Severe gingival enlargement associated with aggressive periodontitis

Abstract

Enlargement of the gingiva can be due to various causes. Most prevalent are the inflammatory type and drug-induced type of gingival hyperplasia. However, sever enlargement associated with an aggressive type of periodontitis is an infrequent finding. Reported here is a case of a female patient aged 18 years who presented with severe enlargement of the maxillary and mandibular gingiva. Examination revealed enlargement extending up to the incisal edge of all the teeth and also an associated generalized loss of attachment with radiographic evidence of reduced bone height resembling an aggressive type of periodontitis. There were no associated systemic signs and symptoms or any family history except that there was generalized vitiligo of the skin and oral mucous membrane. The case was treated by gross electrosection of the gingiva.

Surgical Management of Generalized Gingival Enlargement – A Case Series

“…12,13,18,24,27 In the current study, most of patients were with idiopathic gingival enlargement followed by drug induced type, hereditary type and inflammatory type. All of these cases were with massive disease.…”

“…Moreover, gingival tissue is richly vascular and surgical excision with knife leads to bloody and time consuming procedure. 27 Drug induced gingival enlargement was not resolved by conservative measures (changing the drugs and improving oral hygiene) in any of the patients. 25,26 These patients were also treated by electrosurgery because in these cases the gingival tissue used to bleed profusely.…”

“…Laser surgery (CO 2 Nd: YAG, diode) is also a choice for gingival excision because it leads to sealing of blood vessels during incision to maintain hemostasis and a clear field of view. 26,27 But it is expansive, technique sensitive and not available in our center. In the current study, electrosurgery was preferred to treat gingival enlargement because it is economical than lasers, the electrode cuts on its sides as well as on its tip and may be bent to meet the clinical need especially in maxillary tuberosity, retromolar and interdental areas, cuts are made with ease when the device is set correctly, hemostasis is immediate and leads to bloodless surgical field, cutting is consistent, the wound is nearly painless after the procedure, soft tissue has minimal trauma and the tip is self -disinfecting.…”

“…In the current study, electrosurgery was preferred to treat gingival enlargement because it is economical than lasers, the electrode cuts on its sides as well as on its tip and may be bent to meet the clinical need especially in maxillary tuberosity, retromolar and interdental areas, cuts are made with ease when the device is set correctly, hemostasis is immediate and leads to bloodless surgical field, cutting is consistent, the wound is nearly painless after the procedure, soft tissue has minimal trauma and the tip is self -disinfecting. 27 Ramer et al advocated quadrant by quadrant gingivectomy with periodontal pack placement for 1 week, followed by 0.2% chlorhexidine oral rinse twice a day for 2 weeks after each surgery. In contrast to this; we treated all the patients under general anaesthesia as a single visit procedure.…”

“…[16][17][18][19][20]27 The syndromes associated with gingival fibromatosis include Zimmerman -Laband syndrome (GF, hypoplastic distal phalanges, hepatosplenomegaly, epilepsy, hypertrichosis, and mental retardation), Jones syndrome (GF and progressive neural deafness), Klippel -Trenaunay syndrome (GF, hemihypertrophy, Nevus flammeus, hemangioma, hypertlorism, and macrocephaly), Ramon syndrome (GF, hypertrichosis, mental retardation, epilepsy, rheumatoid arthritis, and diabetes mellitus), Rutherfurd syndrome (GF, unerupted teeth, corneal dystrophy, and mental retardation), Cross syndrome (GF, nanophthalmos, microcornea, and severe mental retardation), Murray -Puretic Drescher syndrome (Juvenile hyaline fibromas), Cornelia de Lange Syndrome, and Tuberous sclerosis. 4,[18][19][20][21]27 In the current study no patient presented with generalized gingival enlargement associated with any syndrome. It has recently been found that there are qualitative and quantitative differences in transforming growth factor beta -isoform (TGF-β) and receptor expression by fibroblasts in gingival overgrowth and this may contribute to the pathogenesis of the disease.…”