A rare case report of grade III gingival enlargement associated with chronic periodontitis: Comparison of two treatment techniques

Idiopathic Gingival Enlargement: A Case Report

Gingival enlargement (GE) is an increase in the size of the gingiva. It may be due to inflammation caused by extensive plaque accumulation, intake of drugs, systemic conditions like pregnancy and puberty, systemic diseases such as leukemia or Wegener's granulomatosis, hereditary gingival fibromatosis, and neoplastic or false enlargement. Idiopathic GE is the massive increase in the size of the gingiva with an unknown etiology. It may have a hereditary basis, be linked to physical impairment, or begin with eruption of primary or permanent dentition. It is also referred as gingivomatosis, hereditary gingival fibromatosis, elephantiasis gingivae, gigantism of the gingiva, or congenital macrogingivae. The enlarged gingiva compromises oral hygiene maintenance, which secondarily adds to the inflammatory component of enlargement. Altogether, this exaggerates the existing condition. This type of extensively disfigured gingiva affects speech, mastication, and esthetics, causes halitosis, and disturbs the overall well-being of the individual. Surgical removal of the enlarged gingiva along with meticulous non-surgical means of plaque control is expected to provide a satisfactory functional and esthetic outcome. This case report presents a rare case of long-standing massive grade III GE extending up to the occlusal level in a 17-year-old systemically healthy, non-syndromic young female involving both arches, thereby posing a diagnostic dilemma. It was treated by gingivectomy using a conventional technique to facilitate precise incision, lower cost, and faster re-epithelialization. This was followed by gingivoplasty using electrocautery. The postoperative results of three months were satisfactory in terms of function and esthetics with uneventful healing. Further follow-up is ongoing for the same.

Chronic Inflammatory Gingival Enlargement: A Case Report

Gingival enlargement can be referred to as an increased size of the gingival tissues. It might have originated because of inflammation, induced by certain drugs, linked to generalized illness, malignant, or pseudo enlargement, based on its etiology and pathogenesis. Enlargements may be widespread, papillary, or marginal, depending on the location. It affects the patient's masticatory, functional, aesthetic, and psychological health. Diagnosing the condition and its underlying cause through a detailed history is the mainstay for management. Diagnosis is based on a careful clinical examination in relation to the consistency, texture, and color of enlarged gingival tissues. Once diagnosed, the intervention relies on treating the causative factor involved in the condition. Early diagnosis and treatment with the elimination of the etiologic factor along with strict oral hygiene instructions and regular follow-up results in the restoration of aesthetics and function. This article presents a case report of a female patient aged 31 years who presented to the Oral Medicine and Radiology Department with chief complaints of swollen gums, bleeding gums while brushing for one month, and pain and loosening of teeth in the upper left back region of the jaw since 15 days. On thorough clinical examination, oral hygiene instructions were given along with antimicrobials and analgesic medications, and extensive scaling and sub-gingival curettage were done. On the follow-up visit after seven days, there was reduced inflammation due to the removal of local irritants like plaque and calculus and reduced gingival enlargement. The takeaway message from this case is that clinicians should be thoroughly acquainted with the normal and pathologic alterations of the gingival tissues and possible etiologic factors for it. Careful examination, prompt diagnosis, and treatment form the mainstay of management.

Long standing Idiopathic gingival hyperplasia of oral cavity with invasion of maxillary sinus: A rare case report

INTRODUCTION

Idiopathic gingival hyperplasia is a rare entity (about one in 1,75,000 individuals). It is characterized by a slow progressive benign enlargement, affecting the attached gingiva, marginal gingiva, and interdental papilla.

PRESENTATION OF CASE

This case report highlights the management of an unusual case of long standing idiopathic gingival hyperplasia involving the right maxillary sinus.

DISCUSSION

Management of gingival hyperplasia depends on the severity of the condition. In this case, surgical excision was performed in both the arches, that resulted in the creation of an oroantral communication, which was protected with a prefabricated custom-made acrylic stent. Despite having a visible raw area of epithelialization evident on the 2^nd post operative day, there were no significant signs of recurrence even at a follow-up of 2 years post surgery. Many authors advocate extraction of involved teeth, in addition to the gingival excision, in the presumption of a permanent cure.

CONCLUSION

The patient was satisfied with the resultant esthetic and functional outcome of the treatment. But, the possibility of recurrence cannot be ruled out, so the patient should be kept under close observation. She may also require subsequent surgeries, thus making psychological counseling mandatory.

Comparative Analysis of Radiosurgery and Scalpel Blade Surgery in Impacted Mandibular Third Molar Incisions: a Clinical Trial

Aims

This study aims to compare the outcome of radiosurgically assisted incision technique with the conventional scalpel blade technique in impacted mandibular third molar incisions.

Methods

On 100 patients (50 patients each in GROUP R and GROUP S) with impacted mandibular third molar, incisions were given using radio surgical and scalpel technique, respectively. Impacted third molars were classified according to Winter's classification. Two types of incisions (Ward's and modified Ward's) were performed. Results were evaluated considering various parameters like surgical ease, field of surgery, odour, bleeding, discomfort/pain, post-operative analgesic intake and healing in both groups.

Results

In our study, mean age of patient was 25.30 years, 54% were females and 46% males; mesioangular was the most common type of impaction, and the average length of incision was 3.105 ± 0.546 cm. There was a significant statistical difference (p < 0.01) in the five measure moments (field of surgery, surgical ease, intra-operative bleeding, odour and post-operative analgesic intake at 3-5th day) between the impacted molars operated with scalpel and the ones done with radiosurgery. There was statistically insignificant difference in pain/discomfort, healing and post-operative analgesic intake at 1st and 7-10th day.

Conclusions

Radiosurgery was very effective in providing clear field of surgery, surgical ease and created less intra-operative bleeding than scalpel blade surgery making day to day minor oral surgery less stress full and productive.