Novel treatment approach of localized juvenile spongiotic gingival hyperplasia with use of Nd:YAG laser.

INTRODUCTION: This article describes the management of two patients who presented with localized juvenile spongiotic gingival hyperplasia. This disease entity is poorly understood, and literature regarding successful treatment is scant. However, there are common themes to management including proper diagnosis and treatment via removal of the affected tissue. The biopsy demonstrates intercellular edema and neutrophil infiltrate with epithelial and connective tissue disease components, so surgical deepithelialization may not be adequate to definitively treat the disease. METHODS AND RESULTS: This article presents two cases of the disease and suggests the use of the Nd:YAG laser as an alternative management modality. CONCLUSION: To our knowledge, we present the first cases of localized juvenile spongiotic gingival hyperplasia treated with the Nd:YAG laser. KEY POINTS: Why are these cases new information? To our knowledge, this case series illustrates the first use of an Nd:YAG laser to treat the rare pathology localized juvenile spongiotic gingival hyperplasia. What are the keys to successful management of these cases? To properly manage this rare presentation, proper diagnosis is paramount. Following diagnosis with microscopic evaluation, deepithelialization and treatment of underlying connective tissue infiltrate via the Nd:YAG laser offers an elegant option to treat the pathology and maintain esthetic outcomes. What are the primary limitations to success in these cases? The primary limitations of these cases include the small sample size, which is attributable to the rarity of the disease.

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.

Localised juvenile spongiotic gingival hyperplasia: A case of spontaneous resolution and a literature review.

AIM: Localised juvenile spongiotic gingival hyperplasia (LJSGH) is a benign lesion occurring in young patients as gingival erythema and overgrowth, typically localised on gingiva of maxillary incisors. The aim of this work is to report a case of LJSGH where complete spontaneous regression was achieved together with a review of the literature on the topic. CASE REPORT: An 8-year-old girl was referred for a gingival painless lesion, which had appeared spontaneously one year before and was refractory to periodontal treatment. Intraoral examination showed a well-defined, red gingival overgrowth involving the left maxillary central incisor, without involving the marginal gingiva. The clinical diagnosis of LJSGH was made, due to the pathognomonic aspect. The patient was periodically recalled for 43 months; at the last visit, the lesion was spontaneously resolved. RESULTS: LJSGH is not plaque-related and not responsive to periodontal treatment. Surgical removal of the lesions correlates with high recurrence, while spontaneous resolution over time has been hardly demonstrated. CONCLUSION: Follow-up of LJSGH may be an option of care, alternative to surgery, in selected cases.

Agrandamiento gingival inducido por fenitoínas / Phenytoin induced gingival enlargement

Se entiende por agrandamiento gingival el incremento en masa y volumen del tejido gingival. Se considera una condición benigna de la cavidad oral, por lo general de manejo rutinario, que logra regularse con medidas simples de control del biofilm microbiano. El agrandamiento gingival puede ser producido por diversas condiciones clínicas, hereditarias, deficiente higiene oral o fármacos. La epilepsia afecta a 1% de la población mundial y requiere el uso de fármacos antiepilépticos o anticonvulsivantes para lograr su control, dentro de éstos la fenitoína actúa como un bloqueador selectivo de los canales de sodio sensibles al voltaje y constituye uno de los fármacos más empleados por su capacidad en el control de crisis focales y generalizadas. La fenitoína se ha relacionado con los agrandamientos gingivales como uno de sus efectos adversos, los cuales se incluyen dentro de las enfermedades por fármaco inducidas en la cavidad oral. El objetivo de este artículo es brindar la información necesaria sobre el manejo correcto de pacientes con agrandamiento gingival producido por fenitoínas y a la vez poder conocer las consecuencias de estos fármacos en la cavidad oral (AU)

Gingival enlargement means the increase in mass and volumen of the gingival tissue. It is considered a benign condition of the oral cavity, usually of routine management, wich can be regulated with simple measures of biofilm control. The gingival enlargement can be produced by diverse clinical conditions, hereditary deficient oral higiene or drugs. Epilepsy affects 1% of the world population and requires the use of antiepileptic or anticonvulsant drugs to achieve its control, within these phenytoin acts as selective blocker or voltage ­ sensitive sodium channels and is one of the most used grugs for its ability to control focal and generalized crises. Phenytoin has been linked to gingival enlargement as one of its adverse effects which is included within the drug diseases induced in the oral cavity. The objective of this article is to provide the necessary information on the correct managment of patients with gingival enlargemen produced by phenytoins and at the same time to know the consequences of these drugs in the oral cavity (AU)

Juvenile Spongiotic Gingival Hyperplasia: Clinicopathological Features of Eight Cases and a Literature Review.

BACKGROUND: Juvenile spongiotic gingival hyperplasia (JSGH) is a benign proliferation of non-keratinised stratified squamous epithelium with evident spongiosis, exocytosis leukocytes and dilated vessels with varying numbers of inflammatory cells. Although uncertain, it has been suggested that the epithelial proliferation is probably related to trauma and local irritants. It emerges as a painless erythematous patch or papule with an irregular surface. CASE REPORTS: We present a series of eight cases and a literature review of the clinical presentation and treatment approaches for JSGH. This series includes four females and four males with a mean age of 11.6 years, all complaining of injury to the gums. All lesions were painless and not bleeding. One patient associated the lesion with the onset of trauma and another with a previous history of an eruption cyst. Periapical radiographs of the adjacent area did not show any alteration of bone or teeth. Based on these findings, the diagnostic hypotheses were a non-neoplastic proliferative process or a factitious injury. Incisional biopsy was performed and histopathologic diagnosis was conclusive for JSGH. Surgical excision was conducted in three cases, and the other five cases were supported by clinical observation and plaque control in order to prevent gingival recession defects. After a follow-up period of 11 months (mean), no recurrence was observed for surgically treated cases and mild improvement was achieved with periodontal treatment. CONCLUSION: This case series illustrates the importance of diagnosis and follow-up of patients with JSGH. A conservative approach consisting of basic periodontal support instead of surgical excision may be indicated because of the risk of aesthetic defects at the involved areas.

Generalised gingival enlargement as a sole manifestation of IgG4-related disease.

An 18-year-old woman presented with enlarged gingivae of 1-year duration with no history of drug consumption or systemic conditions that might explain the enlargement. Biopsy revealed hyperplastic gingival epithelium and a plasma cell-rich inflammatory infiltrate in the subepithelial connective tissue with the presence of scattered multinucleated giant cells. Immunostaining revealed the plasma cells to be positive for IgG4. Serum IgG4 levels were elevated at 3.6 g/L (reference range: 0.049-1.985). These findings led towards the diagnosis of an IgG4-related disease (RD). Other granulomatous conditions were also ruled out via series of investigations. The enlarged tissue was surgically excised. No corticosteroids were administered owing to the localised nature of the manifestations. After 3 months, the gingival size remained unchanged. This case has been reported with a relatively shorter follow-up period because of the rarity of the presentation. IgG4-RD should be considered while diagnosing a patient with gingival enlargement.

A midline neurofibroma, clinically manifested as a mandibular gingival hyperplasia in a seven-year-old girl whose mother suffers from neurofibromatosis / Neurofibromatosisban szenvedo anya hétéves leánya alsó állcsontjának középvonalában kifejlodo, klinikailag gingivalis hyperplasia képében jelentkezo neurofibroma.

A seven-year-old girl was referred to the Department of Periodontology of the Semmelweis University with a symmetric bilateral, painless, non-inflammatory diffuse enlargement on the lingual aspects of her lower jaw. The family history revealed that her mother and elder sister had Recklinghausen's disease with typical characteristic dermatological signs and they are registered by the National NF Registry. Extraoral examination revealed an evident protrusion of the lips. Intraorally, the buccal gingiva around the upper and lower teeth appeared normal. The little patient had neither dermal nor oral mucous membrane signs characteristic of NF1. With the consent of her parents, the lingual firm mass of gingival enlargement was excised under local anesthesia and the removed tissue was histologically analyzed. The histology approved the clinical diagnosis as solitary neurofibroma. The postoperative healing was uneventful. Because of her very young age and the subtotal excision of the tumor, the patient has been regularly monitored. After one and a half years, recurrence or other sign of tumor regrowth have not been observed. The panoramic radiograph showed normal bone morphology and an age-related dental status with mixed dentition and undisturbed tooth eruption. The present case with a midline bilateral diffuse gingival overgrowth in the mouth of a 7-year-old girl without any characteristic dermatological signs in a family with genetically proven Recklinghausen's disease is very rare and unique in the literature. Orv Hetil. 2020; 161(22): 924-930.

Hiperplasia gingival fibrosa asociada a incisivo central superior retenido / Fibrous gingival hiperplasia associated with upper central incisor retained / Hiperplasia gengival fibrosa associada a incisivo central superior retido

RESUMEN Se describió el caso clínico de un adolescente de 12 años de edad, atendido en el Departamento de Ortodoncia de la Clínica Estomatológica Provincial "Mártires del Moncada" de Santiago de Cuba, al cual se le diagnosticó retención del incisivo central superior derecho hace más de dos años y para la cual recibió tratamiento con aparatología fija previo entorche del diente y seguimiento clínico-radiográfico. Durante el proceder ortodóncico, es remitido al Departamento de Periodoncia por presentar en la zona de dicho diente un aumento de volumen de color rosa coral, de consistencia dura y aspecto fibroso, que imposibilitó la incorporación definitiva del diente en su arco y plano de oclusión. Se realizaron los exámenes complementarios correspondientes, se diagnosticó hiperplasia gingival fibrosa localizada y se realizó tratamiento quirúrgico (gingivectomía), lo que permitió llevar a feliz término el tratamiento ortodóncico sin ninguna implicación psicológica y social para el paciente. La poca frecuencia de aparición de este tipo de lesión asociada a la retención de incisivos centrales superiores motivó el presente informe de caso.

ABSTRACT It was described a clinical case of a 12-year-old adolescent, treated at the Orthodontic Department of the Provincial Stomatological Clinic "Mártires del Moncada" in Santiago de Cuba, who was diagnosed with retention of the upper right central incisor more than two years ago and for which he received treatment with fixed appliances prior to tooth straightening and clinical-radiographic follow-up. During the orthodontic procedure, he was referred to the Department of Periodontics because he had a coral pink increase in volume in the area of that tooth, with a hard consistency and fibrous appearance, which made it impossible to definitively incorporate the tooth into its arch and occlusion plane. The corresponding complementary examinations were carried out, localized fibrous gingival hyperplasia was diagnosed and surgical treatment (gingivectomy) was performed, which allowed the successful completion of orthodontic treatment without any psychological or social implications for the patient. The rare occurrence of this type of injury associated with retention of upper central incisors motivated this case report.

RESUMO O caso clínico de um adolescente de 12 anos de idade, atendido no Departamento de Ortodontia da Clínica Estomatológica Provincial "Mártires del Moncada" de Santiago de Cuba, diagnosticado com retenção do incisivo central superior direito, foi descrito mais de dois anos e para os quais ele recebeu tratamento com aparelhos fixos antes do bloqueio dentário e monitoramento clínico-radiográfico. Durante o procedimento ortodôntico, é encaminhado ao Departamento de Periodontia por apresentar na área do referido dente um aumento no volume rosa coral, de consistência dura e aparência fibrosa, o que impossibilitou a incorporação definitiva do dente em seu arco e plano de oclusão. Foram realizados os exames complementares correspondentes, diagnosticada hiperplasia gengival fibrosa localizada e realizado tratamento cirúrgico (gengivectomia), o que permitiu o tratamento ortodôntico sem envolvimento psicológico e social do paciente. A baixa frequência de ocorrência desse tipo de lesão associada à retenção dos incisivos centrais superiores motivou este relato de caso.

Rare case report of idiopathic gingival fibromatosis in childhood and its management.

Idiopathic gingival fibromatosis (GF), also known as gingivomatosis, is a rare condition in childhood, with an unknown aetiology. The oral manifestations of the condition are varied and depend on the severity and age of involvement. This paper describe the case of a 5-year-old male child with extensive gingival enlargement covering almost all the maxillary and mandibular teeth resulted in difficulty with speech, mastication and poor aesthetics. Clinical and radiographic examination along with haematological investigations ruled out any systemic association. The case was managed with conventional scalpel blade surgery along with electrocautery under general anaesthesia yielding good results without any recurrence after a 12-month follow-up. The results revealed that the oral manifestations of GF depend on its severity and the age of onset. Timely intervention can help to prevent associated complications in a growing child.

Nifedipine induced gingival enlargement in an edentulous patient: a case report with one year follow up.

BACKGROUND: Gingival enlargement due to calcium channel blockers is a common complaint reported by patients. It can be localized or generalized and can range from mild to severe, affecting patients appearance and function. Nifedipine induced gingival enlargement is noticed only in 10 % of patients and very few cases of Nifedipine induced gingival enlargement in an edentulous patient have been documented in the literature. CASE PRESENTATION: Here in, we report a case of gingival enlargement in a 70 year old hypertensive edentulous patient who was on low dose Nifedipine therapy. Patient wanted complete dentures. We planned to excise the overgrowth and followed up for 1 year. CONCLUSION: Nifedipine induced gingival enlargement noticed only in 10 % of patients. Hence, there is a need for physicians and dentist to make a coordinated treatment plan and practice care while prescribing these drugs which are associated with gingival overgrowth.

Primary hyperoxaluria: Orthodontic management in a pediatric patient: A case report.

AIMS: The aim of this study is to report the case of the orthodontic treatment in a patient affected by primary hyperoxaluria type 1 and subjected to a combinate liver-kidney transplant. METHODS AND RESULTS: The 9-year patient was admitted to our department for the presence of facial dysmorphism. The patient was affected by primary hyperoxaluria type 1 and has undergone a combined liver-kidney transplantation. At the time of the visit, he was in treatment with immunosuppressive drugs and received a corticosteroid and an antibiotic therapy monthly. An intraoral and extraoral examination, as well as radiographic and model analysis, was performed in order to define an accurate diagnosis and a proper rehabilitation planning. An orthopedic-orthodontic treatment was performed and satisfactory final results obtained. A laser gingivectomy was also realized for eliminate the gengival hyperplasia probably induced by cyclosporine assumption. Both skeletal and dental relationships were improved by the treatment, reaching a good dental arches alignment. CONCLUSION: An early diagnosis, as well as a multidisciplinary approach, is very important in patients with rare diseases. An appropriate treatment allowed us to achieve acceptable results and improve the patient quality of life.

Corrección quirúrgica en una adolescente con hiperplasia gingival hereditaria / Surgical correction in an adolescent with hereditary gingival hyperplasia

Se describe el caso clínico de una adolescente que fue atendida en la consulta de Periodoncia del Hospital General Docente Dr Juan Bruno Zayas Alfonso de Santiago de Cuba, por presentar agrandamiento de las encías desde hacía más de un año, lo que le dificultaba la masticación de los alimentos y, por tanto, le producía trastornos digestivos transitorios, además de afectar su estética. Luego de realizados los exámenes físico y complementarios, se estableció el diagnóstico presuntivo de hiperplasia gingival hereditaria o familiar y se indicó el tratamiento, que incluyó 3 fases: la inicial, la correctiva quirúrgica y la de soporte periodontal. En la fase quirúrgica se tomó una muestra hística cuyo análisis anatomopatológico confirmó el diagnóstico presuntivo inicial

The case report of an adolescent that was assisted in the Periodontics Service of Dr Juan Bruno Zayas Alfonso Teaching General Hospital in Santiago de Cuba is described. He presented enlargement of the gums for more than a year, which made mastication of foods difficult and therefore, transitory digestive dysfunctions took place, besides affecting her aesthetics. After the physical and complementary tests, the presumptive diagnosis of hereditary or family gingival hyperplasia was established and the treatment was indicated into 3 phases: initial phase, surgical corrective phase and that of periodontal support. In the surgical phase a tissue sample was taken which pathologic analysis confirmed the initial presumptive diagnosis

Oral manifestations of lipoid proteinosis in a 10-year-old female: A case report and literature update.

Lipoid proteinosis (LP) is a rare autosomal recessive disorder characterized by the deposition of amorphous hyaline material in the dermis and submucosal connective tissue. Here, we present a case of LP with significant oral, dermatologic, and neurologic manifestations occurring in a 10 year-old female of Asian descent. In addition to the more typical oral findings of restricted tongue movement and labial and buccal mucosal involvement, this case highlights an unusual pattern of gingival enlargement infrequently reported in the literature. As LP almost always involves the oral cavity, often before the onset of cutaneous lesions, it is important for dental providers to be familiar with the oral manifestations of this disease. Early detection and diagnosis of LP by the dental practitioner can help expedite proper multidisciplinary care and lead to significant reductions in patient morbidity and mortality.

Localized Juvenile Spongiotic Gingival Hyperplasia: Report of Two Cases.

OBJECTIVE: Localized juvenile spongiotic gingival hyperplasia (LJSGH) is a painless gingival swelling that histologically exhibits hyperplasia of the non-keratinized stratified squamous epithelium, intercellular edema and spongiosis of the spinus layer, and exocytosis of inflammatory cells. LJSGH pathogenesis remains to be elucidated, while a possible origin from the gingival sulcus epithelium is nowadays proposed. STUDY DESIGN: We report two cases of LJSGH with immunohistochemical evaluation of cytokeratins (CKs) 18 and 19. RESULTS: Both cases concerned 12-year-old boys, who presented with a well-circumscribed bright red pedunculated papillary swelling on the marginal gingiva of the left maxillary lateral incisor. With the provisional diagnosis of LJSGH, the lesions were excised under local anesthesia and histological examination supported the final diagnosis of LJSGH. In both cases, the lesional epithelium showed intense and mild positivity for CK19 and CK18, respectively, while the adjacent normal gingival epithelium expressed CK19, but not CK18, only in the basal cell layer. The postoperative course was uneventful in both patients and no recurrence has been reported. CONCLUSION: LJSGH is a recently introduced entity that is worth attention in the clinical pediatric dentistry. Clinical and histological examination is required for the final diagnosis, while immunohistochemistry has shed light to LJSGH pathogenesis.

[Localised (juvenile) spongiotic hyperplasia of the gingiva; a less common laesion]. / Gelokaliseerde (juveniele) spongiotische hyperplasie van de gingiva: een minder bekende aandoening.

A 49-year-old woman presented with a superficial, ulcerative laesion of approximately 7x3 mm of the marginal labial gingiva of the first upper incisor right. The laesion had returned twice after limited surgical excision. On the basis of a new, extensive excisional biopsy, additional investigation was carried out by the pathologist, which led to a diagnosis of localised (juvenile) spongiotic gingival hyperplasia (LJSGH). The aetiology of LJSGH is still unclear. A typical characteristic is the localised and solitary presence of the laesion. Localised (juvenile) spongiotic hyperplasia of the gingiva is most often seen on the marginal labial gingiva of the maxilla. The laesion can disappear spontaneously, but surgical excision is generally indicated due to the negative cosmetic effect and influence on oral hygiene. The risk of recurrence is high, particularly when the laesion is not radically removed.

Cryotherapy for localized juvenile spongiotic gingival hyperplasia: preliminary findings on two cases.

BACKGROUND: Localized juvenile spongiotic gingival hyperplasia (LJSGH) is a distinct subtype of inflammatory gingival hyperplasia that shows lack of response to traditional periodontal treatment, and after surgical excision, recurrence rate of 6-16% has been reported. CASE REPORT: Two girls (11- and 9-year-old) with multifocal red patches along the maxillary and mandibular labial gingiva showed no regression of the lesions after basic periodontal treatment. Surgical excision of focal lesion in each case was performed, which showed typical features of LJSGH. In both cases, the lesions presented recurrence. Hence, cryotherapy sessions in all lesions were performed. CONCLUSION: Cryotherapy appears to be successfully in LJSGH and well received by paediatric patients.

Rare Root Morphology of a Maxillary Central Incisor Associated With Gingival Hyperplasia: An Endodontic Case Report.

Dilaceration is a developmental disturbance characterized by the angulation of the crown or root of a permanent tooth, which is often related to trauma of primary dentition. We report a case of a dilacerated root in a maxillary central incisor associated with gingival hyperplasia in a patient under fixed orthodontic treatment, a combination of pathological conditions that had never been mentioned before in the scientific literature.A 10-year-old female patient presented to the Department of Odontology and Oral Pathology with tenderness to palpation and bleeding from the oral aspect of the central incisor, alerted by the proliferation of the gingiva. During clinical examination, the palpation performed with a dental probe revealed a carious lesion with dental pulp exposure on the distal aspect of right central incisor and the presence of a sessile mass of inflamed gingival tissue that proliferated inside the defect. On the preoperative radiograph a dilacerated root canal was noted, without periapical bone resorption.The main diagnosis was irreversible pulpitis and gingival hyperplasia and the treatment option was surgical removal of the inflamed tissue with histopathological examination and root canal treatment. Successful endodontic treatment with a good prognosis was recorded.The measurement of the root curvature proved to be extremely helpful in choosing the right endodontic technique and made the treatment easier than expected. An important observation was that, despite the rare clinical and radiographic aspect of this dilacerated tooth, the endodontic treatment proved to be relatively easy to perform and, therefore, the prognosis was considered favorable.

Epithelial and Fibrous Hyperplasia: An Oral Manifestation of Tuberous Sclerosis Complex. A Case Study.

The authors present a case study of a 13-year-old female with a past medical history of tuberous sclerosis complex (TSC), an autosomal dominant disorder. It usually presents with a triad of epilepsy, mental deficiency and facial angiofibromas that are often distributed around the nose, cheek and chin, and are frequently shaped like butterfly wings. In addition, oral manifestations include gingival enlargement and developmental enamel pitting on the facial aspect of the anterior permanent dentition in 50% to 100% of patients. The patient's chief complaint was gingival enlargement and gingival bleeding. The histology of the excised gingival tissue revealed epithelial and fibrous hyperplasia, consistent with TSC.