![]() One year later, the patient reported back to the clinic. A histopathological diagnosis suggestive of inflammatory fibrous hyperplasia was given ( Figure 5). At places the stromal tissue exhibited myxoid degeneration. Few fibroblasts appeared stellate, with numerous nuclei distributed in a collagenized stroma. The underlying stromal tissue showed numerous proliferating young fibroblasts admixed with focal aggregates of chronic inflammatory cells. The histopathological examination revealed a hyperplastic parakeratinized epithelium overlying inflamed connective tissue. Following this, the patient failed to report for subsequent recall appointments. The excised tissue was sent for histopathological examination. An internal bevel gingivectomy was performed for the maxillary sextant. These investigations were non–contributory. At this stage, radiographs were taken and complete blood count investigations (RBC, WBC and platelet counts, ESR, bleeding time, clotting time, prothrombin time) were carried out ( Figure 4). At the next visit, in spite of use of the prescribed medicated mouthwash, the gingival enlargement did not show considerable reduction in size, but the tissues appeared to be firm in consistency. Reddy's Laboratories Ltd., India) twice a day for one week was advised. Oral hygiene instructions were given and the use of chlorhexidine mouthwash (0.2% Clohex™, Dr. The initial periodontal therapy comprising supragingival and subgingival scaling was performed. Further soft tissue assessment revealed soft and edematous consistency and bleeding on probing on all teeth.Ī treatment plan consisting of initial periodontal therapy followed by a gingivectomy procedure was planned to improve aesthetics and function. On clinical examination, marginal and papillary gingiva appeared red and enlarged in the maxillary and mandibular arches, which was more prominent in the anterior sextants and also more pronounced on the right side as compared to the left (Figures 1, 2 and 3). There was no other relevant medical, dental or family history.Ĭonsistent with the history of incomplete orthodontic treatment, intraoral inspection revealed orthodontic molar bands and brackets on all teeth except the maxillary left central incisor. The patient revealed that he had undergone incomplete orthodontic treatment which was initiated 6 years prior. He also complained of bleeding from the gums while brushing. The patient had noticed the swelling 3 years prior and reported that it had not increased in size since then. The patient complained of swelling of the upper and lower gums in the front tooth region. This case report presents a case of chronic gingival enlargement associated with prolonged orthodontic therapy.Ī 19–year–old male patient reported to the Department of Periodontology, Manipal College of Dental Sciences, Manipal, India. The prime treatment modalities involve obtaining a detailed medical history and non–surgical periodontal therapy, followed by surgical excision to retain esthetical and functional demands. The therapeutic approaches related to gingival enlargement are based on the underlying etiology and the subsequent changes it manifests on the tissues. The willingness to perform adequate oral hygiene measures and receive timely periodic recalls and treatment are deemed essential for a successful outcome. One of the most important determinants of treatment outcomes is patient compliance. Thus, there is a transformation of the gingival sulcus into a periodontal pocket creating an area where plaque removal becomes impossible. This may lead to more inflammation and further plaque accumulation perpetuating this vicious cycle. 1 The ability to perform oral hygiene measures is compromised in some patients with gingival enlargements, which may be further complicated by the presence of prosthesis and fixed orthodontic appliances. Inflammatory gingival enlargement may be categorized as acute or chronic, wherein chronic changes are much more common. 1 Based on the extent and severity, these enlargements may lead to functional disturbances like altered speech, difficulty in mastication and aesthetic and psychological problems. A rare variant, idiopathic gingival fibromatosis, with a familial inheritance, has also been reported. It also occurs as a manifestation associated with several blood dyscrasias, such as leukemia, thrombocytopenia or thrombocytopathy. It may be plaque–induced or associated with systemic hormonal disturbances. It is a multifactorial condition that develops in response to various stimuli and interactions between the host and the environment. Gingival enlargement, a globally accepted terminology for an increase in the size of the gingiva, is a general feature of gingival diseases.
0 Comments
Leave a Reply. |
AuthorWrite something about yourself. No need to be fancy, just an overview. ArchivesCategories |