Incidence, treatment method and recurrence rate in giant cell granulomas: Retrospective study

Central and peripheral giant cell granulomas are benign entities mostly seen in mandibular anterior region at female individuals, usually with observed recurrence. Their etiology is still unclear, as is the optimal method for treating them. The aim of this study was to evaluate the incidence, treatment methods, recurrence rates, and initial and definitive correlation of central and peripheral giant cell granulomas. Patients who were referred to our clinic between 2013 and 2023 and who had the lesions' definitive diagnosis as "central giant cell granuloma" (CGCG) or "peripheral giant cell granuloma" (PGCG) were included in the study. Demographic data, recurrence rates, treatment methods, lesion location, clinical behaviors, and sizes were noted on the reports. A total of 30 lesions in 23 patients (14 PGCG and 9 CGCG) were evaluated in this study. The mean follow-up time was 62.6 months; 8 of 23 patients had systemic disease. While only 1 patient was observed to have cortical bone destruction in PCGC, all patients were found to have cortical bone destruction in CGCG (p < 0.05). In both lesions, the correlation of preliminary and definitive diagnosis was evaluated, and it was found to be 50% in PGCG while it was 77.7% in CGCG. The recurrence rates were 21.4% in PGCG and 33.3% in CGCG. Curettage was applied in all patients. Additional treatments (intralesional steroid injections, denasumab applications, resection, and graft application) were performed in 5 patients who were found to have CGCG (p = 0.004). However, there was no significant relation between treatment method and recurrence in CGCG (p > 0.05). Various peripheral lesions could mimic PGCG; thus, curettage therapy could be appropriate in the treatment of PGCG. Nevertheless, in some cases of CGCG, additional treatment methods could be more effective for preventing recurrence and any other complications.

Giant cell epulis

Giant cell epulis (peripheral giant cell granuloma) typically appears as a reactive benign lesion in the oral cavity in areas following local irritation or chronic trauma. Here we describe the case of a 45-year-old male patient who presented with the chief complaint of a large gingival mass in the anterolateral maxilla. There had been progressive growth within the past few months, with increased painless discomfort during mastication. The patient also reported bleeding during interdental cleaning. A full physical work-up led to the suspicion of giant cell epulis alongside other differentials including mucosal hemangioma and squamous cell carcinoma, with unremarkable laboratory values. Imaging including computed tomography showed signs of previous insertion of metal implants on either side of the lesion alongside mucosal hyperplasia. A confirmatory biopsy was taken and showed multiple giant cells on a reactive bed of stroma, in line with the diagnosis of giant cell epulis. Oral inflammatory conditions such as giant cell epulis have greater chances of local recurrence and, therefore, careful investigation with timely and accurate diagnosis is imperative for appropriate early treatment. Complete surgical excision should then be employed to prevent relapses, as incomplete removal can lead to further recurrence. Identification and eradication of potential sources of irritation should also be considered when treating the patient, to avoid further recurrence.

Surgical excision of peripheral giant cell granuloma of the maxilla: a case report

Peripheral giant cell granuloma (PGCG) is described as an elevated lesion that is located mostly on the gingival mucosa and alveolar crest, consecutive to irritative factors and trauma. It predominantly occurs more in the mandible than the maxilla, and it is usually seen in the 4^th to the 6^th decades. The clinical appearance of this lesion is red-bluish in color, presenting a similar tissue to the one observed in the liver, usually measuring less than 2 cm. The treatment of the PGCG is the surgical excision. The recurrence of this lesion is rarely described in the literature. The present case highlights the importance of considering the traumatic extractions as one of the main uncommon etiologic factors, leading to the development of peripheral giant cell granuloma. It precisely describes the diagnosis, the treatment of a peripheral giant cell granuloma located in maxillary canine-premolar region, occurred consecutively after ancient traumatic extractions of the 13 and 14 since 1 year. This paper also reports a maxillary location of giant cell granuloma, while the literature reports more commonly the mandibular location. This lesion was excised surgically, and healed uneventually, and in which the follow-up didn´t show any sign of recurrence.

An analysis of the prevalence of peripheral giant cell granuloma and pyogenic granuloma in relation to a dental implant

Background

The aim of the present investigation was to evaluate the literature recurrence of peripheral giant cell granuloma and pyogenic granuloma associated with dental implants. It’s important to know the characteristics present in these lesions and possible effects on the prognosis of dental implants.

Methods

An electronic search without time restrictions was done in the databases: PubMed/Medline. With the keywords "Granuloma" OR "Granuloma, Giant Cell" OR "peripheral giant cell" OR "Granuloma, Pyogenic” AND "Dental implants" OR "Oral implants”.

Results

After applying the inclusion and exclusion criteria, a total of 20 articles were included, which reported 32 lesions (10 pyogenic granulomas, 21 peripheral giant cell granulomas and one peripheral giant cell granuloma combined with peripheral ossifying fibroma, all associated with implants). According to our review, these lesions are more frequent in males and in the posterior region of the mandible. Both excision and curettage of the lesion, compared to only excision, presented similar recurrences (40%). Explantation of the implant was performed in 41% of cases without additional recurrences. The results are not statistically significant when comparing one lesion to the other in terms of explantation (p = 0.97), recurrence (p = 0.57) or bone loss (p = 0.67).

Conclusions

The main therapeutic approach is tissue excision. The lesions show a high recurrence rate (34.4%), which often requires explantation of the associated implant. This recurrence rate is not affected by curettage after excision.

Peripheral giant cell granuloma associated with a dental implant

Background

Peripheral giant cell granuloma (PGCG) is an uncommon pathology that affects gingival or alveolar mucosa. Although PGCG can be associated with dental implants, little is known about this lesion and implant osseointegration as well as its etiopathogenesis and the treatments available. This study sought to report a rare case of PGCG associated with dental implant, emphasizing its clinical and histopathological aspects.

Case presentation

A 53-year-old man had an exophytic, reddish lesion, around a crown attached to a dental implant located in the left mandible. Radiographically, there was bone loss around the implant. After excisional biopsy, histological examination revealed a submucosal proliferation of multinucleated giant cells rendering the diagnosis of peripheral giant cell granuloma. Patient has been under follow-up for 6 months with no recurrence.

Conclusions

Peri-implant lesions must be completely removed to prevent recurrence of PGCG and implant failure, even in cases suspected to be reactive. Besides, histological examination must be performed on all peri-implant reactions to achieve the appropriate diagnosis and, consequently, the best treatment and follow up.

Peripheral giant cell granuloma associated with dental implants: a systematic review

The purpose of the present review was to integrate the available published data on peripheral giant cell granuloma (PGCG) associated with dental implants into a comprehensive analysis of its clinical/radiologic features. An electronic search was undertaken in February/2018 in three databases, looking for publications reporting cases of PGCGs associated with dental implants. Nineteen publications were included, reporting 37 implant-associated PGCG. These lesions are more prevalent in women, in mandible, and in posterior regions of the jaws. Both 'excision alone' and 'excision + curettage' presented high recurrence rates (40% and 31.3%, respectively). The etiology of implant-associated PGCG has not yet been determined. Despite the small number of cases reported, implant-associated PGCG shows a high recurrence rate (1/3) for a benign non-neoplastic lesion and sometimes it requires the removal of the associated implant in order to prevent further recurrences. This recurrence rate is not affected by curettage after excision.

Reactive hyperplastic lesions of the oral cavity: A retrospective survey study and literature review

Context

The reactive lesions are relatively common in the oral cavity because of the frequency with which the tissues are injured. They often result from a known stimulus or injury such as dental plaque, calculus, or foreign material.

Aims:

The aim of this study was to review the clinicopathologic features of reactive hyperplastic lesions (RHLs) of the oral cavity at MIDSR, Dental College and Hospital, Latur, Maharashtra, and to compare these data with those of previously reported studies.

Settings and Design

The patient case files from the Department of Oral and Maxillofacial Pathology from June 2010 to May 2016 were reviewed for cases of RHLs of the oral cavity.

Subjects and Methods

Both clinical and histopathological diagnosis of reactive lesions was selected for the study. Data including the type of the lesion, age, gender, and the site involved were collected.

Statistical Analysis Used

Descriptive statistics was applied to the data and differences in frequencies among groups were evaluated using SPSS (IBM Corporation) software.

Results:

A total of 155 histologically diagnosed cases of RHLs were obtained with a prevalence of 11.7%. The data consist of 56 (36.1%) males and 99 (63.9%) females. The most common lesion clinically was traumatic fibroma (36.5%) and histologically fibrous hyperplasia (37.4%). The reactive lesions clinically presented as either sessile (51%) or pedunculated (49%) lesions.

Conclusions

The clinical features of reactive hyperplasia among our patients were similar to those reported previously with divergence in some analyzed data. The novelty in our study was the correlation between histopathology and clinical features which were not reported in literature till date.

A Case of Painless Excision

Soft tissue lesions of the oral cavity are seen in children at the dental office. This case report aims to showcase the ability of laser to treat recurrent soft tissue lesions in the oral cavity in a painless manner. This painless procedure provides relief to the child and parent who suffer from anxiety toward dental treatment.

How to cite this article: Suyash IA, Bhatia R. A Case of Painless Excision. Int J Clin Pediatr Dent 2018;11(2):135-140.

Reactive hyperplasic lesions of the oral cavity: A survey of 295 cases at a Tertiary Health Institution in Kerala

Background:

The aim of this study was to review the clinicopathologic features of reactive hyperplastic lesions (RHLs) of the oral cavity at a Tertiary Health Institution in Kerala and compare these data with those of previously reported studies.

Materials and Methods:

The patient case files from the Department of Oral and Maxillofacial Pathology during the period between January 2007 and December 2011 were reviewed for cases of RHLs of the oral cavity. Both clinical and histopathological diagnoses of reactive lesions were selected for the study. Data including the type of the lesion, age, gender and the site involved were collected.

Results:

From a total of 2753 cases reviewed, 295 histologically diagnosed cases of RHLs were obtained with a prevalence of 10.7%. The data consist of 85 (28.8%) males and 210 (71.2%) females. The most common lesion clinically was traumatic fibroma (69.3%) and histologically fibrous hyperplasia (51.9%). The reactive lesions clinically presented as either sessile (54.9%) or pedunculated (45.1%) lesions.

Conclusion:

The clinical features of reactive hyperplasia among our patients were similar to those reported previously with divergence in some analyzed data. The novelty in our study was the correlation between histopathology and clinical features which were not reported in literature until date.

Peripheral ossifying fibroma, some rare findings

The peripheral ossifying fibroma (POF) is a benign reactive gingival overgrowth; it occurs mainly in the anterior portion of maxilla in young adults, predominantly among females. The present report describes a case of POF in a male patient, which relapsed ten years later and of the lesion showed superficial bone erosion on surgical excision.

The peripheral giant cell granuloma in edentulous patients: report of three unique cases

The peripheral giant cell granuloma (PGCG) is a rare reactive exophytic lesion taking place on the gingiva and alveolar ridge usually as a result of local irritating factors such as trauma, tooth extraction, badly finished fillings, unstable dental prosthesis, plaque, calculus, chronic infections, and impacted food. This article presents 3 cases of PGCG that presented at the same location of the edentulous mandible of patients that using complete denture for over ten years.