 12 meses de seguimiento no se ha presentado recidiva. Se han reportado algunos casos de GPCG de más de 5 cm de diámetro. Además, casos excepcionales también pueden presentar un crecimiento rápido anormal. Un diagnóstico oportuno basado en el examen clínico, radiográfico e histopatológico es fundamental para un tratamiento rápido y eficaz

Ascher Syndrome: Acquired Double Lower Lip Combined With Epulis Fissuratum.

Ascher syndrome is characterized by double lip, blepharochalasis, and non-toxic goiter triad. This condition of unknown etiology usually occurs in patients younger than 20 years of age. In this case report, the authors present the diagnostic process of Ascher syndrome and surgical procedure of double lower lip in a female patient who applied to our clinic for prosthetic reasons. A 70-year old female patient was referred to our clinic with the chief complaint of incompatible dentures. The patient had been using the same complete dentures for 40 years. Extraoral clinical examination revealed protruded, bulged lower lip at rest and bilateral blepharochalasis, defined as atrophy of the upper eyelid skin. The upper lip and lower eyelids were not affected. Intraoral examination revealed complete edentation of both jaws and a double lower lip, an accessory fold of excess mucosae inside the vermillion border. Furthermore, epulis fissuratum was observed in the lower jaw. There was no family history of double lip. The patient stated that she had noticed another lip inside her lip for several years. As Ascher syndrome was suspected, the patient was referred to the endocrinology department for thyroid examination, and the non-toxic goiter diagnosis was confirmed. Surgical removal of the redundant tissues was necessary because of deficiencies in speech, chewing, and aesthetics. The excess tissues were excised by transverse ellipse incision technique. Dentists should be familiar with Ascher syndrome, as they may be the first physicians to encounter patients with double lip.

Oral focal mucinosis of the palate: a rare disease entity.

Oral focal mucinosis (OFM) is an extremely rare, benign oral soft tissue condition; less than 10 documented cases have been reported in the literature in patients under 18 years old. OFM has an unknown aetiology and predominantly presents in the fourth and fifth decades. The pathogenesis of OFM may be due to fibroblast overproduction of hyaluronic acid. Clinically, it remains almost impossible to diagnose definitively, due to its lack of pathognomonic features, therefore such lesions may have multiple differential diagnoses and histological analysis is essential to confirm OFM. We present an unusual presentation of OFM in a 14-year-old female patient. Following excision, focal myxoid degeneration of the connective tissue was apparent. This case highlights this rare condition for consideration in differential diagnosis of clinically similar lesions.