PERIPHERAL

OSSIFYING FIBROMA

ASHOK KUMAR ACRRI

INTRODUCTION :First description of ossifying fibroma was given by Menzel in 1872 while the term was given by Montgomery in 1927. It was first described as relatively uncommon, solitary, nonneoplastic gingival growth by Eversol and Robin. Ossifying fibroma - Central - peripheral

• POF are reactionary lesion defined as any solitary growth on the gingiva thought to arise from the PDL; most commonly at the region of the interdental papilla. • Exuberance of tissue is caused by an initiating factor such

as calculus, or a food particle that becomes lodged in the sulcus ,creating an initial irritation.

CASE REPORT : A 22-year-old female patient , with a chief complaint of swelling on the upper front region of mouth since last 6 months ,the swelling was insidious in onset. Initially, it was small peanut sized and progressively increased to present size. Occasionally, it was associated with pain. Patient did not give any history of trauma, injury, or food impaction and there was no significant medical history.

• The gingival growth was nontender, firm to hard in consistency, nonreducible, noncompressible and fixed to underlying structures. No bleeding on probing was seen. Pathological migration and midline diastema ,

? Pyogenic granuloma

? Inflammatory gingival hyperplasia and POF

FIBROCELLULAR CONNECTIVE TISSUE CONSISTING OF DENSE COLLAGEN FIBERS INTERSPERSED WITH BONY TRABECULAE AND AREAS OF DYSTROPHIC CALCIFICATION

DISCUSSION :

POF – Gingiva , 1 st and 2 nd decade of life , Female ,maxillary incisor-cuspid region ,pink to red ,slow growing asymptomatic ,firm to hard .Trauma and chronic irritation from subgingival plaque and calculus are considered to be the most common etiologic agent for POF. It is thought to be originating from PDL. Exclusively seen on gingiva mostly interdental, lesion are in close proximity to PDL, within some lesions oxytalan fibers can be seen, and fibrocellular response which is similar to other gingival lesions of PDL origin.

• Pathogenesis is still unclear. Certain hypothesis that has been given are - since these are clinically and histologically similar to pyogenic granuloma, some author thought it to be originating secondary to fibrosis of granulation tissue. Similarly, these have a high predilection for female and the 2 nd decade of life hormones are thought to play an important role. Most widely accepted hypothesis states that the presence of local irritants such as plaque, calculus, overhanging restoration, and ill-fitting denture can lead inflammatory reaction which in turn leads to inflammatory hyperplasia of cells of periodontium and PDL.

• Radio graphically, it appears as radio-opaque flecks or patches. Sometimes, separation of the adjacent teeth and occasionally resorption of the adjacent teeth may occur.

• Surgical excision is considered to be treatment of choice.Recurrence rate of POF is high and varies from 7% to 45%.The lesion is removed from periosteum, and the adjacent teeth should be scaled to remove any remaining irritants. This helps in reducing the rate of recurrence. Furthermore, ill-fitting dental appliance and rough restoration if any should be removed.

• Cases can be misdiagnosed as pyogenic granuloma, peripheral giant cell granuloma, or odontogenic tumors, and therefore histopathological examination is essential for accurate diagnosis.Literature shows that most of the cases of POF have a range of 1 st -2 nd decades, more common in females and maxillary anterior region. Same were the finding of the present case. Hormonal changes were thought to be main etiological agent for the present case; however, minimal plaque could be seen in the region. Therefore, along with surgical excision of lesion removal of risk factor was considered as the treatment of choice.

CONCLUSION :

• A slowly growing soft tissue mass with speckled calcifications in the anterior oral cavity of young adults or children should raise a suspicion of a reactive gingival lesion such as POF. Histopathological examination is essential for accurate diagnosis. Once diagnosed, POF should be treated by total excision to prevent recurrence.

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