Peripheral Ossifying Fi Broma: ASE Eport

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CASE REPORT
Peripheral ossifying fibroma

Ameet Mani, Shubhangi Mhaske3, P. P. Marawar, Sanjay Lagdive1, Jitendra V. Kalburge2
Departments of Periodontics and Oral Implantology, 1Prosthodontics, 2Oral Pathology and 3Orthodontics, Pravara Institute of
Medical Sciences, Rural Dental College, Loni, Ahmednagar, Maharashtra, India
ABSTRACT
The peripheral ossifying fibroma (POF) is an exophytic gingival mass of fibrous
connective tissue covered with a surface epithelium associated with the formation of
randomly dispersed foci of a mineralized product consisting of bone, cementum-like
tissue, or dystrophic calcifications having a recurrent rate of nearly 20%. It is one
of the most common reactive gingival lesions, which have often been called by the
generic term epulis. This case report describes the clinical and histopathological
findings of POF, its differential diagnosis, and treatment.
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Key words: Ossifying fibroma, gingival mass, bone
INTRODUCTION
Peripheral ossifying fibroma (POF) is an oral
pathologic condition that appears in the mouth as
an overgrowth of gingival tissue due to irritation
or trauma. A gingival fibroma is derived from
cells of the periodontal ligament and usually
developing in response to local irritants such as
plaque and calculus on associated teeth. It may
be mistaken for other more common exophytic
gingival lesions such as fibrous hyperplasia or
pyogenic granuloma.[1] POF is localized reactive
enlargement of the gingiva that typically measures
less than 1.5 cm at its greatest dimension.[2] It
is relatively common, accounting for 9.6% of
all biopsied gingival lesions.[3] The POF may be
pedunculated or sessile and does not blanch upon
palpation; it mostly occurs between the ages of
Address for correspondence:
Dr. Ameet Mani, Dept. of Periodontics & Oral
Implantology, Pravara Institute of Medical Sciences,
Rural Dental College, Loni - 413736, Ahmednagar,
Maharashtra, India.
E-mail: [email protected]
82
25 and 35 years.[4,5] It may appear ulcerated and

erythematous or exhibit a color similar to adjacent
gingiva. As it occurs exclusively on the gingival,
its occurrence is correlated with the presence of
periodontal ligament.[6]
The following case describes POF of the maxillary
posterior attached gingiva and its treatment.
CASE REPORT
A female patient aged 32 years reported to the
Department of Periodontics, Rural Dental College,
Loni, with the chief complaint of bleeding and
swelling in the buccal and palatal aspect of 25 and
26 regions since 6 months. The swelling started
as a small growth and grew to the present size. It
posed no other problems other than interfering
with food intake. Bleeding was noticed with slight
ulceration due to indentation of lower teeth on
occlusal side which caused discomfort during
mastication to the patient.
Intraoral examination revealed a single, unilateral
growth on buccal and palatal aspect of 25 and 26
Journal of the International Clinical Dental Research Organization | May-August 2010 | Vol 2 | Issue 2
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Mani, et al.: Peripheral ossifying fibroma
measuring about 3.0 2 cm in diameters, reddish

pink in color, somewhat oval in shape, firm in
consistency with pedunculated base, and painless.
The growth extended horizontally from distal line
angle of 24 to mesial line angle of 26 and vertically
from mucogingival junction, involving marginal
gingiva and extending palatally to involve palatal
mucosa as shown in Figures 1 and 2. The origin
was seen primarily from interdental papilla
with 24 and 25 regions. Evidence of erythema,
ulceration, and intermittent bleeding was seen
due to palatal indentation due to antagonist teeth.
Color was slight reddish compared with adjacent
gingiva. There was no pertinent medical history
and further head and neck examination was
unremarkable. A periapical radiograph revealed
osseous defect with 24 and 25 regions.
Differential diagnosis included pyogenic
granuloma, irritational fibroma, aneurismal bone
cyst, gingival cyst of adult, peripheral odontogenic
fibroma, peripheral giant cell granuloma, and POF.
Investigations ordered were intraoral periapical
radiograph in relation to 24, 25, and 26 regions
and complete hemogram.
The radiographic findings showed mild angular
bone loss, and hemogram revealed normal values.
Thorough scaling and root planing was done and
patient was put on maintenance phase. After 1
week, the growth was surgically excised under
local anesthesia. A wide excision of the mass
was performed, and the adjacent gingival tissues
were plastied to create symmetrical postoperative
gingival contours as shown in Figures 3 and 4. The
biopsy was transported to the Department of Oral
Pathology in 10% formalin for histological report.
Histopathological findings
Section shows a parakeratinized stratified
squamous epithelium with proliferation. There
was forking and arcading of rete ridges. The
connective tissues just below the epithelium were
fibrocellular, made up of proliferating fibroblasts
arranged in strands and whorls with areas of
globular calcified masses resembling cementumlike material and osteoid tissue. Rest of the
connective tissue was fibrocellular with blood
vessels and chronic inflammatory cell infiltrate
suggestive of POF as shown in Figure 5.
DISCUSSION
POF can occur at any age, although it appears
to be somewhat more common in children
and young adults.[7] The present clinical case
report concerns a relatively common gingival
lesion. In 1982, Gardner described the nature
of the POF which had been considered the
extraosseous counterpart of the central ossifying
fibroma.[8] Most reported series of cases show a
predilection for occurrence in females by a ratio
ranging from 2:1 to 3:2. Plaque, calculus, rough
restorations, illfitting dentures, microorganisms,
masticatory forces, minor trauma, trapped food
and debris, and iatrogenic factors all influence
the development of these lesions. In most
instances (<5%), a POF lesion is associated with
radiographic signs and tooth migration.[9] For this
reason, POF is considered not to be neoplastic,
but rather to be a hyperplastic reaction due to
inflammation.[10] POFs may exhibit diffuse radioopaque calcifications, but not all lesions exhibit
these radiographic features. Majority of these
lesions are not associated with radiographic
destruction of bone.[11]
The POF must be differentiated histologically
from the peripheral odontogenic fibroma. The
main histological differences are the presence
of odontogenic epithelium in the peripheral
odontogenic fibroma and the presence of
displastic dentin in the POF.[12]
The treatment requires proper surgical
intervention that ensures deep excision of the
lesion including periosteum and affected PDL.
Thorough root scaling of adjacent teeth and/or
removal of other sources of irritation should be
accomplished.[13]
83
Cundiff found a recurrence rate following excision

of 16%, and Eversole and Rovin found a recurrence
rate of 20% in 50 cases.[7] Most probably, the
incomplete removal of the tumor at the initial
surgical procedure and failure to eliminate local

irritants are responsible for its recurrence. In this
case, recurrence was not observed after 1 year of
period as shown in Figure 6. However, recurrences
are easily managed with additional surgery.
Figure 1: Preoperative lesion associated with 24, 25, and 26

regions
Figure 2: Preoperative palatal view
Figure 3: Intraoperative view
Figure 4: Excised lesion
Figure 5: Histological photograph
Figure 6: 1 year postoperatively (no recurrence observed)
84
CONCLUSION
The POF is a well-defined pathologic entity
among reactive gingival lesions. They are most
common in females, found most often in the
maxillary incisor-cuspid region, but may occur at
any gingival site. As of the POF behavior pattern,
a proper treatment protocol is warranted with
close follow-up.
7.
8.
9.
REFERENCES
10.
1.
2.
3.
4.
5.
6.
Michaelides PL. Recurrent peripheral odontogenic

fibroma of the attached gingiva: A case report. J
Periodontol 1992;12:645-7.
Kfir Y, Buchner A, Hansen LS. Reactive lesions of
the gingiva: A clinicopathologic study of 741 cases. J
Layfield LL, Shopper TT, Weir JC. A diagnostic survey
of biopsied gingival lesions. J Dent Hyg 1995;69:175-9.
Bhaskar SN, Jacoway JR. Peripheral fibroma and
peripheral fibroma with calcification: Report of 376
cases. J Am Dent Assoc 1966;73:1312-20.
Zain RB, Fei YJ, Fibrous lesion of the gingiva: A
histological analysis of 204 cases. Oral Surg Oral Med
Oral Pathol 1990;70:466-70.
Kenny JN, Kaugars GE, Abbeu LM. Comparision
11.
12.
13.
between peripheral ossifying fibroma and peripheral

odontogenic fibroma. J Oral Maxillofac Surg
1989;47:378-82.
Shafers Textbook of Oral Pathology. 5th Ed.
Gardner DG. Peripheral odontogenic fibroma: An
attempt of classification. Oral Surg Oral Med Oral
Pathol 1982;54:40-8.
Silva CO, Sallum AW, do Couto-Filho CE, Costa
Pereira AA, Hanemann JA, Tatakis DN. Localized
gingival enlargement associated with alveolar
process expansion: Peripheral ossifying fibroma
coincident with central odontogenic fibroma. J
Eversole LR, Rovin S. Reactive lesions of the gingiva.
J Oral Pathol 1972;1:30-8.
Abitbol TE, Santi E. Peripheral ossifying fibroma
Literature update and clinical case. Periodontal Clin
Investig 1997 Spring;19:36-7.
Buchner A. Peripheral odontogenic fibroma: Report
of 5 cases. J Craniomaxillfac Surg 1989;17:134-8.
Walters JD, Will JK, Hatfield RD, Cacchillo DA,
Raabe DA. Excision and repair of the peripheral
ossifying fibroma: A report of 3 cases. J Periodontol
2001;72:939-44.
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Source of Support: Nil. Conflict of Interest: None declared.
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[Downloaded free from http://www.jicdro.org on Monday, November 28, 2016, IP: 202.67.42.

Peripheral ossifying fibroma

Access this article online

Key words: Ossifying fibroma, gingival mass, bone

25 and 35 years.[4,5] It may appear ulcerated and

measuring about 3.0 2 cm in diameters, reddish

Cundiff found a recurrence rate following excision

surgical procedure and failure to eliminate local

Figure 1: Preoperative lesion associated with 24, 25, and 26

Figure 2: Preoperative palatal view

Figure 3: Intraoperative view

Figure 4: Excised lesion

Figure 5: Histological photograph

Figure 6: 1 year postoperatively (no recurrence observed)

Michaelides PL. Recurrent peripheral odontogenic

between peripheral ossifying fibroma and peripheral

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