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Meshram M, Durge K, Shirbhate U. An Overview of Oral Pyogenic Granuloma and Its Management: A Case Report. Cureus 2023; 15:e48305. [PMID: 38058325 PMCID: PMC10697180 DOI: 10.7759/cureus.48305] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2023] [Accepted: 11/05/2023] [Indexed: 12/08/2023] Open
Abstract
An inflammatory hyperplasia known as a pyogenic granuloma (PG) appears as a nodular growth on the oral mucosa. The most frequent place is the gingiva, followed by the buccal mucosa, tongue, and lips. Histologically, the surface epithelium may be hyperkeratotic, have ulceration foci, or be intact. It lies on the dense connective tissue that contains a sizable amount of fully developed collagen. Most of the pregnancies result in PG of the gingiva; for this reason, the phrases "Pregnancy Tumor" and "Granuloma Gravidarum" are frequently used. It typically occurs during the second and third months of pregnancy and tends to bleed, making it challenging to masticate. Estrogen increases the vascular endothelial growth factor (VEGF) synthesis in macrophages, which is associated with PG development during pregnancy. This case describes a surgically treated case of PG in a middle-aged female with a conventional scalpel technique, giving functional and esthetic outcomes in a patient.
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Affiliation(s)
- Mrunal Meshram
- Department of Oral Medicine and Radiology, Sharad Pawar Dental College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Khushboo Durge
- Department of Periodontics, Sharad Pawar Dental College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Unnati Shirbhate
- Department of Periodontics, Sharad Pawar Dental College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
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Zhao N, Yesibulati Y, Xiayizhati P, He YN, Xia RH, Yan XZ. A large-cohort study of 2971 cases of epulis: focusing on risk factors associated with recurrence. BMC Oral Health 2023; 23:229. [PMID: 37081478 PMCID: PMC10116732 DOI: 10.1186/s12903-023-02935-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2023] [Accepted: 04/04/2023] [Indexed: 04/22/2023] Open
Abstract
BACKGROUND To analyze the clinicopathological features of different histological subtypes of epulis, and evaluate the risk factors associated with recurrence. MATERIALS AND METHODS A retrospective study including 2971 patients was performed. The patients' sex, age, location, size, histological subtypes, recurrence information, oral hygiene habits, periodontitis symptoms and smoking history were retrieved from the patient medical records and follow-up information. RESULTS Among the 2971 cases, focal fibrous hyperplasia (FFH) was the most common lesion (60.92%), followed by peripheral ossifying fibroma (POF) (29.32%), pyogenic granuloma (PG) (8.08%) and peripheral giant cell granuloma (PGCG) (1.68%). The peak incidence of epulis was in the third and fourth decade of life, with a mean age of 45.55 years. Female predominance was found in all types of lesions with a female to male ratio of 1.71:1. PG had the highest recurrence rate (17.18%), followed by POF (12.98%), FFH (9.55%) and PGCG (8.82%). Histological subtypes were significantly correlated with the recurrence of epulis (P = 0.013). Regular supportive periodontal therapy (P = 0.050) had a negative correlation with recurrence, whereas symptoms of periodontitis (P < 0.001) had a positive correlation with the recurrence of epulis. CONCLUSIONS Controlling the periodontal inflammation and regular supportive periodontal therapy might help reduce the recurrence of epulis.
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Affiliation(s)
- Na Zhao
- Shanghai Engineering Research Center of Tooth Restoration and Regeneration, Stomatological Hospital and Dental School of Tongji University, Shanghai, 200072, P. R. China
| | - Yelidana Yesibulati
- Shanghai Engineering Research Center of Tooth Restoration and Regeneration, Stomatological Hospital and Dental School of Tongji University, Shanghai, 200072, P. R. China
| | - Pareyida Xiayizhati
- Shanghai Engineering Research Center of Tooth Restoration and Regeneration, Stomatological Hospital and Dental School of Tongji University, Shanghai, 200072, P. R. China
| | - Yi-Ning He
- Biostatistics Office of Clinical Research Unit, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200011, P. R. China
| | - Rong-Hui Xia
- Department of Oral Pathology, Shanghai Ninth People's Hospital, School of Medicine, College of Stomatology, National Center for Stomatology, Shanghai Key Laboratory of Stomatology, Shanghai Jiao Tong University, Shanghai Jiao Tong University, National Clinical Research Center for Oral Diseases, Shanghai Research Institute of Stomatology, Shanghai, 200011, P. R. China.
| | - Xiang-Zhen Yan
- Department of Periodontology, Shanghai Engineering Research Center of Tooth Restoration and Regeneration, Stomatological Hospital and Dental School of Tongji University, Yanchang Road 399, Shanghai, 200072, P. R. China.
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Niranjan B, Shashikiran ND, Dubey A, Singla S, Shukla C, Mali S. A Rare Gingival Lesion in Children: Fibroepithelial Hyperplasia. Int J Clin Pediatr Dent 2022; 15:468-471. [PMID: 36875987 PMCID: PMC9983591 DOI: 10.5005/jp-journals-10005-2412] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
Aim and objective This case report aims to describe the management of a case of rare gingival lesion in a young pediatric patient. Background An increase in the size of the gingival tissue is known as gingival hyperplasia. This can cause esthetic as well as functional problems, and interfere with normal functions like mastication and speech. A histological form of fibroma, fibroepithelial hyperplasia is a proliferative fibrous lesion of the gingival tissue. These lesions can be caused by trauma or persistent irritation, or they can develop from the periodontal, periodontal ligament, or periosteum cells. Case description This paper discusses a situation in which the parents of a 4-year-old girl presented to the department with a major complaint of swelling in the upper front tooth region, who was diagnosed with fibroepithelial hyperplasia with the help of a biopsy and histologic evaluation. Conclusion In this case surgical excision was performed under local anesthesia with no postoperative complications, and a 2-year follow-up was made with a positive outcome. Clinical significance When these type of gingival lesions are present, they should be investigated and diagnosed properly. They should be managed as soon as possible without causing any further complications to permanent dentition. How to cite this article Niranjan B, Shashikiran ND, Dubey A, et al. A Rare Gingival Lesion in Children: Fibroepithelial Hyperplasia. Int J Clin Pediatr Dent 2022;15(4):468-471.
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Affiliation(s)
- Babita Niranjan
- Department of Pediatric & Preventive Dentistry, Rishiraj college of Dental Science, Bhopal, Madhya Pradesh, India
| | | | - Ashutosh Dubey
- Department of Periodontology, People's College of Dental Sciences & Research Centre, Bhopal, Madhya Pradesh, India
| | - Shilpy Singla
- Department of Pediatric & Preventive Dentistry, Index Institute of Dental Sciences, Indore, Madhya Pradesh, India
| | - Chandresh Shukla
- Department of Orthodontics, People's College of Dental Sciences & Research Centre, Bhopal, Madhya Pradesh, India
| | - Shikha Mali
- Department of Pediatric & Preventive Dentistry, People's College of Dental Sciences & Research Centre, Bhopal, Madhya Pradesh, India
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Retrospective Clinicopathological Analysis of 65 Peri-Implant Lesions. ACTA ACUST UNITED AC 2021; 57:medicina57101069. [PMID: 34684106 PMCID: PMC8539918 DOI: 10.3390/medicina57101069] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2021] [Revised: 10/02/2021] [Accepted: 10/04/2021] [Indexed: 11/17/2022]
Abstract
Background and Objectives: Peri-implantitis is a common finding among patients with dental implants. There is no consensus regarding the treatment of this disease, but in many cases, surgical treatment is common practice. A histopathological analysis is not an integral part of suggested protocols. The present study investigated the clinical and histopathological parameters of lesions mimicking peri-implantitis and correlated them with the outcome and follow-up data. Materials and Methods: The study included 65 consecutive biopsies taken from peri-implantitis patients between 2008-2019. Results: The three common diagnoses were fibro-epithelial hyperplasia 20 (30.7%), pyogenic granuloma 16 (24.6%), and peripheral giant cell granuloma 15 (23%). There were 18 cases of recurrent lesions in the study group (27.7%). The recurrence rate was the highest in peripheral giant cell granuloma (8, 12.3%), versus 6% in pyogenic granuloma and fibro-epithelial hyperplasia. These differences in the recurrence rate were statistically significant (p = 0.014). Conclusions: This study emphasizes the necessity of submitting tissue of peri-implantitis cases for histopathological analysis since the more locally aggressive lesions (peripheral giant cell granuloma and pyogenic granuloma), which comprise nearly half of the cases in this study, do not differ in clinical or radiographic characteristics from other peri-implant lesions.
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Bhutada GP, Mishra MK, Ansari ST, Wankhede AN, Soni GS. Evaluation of clinico-pathological reports and recurrence of 20 cases of localized gingival overgrowths. J Indian Soc Periodontol 2018; 21:76-79. [PMID: 29386807 PMCID: PMC5767997 DOI: 10.4103/jisp.jisp_414_16] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
The aim of the present study was to assess the clinico-histopathological picture and to examine the recurrence of various localized hyperplastic gingival growths after their surgical treatment. Twenty patients of localized hyperplastic gingival outgrowth were evaluated in the present clinico-histopathological study. The data regarding age, sex, location, size, and duration of lesion were summarized. After 4 weeks of initial therapy, an excision of the growth with conventional flap surgery was performed. The excised tissues were sent for histopathological analysis, and the lesions were reclassified into four groups. All the patients were recalled after 3 and 6 months to study the recurrence of the growth. Twenty lesions were inspected, the pyogenic granuloma was the most common (55%), followed by peripheral fibroma (25%), peripheral giant cell granuloma (15%), and calcifying fibroblastic fibroma (5%). Out of the twenty lesions evaluated, the pyogenic granuloma was the most common with no recurrence in any case.
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Affiliation(s)
- Girish Parshuram Bhutada
- Department of Periodontology, Swargiya Dadasaheb Kalmegh Smruti Dental College and Hospital, Nagpur, Maharashtra, India
| | - Mitul Kumar Mishra
- Department of Periodontology, Swargiya Dadasaheb Kalmegh Smruti Dental College and Hospital, Nagpur, Maharashtra, India
| | - Salam Tarique Ansari
- Department of Periodontology, Swargiya Dadasaheb Kalmegh Smruti Dental College and Hospital, Nagpur, Maharashtra, India
| | - Anand Narayanrao Wankhede
- Department of Periodontology, Swargiya Dadasaheb Kalmegh Smruti Dental College and Hospital, Nagpur, Maharashtra, India
| | - Geetika Sanjiv Soni
- Department of Periodontology, Swargiya Dadasaheb Kalmegh Smruti Dental College and Hospital, Nagpur, Maharashtra, India
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Halperin-Sternfeld M, Sabo E, Akrish S. The Pathogenesis of Implant-Related Reactive Lesions: A Clinical, Histologic and Polarized Light Microscopy Study. J Periodontol 2016; 87:502-10. [PMID: 26832832 DOI: 10.1902/jop.2016.150482] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
BACKGROUND Peri-implant soft tissue reactive lesions (I-RLs) may jeopardize implant success and survival. To the best of the authors' knowledge, its pathogenesis is unknown. The objective of this study is to conduct a clinicopathologic and polarized light microscopy (PLM) analysis of 14 new I-RLs and compare them with comparable tooth-associated cases (T-RLs) to better understand I-RL pathogenesis. METHODS Fifty-eight new cases of I-RL and T-RL were retrieved from the pathology department archives of Rambam Health Care Campus, Haifa, Israel. Retrospective analysis of histopathologic and clinical features was conducted, documented, and then compared for: 1) I-RL (n = 14), 2) peri-implant pyogenic granuloma (I-PG) (n = 5), 3) peri-implant peripheral giant cell granuloma (I-PGCG) (n = 9), 4) T-RL (n = 44), 5) tooth-associated pyogenic granuloma (T-PG) (n = 21), and 6) tooth-associated peripheral giant cell granuloma (T-PGCG) (n = 23). Presence of foreign bodies was assessed using PLM. RESULTS Foreign bodies were found more commonly in I-RLs (n = 13/14; 93%) when compared with T-RLs (n = 18/44; 41%), which was a statistically significant difference (P = 0.01) with an odds ratio of 7.9. Microscopically, I-PGCG was associated with: 1) lower multinucleated giant cell count (P = 0.04); 2) lower density of mesenchymal cells (P = 0.05); and 3) more diffuse, non-lobulated stromal morphology (P = 0.001). Clinically, I-RLs were found in patients who were older, and all cases were located in the posterior region: mandible (n = 12/14; 86%) and maxilla (n = 2/14; 14%). CONCLUSIONS In cases of implant failure, implantation of foreign bodies may play a role with subsequent development of I-PG and I-PGCG-like lesions. Clinicians should be aware of this risk so they can implement measures to minimize adverse implant outcomes.
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Affiliation(s)
- Michal Halperin-Sternfeld
- Department of Periodontology, School of Graduate Dentistry, Rambam Health Care Campus, Haifa, Israel
| | - Edmond Sabo
- Department of Pathology, Rambam Health Care Campus.,Bruce Rappaport Faculty of Medicine, Technion, Israel Institute of Technology, Haifa, Israel
| | - Sharon Akrish
- Department of Pathology, Rambam Health Care Campus.,Bruce Rappaport Faculty of Medicine, Technion, Israel Institute of Technology, Haifa, Israel.,Department of Oral and Maxillofacial Surgery, Rambam Health Care Campus
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Epulis: a study of 92 cases with special emphasis on histopathological diagnosis and associated clinical data. Clin Oral Investig 2015; 20:1757-64. [DOI: 10.1007/s00784-015-1665-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2015] [Accepted: 11/11/2015] [Indexed: 10/22/2022]
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8
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Anitua E, Pinas L. Pyogenic granuloma in relation to dental implants: Clinical and histopathological findings. J Clin Exp Dent 2015; 7:e447-50. [PMID: 26535087 PMCID: PMC4628795 DOI: 10.4317/jced.52094] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2014] [Accepted: 03/15/2015] [Indexed: 11/25/2022] Open
Abstract
Background The occurrence of pyogenic granuloma in association to dental implants is rare and only five cases have been reported in the literature. Material and Methods Patients charts were analyzed to select patients who had been diagnosed for pyogenic granuloma and its association with dental implants had been evaluated. The clinical status of the dental implants and the prosthesis had also been assessed. Results Clinical and histopathological diagnosis of pyogenic granuloma had been reached for soft mass growth in association with dental implants in 10 patients. Histological analysis of all samples was performed to obtain a firm diagnosis of finding against pyogenic granuloma lesions. Accumulation of dental plaque due to poor oral hygiene and improper design of the prosthesis had been related to the occurrence of pyogenic granuoloma. This lesion showed no predilection to specific surface type and had no significant association with marginal bone loss. Conclusions Pyogenic granuloma should be included in the differential diagnosis of soft mass growth around dental implants. Key words:Reactive lesion, soft mass, pyogenic granuloma, dental implant, titanium.
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Affiliation(s)
- Eduardo Anitua
- Private practice in implantology and oral rehabilitation in Vitoria, Spain
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Kuyama K, Fukui K, Ochiai E, Wakami M, Oomine H, Sun Y, Morikawa M, Iwadate K, Yamamoto H. Pyogenic granuloma associated with Actinomyces israelii. J Dent Sci 2013; 13:285-288. [PMID: 30895135 PMCID: PMC6388859 DOI: 10.1016/j.jds.2012.09.026] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2012] [Revised: 09/13/2012] [Indexed: 11/17/2022] Open
Abstract
Peculiar findings of orofacial actinomycosis mimicking the clinical appearance of a tumor of the upper gingiva are reported. An 83-year-old man with bleeding of the gingiva visited our hospital. The clinical diagnosis was a benign gingival tumor, and the lesion was surgically removed. Histologically, the excised specimens showed an ulcerative granuloma lesion covered by bacterial colonies consisting of club-shaped filaments. DNA samples were extracted from paraffin sections and examined by polymerase chain reaction (PCR) for Actinomyces species. The PCR products examined by direct DNA sequencing demonstrated the presence of Actinomyces israelii. Finally, a pathological diagnosis was made of a pyogenic granuloma associated with actinomycosis. The PCR method aided the early and exact diagnosis of the paraffin-embedded sample of oral mucosal infectious diseases including actinomycosis.
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Affiliation(s)
- Kayo Kuyama
- Department of Oral Pathology, Nihon University School of Dentistry at Matsudo, Chiba, Japan.,Department of Forensic Medicine, The Jikei University School of Medicine, Minato-ku, Tokyo, Japan
| | - Kenji Fukui
- Department of Forensic Medicine, The Jikei University School of Medicine, Minato-ku, Tokyo, Japan
| | - Eriko Ochiai
- Department of Forensic Medicine, The Jikei University School of Medicine, Minato-ku, Tokyo, Japan
| | - Masanobu Wakami
- Department of Crown and Bridge Prosthodontics, Nihon University School of Dentistry at Matsudo, Chiba, Japan
| | - Hirotaka Oomine
- Department of Maxillo-Facial Orthodontics, Nihon University School of Dentistry at Matsudo, Chiba, Japan
| | - Yan Sun
- Department of Oral Pathology, Nihon University School of Dentistry at Matsudo, Chiba, Japan
| | - Miyuki Morikawa
- Department of Oral Pathology, Nihon University School of Dentistry at Matsudo, Chiba, Japan
| | - Kimiharu Iwadate
- Department of Forensic Medicine, The Jikei University School of Medicine, Minato-ku, Tokyo, Japan
| | - Hirotsugu Yamamoto
- Department of Oral Pathology, Nihon University School of Dentistry at Matsudo, Chiba, Japan
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Shumway BS, Eskan MA, Bernstein ML. Recurrent gingival fibrous lesions: comparison of 2 cases and potential need for additional classification. Oral Surg Oral Med Oral Pathol Oral Radiol 2013; 116:e287-96. [PMID: 23582456 DOI: 10.1016/j.oooo.2013.02.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2012] [Revised: 01/25/2013] [Accepted: 02/04/2013] [Indexed: 10/26/2022]
Abstract
Historically, the classification of localized gingival fibrous lesions has been inconsistent, leading to multiple naming schemes and confusion among pathologists. Currently, lesions are broadly grouped into localized hyperplastic lesions and true neoplasms. Although some cases are clearly defined histologically (i.e., peripheral ossifying fibroma, peripheral odontogenic fibroma), another set of "reactive" fibrous lesions exhibit overlapping histologic features including nondistinctive fibrosis and inflammation. This group can exhibit recurrence, classically related to a local stimulus. However, when local factors are absent, recurrence suggests inherent neoplastic potential. Herein, we describe 2 recurrent fibrous gingival masses, one of which reportedly recurred 3 times with no obvious inciting agent. The histologic appearance of both lesions was similarly distinctive but not well classifiable, while the immunohistochemical profile indicated divergent lesions. This highlights the need for further study of recurrent gingival fibrous lesions to better predict independent growth potential.
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Affiliation(s)
- Brian S Shumway
- Assistant Professor, Oral and Maxillofacial Pathology, Department of Surgical and Hospital Dentistry, University of Louisville, Louisville, KY, USA.
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Damasceno LS, Gonçalves FDS, Silva ECE, Zenóbio EG, Souza PEA, Horta MCR. Stromal myofibroblasts in focal reactive overgrowths of the gingiva. Braz Oral Res 2012; 26:373-7. [DOI: 10.1590/s1806-83242012005000012] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2012] [Accepted: 04/25/2012] [Indexed: 01/21/2023] Open
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12
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Peñarrocha-Diago MA, Cervera-Ballester J, Maestre-Ferrín L, Peñarrocha-Oltra D. Peripheral giant cell granuloma associated with dental implants: clinical case and literature review. J ORAL IMPLANTOL 2012; 38 Spec No:527-32. [PMID: 22712772 DOI: 10.1563/aaid-joi-d-11-00143] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Peripheral giant cell granuloma (PGCG) associated to dental implants is a very infrequent peri-implant soft-tissue complication, with only 11 cases recorded in the literature to date. The present study describes a 54-year-old woman presenting a swelling of the alveolar margin in the fourth quadrant in relation to a fixed prosthesis cemented over implants. Treatment consisted of complete resection of the lesion with implantoplasty of the exposed implant threads. The diagnosis of PGCG was confirmed by histological study, and no relapse has been recorded after 12 months of follow-up.
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Isaza-Guzmán DM, Teller-Carrero CB, Laberry-Bermúdez MP, González-Pérez LV, Tobón-Arroyave SI. Assessment of clinicopathological characteristics and immunoexpression of COX-2 and IL-10 in oral pyogenic granuloma. Arch Oral Biol 2012; 57:503-12. [DOI: 10.1016/j.archoralbio.2011.11.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2011] [Revised: 10/05/2011] [Accepted: 11/04/2011] [Indexed: 10/14/2022]
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Shaikh S, Singh G, Singh A, Gaur A. Pyogenic granuloma of unusual size with alveolar resorption in a 75-year-old patient. Natl J Maxillofac Surg 2012; 3:75-9. [PMID: 23251065 PMCID: PMC3513816 DOI: 10.4103/0975-5950.102170] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
Pyogenic granuloma is an overzealously proliferative non-neoplastic lesion of connective tissue origin, found commonly in oral cavity and is secondary to chronic low grade local irritation, poor oral hygiene, and hormonal disturbances. The term is misnomer because a lesion is unrelated to infection. It is characterized by excessive and exuberant tissue repair response with varied inflammatory component. Since it is a benign lesion, choice of treatment is surgical excision with removal of underlying cause if any. This article aims at presenting a case of pyogenic granuloma in an extremely old patient which is unusual as it attained a very large size and also has caused mild resorption of underlying alveolar bone of mandible.
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Affiliation(s)
- Shoyeb Shaikh
- Department of Oral and Maxillofacial Surgery, Sardar Patel Post Graduate Institute of Dental and Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Gaurav Singh
- Department of Oral and Maxillofacial Surgery, Sardar Patel Post Graduate Institute of Dental and Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Anil Singh
- Department of Oral and Maxillofacial Pathology, Sardar Patel Post Graduate Institute of Dental and Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Amit Gaur
- Department of Oral and Maxillofacial Surgery, Sardar Patel Post Graduate Institute of Dental and Medical Sciences, Lucknow, Uttar Pradesh, India
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Panseriya BJ, Hungund S. Pyogenic granuloma associated with periodontal abscess and bone loss - A rare case report. Contemp Clin Dent 2011; 2:240-4. [PMID: 22090773 PMCID: PMC3214537 DOI: 10.4103/0976-237x.86478] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
A diverse group of the pathologic process can produce the enlargement of soft tissues in the oral cavity and often present a diagnostic challenge. This soft tissue enlargement may represent a variation of the normal anatomic structure, inflammatory reaction, cyst, neoplasm, and developmental anomalies. A group of reactive hyperplasias, which develop in response to chronic recurring tissue injury that stimulates an excessive tissue repair response. The pyogenic granuloma (PG) is a reactive enlargement that is an inflammatory response to local irritation such as calculus, a fractured tooth, rough dental restoration, and foreign materials or hormonal (pregnancy tumor) and rarely associated with bone loss. This paper presents a rare case of PG associated with periodontal abscess and bone loss in a 30-year-old male.
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Affiliation(s)
- Bhrugesh J Panseriya
- Department of Periodontics, Darshan Dental College, Loyara, Udaipur, Rajasthan, India
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Buchner A, Shnaiderman-Shapiro A, Vered M. Relative frequency of localized reactive hyperplastic lesions of the gingiva: a retrospective study of 1675 cases from Israel. J Oral Pathol Med 2010; 39:631-8. [DOI: 10.1111/j.1600-0714.2010.00895.x] [Citation(s) in RCA: 54] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Mandali G, Sener ID, Turker SB, Ülgen H. Factors affecting the distribution and prevalence of oral mucosal lesions in complete denture wearers. Gerodontology 2010; 28:97-103. [DOI: 10.1111/j.1741-2358.2009.00351.x] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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18
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Lev R, Moses O, Holtzclaw D, Tal H. Esthetic treatment of peripheral giant cell granuloma using a subepithelial connective tissue graft and a split-thickness pouch technique. J Periodontol 2010; 81:1092-8. [PMID: 20350158 DOI: 10.1902/jop.2010.090674] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND Peripheral giant cell granuloma (PGCG) is a reactive hyperplastic lesion involving the gingiva or alveolar mucosa consisting of proliferating endothelial cells, a rich capillary bed, chronic inflammatory cells, fibroblasts, and giant cells. After complete clinical removal of PGCG recurrence occurs in about 10% of cases, and may result in an esthetic and functional soft tissue defect. This report describes a surgical procedure involving complete removal of a gingival PGCG in the maxillary esthetic zone and immediate tissue restoration achieving complete gingival augmentation. METHODS A 15-year-old female presented with a red, nodular, asymptomatic lesion, approximately 3.5 mm in diameter, located above the maxillary left lateral incisor. The lesion was excised down to the underlying root resulting in a 6 x 5-mm mucogingival dehiscence defect. Corrective surgery included a subepithelial connective tissue graft peripherally covered by the surrounding gingiva and stabilized by 5/0 resorbable sutures. RESULTS Healing was uneventful, resulting in healthy and esthetic gingiva. Microscopic examination of the biopsy specimen was consistent with the diagnosis of PGCG. CONCLUSIONS PGCG may follow an aggressive course, sometimes requiring preemptive surgical intervention. Grafting a subepithelial connective tissue graft peripherally covered by the surrounding gingiva, without raising a gingival flap, successfully eliminated the gingival defect. The free gingival margin of the neighboring teeth and the mucogingival junction remained unchanged.
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Affiliation(s)
- Ron Lev
- Department of Periodontology, School of Dental Medicine, Tel Aviv University, Ramat Aviv, Israel
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Hernandez G, Lopez-Pintor RM, Torres J, de Vicente JC. Clinical outcomes of peri-implant peripheral giant cell granuloma: a report of three cases. J Periodontol 2009; 80:1184-91. [PMID: 19563300 DOI: 10.1902/jop.2009.090081] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND Peripheral giant cell granuloma (PGCG) is a reactive lesion that occurs on the gingiva or alveolar mucosa and contains numerous giant cells. Its recurrence rate is 10%. Only five cases associated with dental implants have been reported. This case report describes three additional cases with clinical courses and outcomes. METHODS Three women presented with a chief complaint of a gingival mass around the implants. The lesions were surgically excised under local anesthesia. RESULTS The initial diagnosis at presentation was pyogenic granuloma. Radiography showed marginal bone loss accompanying the lesions. Histopathology confirmed the diagnosis of PGCG. In two cases, several recurrences resulted in explantation of the fixture. One case healed uneventfully. CONCLUSIONS Despite its usually benign clinical behavior, peri-implant PGCG may follow an aggressive course. Treatment planning for this condition should take into account the presence of recurrences to evaluate the necessity of an aggressive surgical approach that may involve advanced bone loss and explantation. Further research on the origin of this implant-associated condition with a larger series of cases is necessary to provide a basis for adequate management.
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Affiliation(s)
- Gonzalo Hernandez
- Department of Oral Medicine and Buccofacial Surgery, School of Dentistry, Complutense University, Madrid, Spain.
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20
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Turker SB, Sener ID, Koçak A, Yilmaz S, Ozkan YK. Factors triggering the oral mucosal lesions by complete dentures. Arch Gerontol Geriatr 2009; 51:100-4. [PMID: 19819567 DOI: 10.1016/j.archger.2009.09.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2009] [Revised: 08/29/2009] [Accepted: 09/01/2009] [Indexed: 11/26/2022]
Abstract
Oral mucosal lesions may represent acute or chronic reactions to factors related with dentures. The aim of this study was to determine the frequency of the oral lesions related to gender, age, the length of time of denture usage, the balance of denture and cleaning methods and frequency. The 106 patients who have old complete dentures came to the Dental Faculty of Marmara University, Istanbul (Turkey) to have new complete dentures were asked to participate in the investigation. The subjects (51 men and 55 women) were 37-80 years of age with a mean age of 60.28+/-10.52 years. All main factors were estimated in subgroups: cleaning methods and frequency were divided into 3 subgroups respectively as toothbrush and toothpaste/soap, denture cleansing tablets and sodium carbonate, and 3 times a day, everyday, every 3 day and once a week. The data obtained was evaluated by One-way ANOVA, Mann-Whitney U-test, Kruskal-Wallis-test, Student t-test and chi(2)-test. The level of statistical significance was set at p<0.05. The patients displayed statistically significant differences in the topics of the length of time of denture usage and the balance of denture in terms of retention. The complete denture wearers should be educated in the importance of periodic examination due to the changing of supporting tissues for detection early mucosal lesions to maintain their oral and dentures hygiene in optimum level.
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Affiliation(s)
- Sebnem Begum Turker
- Marmara University, Department of Prosthodontics, Faculty of Dentistry, Istanbul, Turkey.
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21
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Epivatianos A, Antoniades D, Zaraboukas T, Zairi E, Poulopoulos A, Kiziridou A, Iordanidis S. Pyogenic granuloma of the oral cavity: Comparative study of its clinicopathological and immunohistochemical features. Pathol Int 2005; 55:391-7. [PMID: 15982213 DOI: 10.1111/j.1440-1827.2005.01843.x] [Citation(s) in RCA: 48] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
There are two histological types of pyogenic granuloma (PG) of the oral cavity: the lobular capillary hemangioma (LCH) and non-LCH type. The aim of the present study was to examine and compare the clinical features, etiological factors, diameter of vascular elements and immunohistochemical features of LCH and non-LCH histological types of PG to determine whether they are two distinct entities. Thirty cases of LCH and 26 cases of non-LCH PG were retrieved and retrospectively studied. Clinically, LCH PG occurred more frequently (66.4%) as sessile lesion whereas non-LCH PG occurred as pedunculated (77%). Non-LCH PG was associated more frequently (86.4%) with etiological factors. The lobular area of the LCH PG contained a greater number of blood vessels with small luminal diameter than did the central area of non-LCH PG. In the central area of non-LCH PG a significantly greater number of vessels with perivascular mesenchymal cells non-reactive for alpha-smooth muscle actin and muscle-specific actin was present than in the lobular area of LCH PG. The differences found in the present study suggest that the two histological types of PG represent distinct entities.
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Affiliation(s)
- Apostolos Epivatianos
- Department of Oral Medicine and Oral Pathology, School of Dentistry, University of Thessaloniki, Thessaloniki, Greece.
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22
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Coelho CMP, Sousa YTCS, Daré AMZ. Denture-related oral mucosal lesions in a Brazilian school of dentistry. J Oral Rehabil 2004; 31:135-9. [PMID: 15009597 DOI: 10.1111/j.1365-2842.2004.01115.x] [Citation(s) in RCA: 80] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
The purpose of this study was to survey the frequency of denture-related lesions of the oral mucosa in patients treated at a Brazilian dental school and to determine if the oral lesions were related to age, sex, denture type, length of denture use and denture cleaning methods. The denture-related lesions observed in this study were chronic atrophic candidiasis, chronic hyperplastic candidiasis, denture-induced fibrous inflammatory hyperplasia (FIH), traumatic ulcer, angular cheilitis and flabby ridge. The most frequent lesion, chronic atrophic candidiasis, occurred more frequently in females, in complete maxillary denture wearers, with denture use for 16-20 years. The most common method of cleaning dentures was a toothbrush and toothpaste. These results suggest that dentures can cause a wide range of lesions of the oral mucosa, that could be prevented with follow-up to evaluate dentures and provide instructions on how to maintain oral tissues healthy.
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Affiliation(s)
- C M P Coelho
- School of Dentistry, University of Ribeirão Preto, UNAERP, Ribeirão Preto, SP, Brazil.
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23
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Reynolds MA, Aberdeen GW, Pepe GJ, Sauk JJ, Albrecht ED. Estrogen Suppression Induces Papillary Gingival Overgrowth in Pregnant Baboons. J Periodontol 2004; 75:693-701. [PMID: 15212352 DOI: 10.1902/jop.2004.75.5.693] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND Alterations in sex steroids during pregnancy are associated with the development and exacerbation of reactive lesions involving the gingiva. Currently, few experimental animal models similar to humans are available to examine regulatory pathways involving sex steroids and the periodontium. METHODS In the present study, we used the baboon as a novel experimental model for the study of the regulatory actions of estrogen on the periodontium during pregnancy. Pregnant baboons (N = 5) were administered the potent, highly specific aromatase inhibitor CGS 20267 (2 mg/day subcutaneously) daily on days 60 through 165 of gestation (term = 184). Untreated females (N = 10) and females (5) concomitantly administered aromatase inhibitor and estradiol benzoate (2.0 mg/day each subcutaneously) served as controls. Gingival biopsies were taken between days 145 and 165 of gestation. RESULTS Administration of CGS 20267 in all females suppressed maternal serum concentrations of estradiol by 95% and induced the development of an exuberant papillomatous enlargement of the gingiva by gestational day 110, with the most prominent development involving the labial aspects of the anterior sextants. None of the untreated pregnant controls or females concomitantly administered aromatase inhibitor and estradiol benzoate developed gingival overgrowth. Thus, estradiol alone prevented the onset of gingival overgrowth induced by estrogen suppression. In all baboons, discontinuation of the aromatase inhibitor at time of cesarean section resulted in spontaneous regression and resolution of the papillomatous hyperplasia within 4 to 6 weeks. Clinically, the gingival papillary overgrowth was erythematous and edematous, with a propensity toward spontaneous subgingival hemorrhage. Histologically, the biopsy specimens demonstrated hyperplasia of the epithelium typified by mild hyperkeratosis, acanthosis, and elongation and isolated anastamoses of rete ridges. Subjacent to the intact epithelium was a loose connective tissue stroma with isolated areas of inflammatory cell infiltrate. Special stains verified the presence of isolated bacterial biofilms; however, no evidence of fungal filaments was present. Histological features suggestive of viral infection were notably absent in the epithelium. No evidence of viral particles or capsids was identified using transmission electron microscopy. Reverse transcription polymerase chain reaction analysis, using a panel of degenerate primers, was negative for papilloma family viruses. CONCLUSIONS These results are consistent with a significant role for estrogen during primate pregnancy in the regulation of cellular proliferation and differentiation within the gingiva. The baboon represents an important experimental model for studying the regulatory actions of estrogen on the periodontium during pregnancy.
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Affiliation(s)
- Mark A Reynolds
- Department of Periodontics, University of Maryland, Dental School, Baltimore, MD 21201, USA.
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24
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Bodner L, Peist M, Gatot A, Fliss DM. Growth potential of peripheral giant cell granuloma. ORAL SURGERY, ORAL MEDICINE, ORAL PATHOLOGY, ORAL RADIOLOGY, AND ENDODONTICS 1997; 83:548-51. [PMID: 9159813 DOI: 10.1016/s1079-2104(97)90118-9] [Citation(s) in RCA: 45] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
PURPOSE The purpose of this study was to investigate the association of selected demographic, systemic health, and oral health characteristics of patients with large (> 2 cm) peripheral giant cell granuloma and to assess its growth potential and the possible underlying causes. METHODS A series of 79 cases including 15 subjects with lesions 2 to 5 cm in the largest diameter is presented. Age, sex, site, size, systemic health, oral hygiene, and report of oral dryness of subjects with large lesions were compared with those of subjects with small lesions (< 2 cm). RESULTS No differences were found in mean age between the small lesion group (mean age = 31 +/- 6 years) and the large lesion group (mean age 53 +/- 24.2 years). Female predilection (male/female ratio 1:1.5, 1:2.75.) was more significant in patients with large lesions. No statistically significant differences were found in systemic health score (mean American Society of Anesthesiology score 1.39, 1.53). Oral hygiene score (percent calculus 78% +/- 3.1%, 95% +/- 2.7%, percent gingival bleeding 58% +/- 3.6%, 73% +/- 5.4%, percent deep pocket 30% +/- 2.8%, 42% +/- 3.1) was better among the patients with small lesions. The percentage of patients with a report of oral dryness was significantly higher (3.1%, 27%) among patients with large lesions. CONCLUSIONS Findings from this study suggest that patients with large (> 2 cm) peripheral giant cell granuloma lesions are more likely to be women with lower oral hygiene scores and xerostomia. Further studies are required to measure the relative risk of these factors.
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Affiliation(s)
- L Bodner
- Department of Oral and Maxillofacial Surgery, Soroka Medical Center Ben-Gorion University of the Negev, Beer-Sheva, Israel
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25
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Nedir R, Lombardi T, Samson J. Recurrent peripheral giant cell granuloma associated with cervical resorption. J Periodontol 1997; 68:381-4. [PMID: 9150044 DOI: 10.1902/jop.1997.68.4.381] [Citation(s) in RCA: 19] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
A case of recurrent peripheral giant cell granuloma in a 38-year-old man is reported. The lesion was localized on the attached gingiva of the lower left second premolar (tooth #35). The surgical excision of the lesion revealed a superficial resorption of the cervical region of the involved tooth. The resorption was smoothed out, and there was no sign of recurrence or further resorption after 14 months. Root resorption, although extremely rare, may be associated with peripheral giant cell granuloma.
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Affiliation(s)
- R Nedir
- Division of Stomatology and Oral Surgery, School of Dental Medicine, Faculty of Medicine, Geneva University, Switzerland
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26
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Mighell AJ, Robinson PA, Hume WJ. Peripheral giant cell granuloma: a clinical study of 77 cases from 62 patients, and literature review. Oral Dis 1995; 1:12-9. [PMID: 7553374 DOI: 10.1111/j.1601-0825.1995.tb00151.x] [Citation(s) in RCA: 42] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
OBJECTIVES The aim of this study was to identify the principle clinical features of the peripheral giant cell granuloma (PGCG), and to recognise clinical features of PGCG that are poorly defined. DESIGN We reviewed retrospectively 77 cases of PGCG from 62 patients, from our files with respect to incidence, sex, patient age, race, clinical symptoms and signs, radiographic features and recurrence following excision. RESULTS AND CONCLUSIONS Our results were largely in agreement with previous reports, although there is wide variation in the results published between series. In addition, some clinical features of PGCG are poorly defined. Little is known about the relative incidences of PGCG and central giant cell granuloma. An association between PGCG and tooth loss may exist, but is poorly defined, and not all PGCG that involve edentulous areas follow recent tooth loss. Information about PGCG recurrence after excision is limited, and does not necessarily follow incomplete excision. Despite the large number of reported cases of PGCG, clarification of some clinical features is required, and may help formulation and interpretation of future laboratory-based research into this poorly understood lesion.
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Affiliation(s)
- A J Mighell
- Division of Dental Surgery, Leeds Dental Institute, United Kingdom
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27
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Zain RB, Fei YJ. Fibrous lesions of the gingiva: a histopathologic analysis of 204 cases. ORAL SURGERY, ORAL MEDICINE, AND ORAL PATHOLOGY 1990; 70:466-70. [PMID: 2120653 DOI: 10.1016/0030-4220(90)90212-b] [Citation(s) in RCA: 46] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Two hundred four cases of fibrous lesions of the gingiva were studied histologically for the presence of calcified tissue, the nature of the connective tissue, the type of keratinization, and the degree of epithelial thickness. Initially these lesions were subcategorized into four specific entities, namely fibrous epulis, fibroepithelial polyp, calcifying fibroblastic granuloma, and ossifying fibrous epulis. It was found that 46.5% of the lesions contained calcifications. The connective tissue was represented predominantly by either the collagenous type (50.5%) or the mixed (cellular and collagenous) type (44.6%). It was also found that 36% of the lesions were ulcerated, and, of these, 79.5% were associated with the cellular type of connective tissue and calcifications. In an attempt to subcategorize the fibrous lesions into specific entities, it was found that 32 cases (15.7%) had mixed features. This fact supports the suggestion that these lesions are stages in the spectrum of a single disease process and should collectively be termed fibroblastic gingival lesions. However, it is also suggested that the two terms, namely peripheral fibroma and fibrous epulis with and without ossification, should be retained whereas the usage of other terminologies should be avoided.
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Affiliation(s)
- R B Zain
- Department of Oral Pathology and Oral Medicine, Dental Faculty, University of Malaya, Kuala Lumpur
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28
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Dayan D, Buchner A, David R. Myofibroblasts in peripheral giant cell granuloma. Light and electron microscopic study. Int J Oral Maxillofac Surg 1989; 18:258-61. [PMID: 2509574 DOI: 10.1016/s0901-5027(89)80088-8] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Myofibroblasts are found in various pathologic conditions including lesions containing giant cells, such as central giant cell granuloma and the giant cell tumor of tendon sheath (nodular tendosynovitis). In the present study, myofibroblasts were found in peripheral giant cell granuloma (PGCG) using the TP-Levanol fast cyanine 5RN histochemical procedure and electron microscopy. A number of myofibroblasts displayed intracellular collagen fibrils. The presence of myofibroblasts supports the reactive nature of PGCG.
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Affiliation(s)
- D Dayan
- Section of Oral Pathology and Oral Medicine, Maurice and Gabriela Goldschleger School of Dental Medicine, Tel Aviv University, Israel
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29
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Helft M, Cardash HS, Rones B, Ben-Ur Z. The prevalence of denture-related injuries in patients resident at two Israeli geriatric hospitals. Gerodontology 1986; 5:123-7. [PMID: 3466857 DOI: 10.1111/j.1741-2358.1986.tb00059.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
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