Long standing Idiopathic gingival hyperplasia of oral cavity
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A 32-year-old female reported with a chief complaint of swelling in the gums of maxillary and mandibular jaw for 7-8 years, along with burning, occasional bleeding, difficulty in speaking, masticating, and swallowing food. She was also concerned about the migration and drifting of the maxillary anterior teeth from their normal functional position. She reported having received nonsurgical therapy for the same several times in the past 6-7 years with temporary symptomatic relief. Her personal, medical, and family history was noncontributory.

Intraoral findings disclosed significant diffused nodular gingival enlargement, on both buccal and palatal/lingual sides of maxillary as well as the mandibular arches. The gingivae were pinkish-red in color, firm, and fibrous inconsistency, with the absence of the characteristic stippling. The enlargement was found to involve the marginal, attached gingiva and the interdental papillae of both arches, that covered almost all the surfaces of the teeth except incisal or occlusal surfaces. The gingival contour was also altered and projected into the oral vestibule. There were increased mobility and pathologic migration of both anterior and posterior teeth along with the presence of deep pseudopockets. The intermaxillary rest position was also increased. The orthopantomogram(OPG) and cone beam computed tomography(CBCT) scan showed severe generalized alveolar bone loss with floating teeth in both the arches. Significant bone loss causing erosion of the floor of the right maxillary sinus in the molar region was also noted. The hematological investigations were within normal limits. So, an Incisional biopsy was performed and the histopathological examination revealed the features of inflammatory gingival hyperplasia. Based on all the findings available, a provisional diagnosis of idiopathic gingival hyperplasia was made.

Under general anesthesia surgical excision of Gingival overgrowth using scalpel was done arch wise on both the arches along with removal of floating teeth having poor prognosis (18,17,16,15,14,13,12,11,21,28,37,38,48). The teeth with good bone support were left in place. In the right maxilla, an iatrogenic oroantral communication was created intraoperatively. For the protection of this fistula preoperatively fabricated custom-made palatal acrylic stent was placed. The patient’s postoperative course was uneventful.

Source: https://www.sciencedirect.com/science/article/pii/S2210261220309627?dgcid=rss_sd_all