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CASE REPORT Nisal S et al.: Management of Pier Abutment Using Non Rigid Connector A n U nusual P resentation of H ereditary G ingival F ibromatosis with M axillary B uccal A lveolar B one E xostosis: A C ase R eport Sonia 1 , Vipin Bharti 2 , Mohita Singla 3 , Harmesh Sharma 4 1,3-Post graduate student, Department of periodontology, government dental college, Correspondence to : Patiala, India. 2- M.D.S. Head of Department, Department of periodontology government Dr. Sonia, House no. 901/24 Geeta Colony, near double phatak, Rohtak-124001, Haryana, India. dental college, Patiala, India. 4- M.D.S. Associate professor, Department of periodontology, government dental college, Patiala, India. Contact Us: www.ijohmr.com ABSTRACT Hereditary gingival fibromatosis is a rare condition. The enlargement characterized by slow and progressive enlargement of attached gingiva as well as the gingival margin and interdental papilla. It can occur as an isolated disorder and also as a part of syndrome. This case report present a case of 18 year old male who presented with generalized gingival overgrowth with maxillary buccal alveolar bone exostosis. This non-syndromic case was treated by modified gingivectomy technique with osteoplasty. The post-operative result was uneventful, and the patient appearance improved considerably. After completing the treatment regular follow up visits are necessary in order to evaluate oral hygiene and stability of periodontal treatment. KEYWORDS: Hereditary Gingival Fibromatosis, Modified Gingivectomy Technique, Osteoplasty AA INTRODUCTION aaaasasasss Weber syndrome, Wilson syndrome Zimmerman – Laband syndrome, Maroteaux-Lamy syndrome, Gingival fibromatosis (GF) is an abnormal growth of KlippelTrenaunay syndrome, Goltz syndrome, Ramon gingival tissues caused by an increase in submucosal syndrome, Scheie syndrome, Regional Systemic connective tissue elements Many cases reported are hyalinosis Hurler/ scheie, Odontodysplasia, Jones iatrogenic; some are inherited while others are syndrome Hunter syndrome, Rutherfurd syndrome, Sly idiopathic. 1 The etiology and pathogenesis of gingival syndrome, Cross Syndrome, I- Cell disease, fibromatosis are not well established; however it can Neurofibromatosis type I, Anderson – Fabry disease, occur due to factors like plaque accumulation, caries, Alpha Mannosidosis, Schinzel – Giedion syndrome, hormonal stimulation, drugs, blood dyscrasias, or Ligneous periodontitis, Niemann – Pick disease, Menkes idiopathic. Kinky hair disease, Cowden syndrome and many more. 4 Hereditary gingival fibromatosis is a rare type of gingival An exostosis is a localized, peripheral overgrowth of the enlargement which may be generalized or localized. In bone which is benign in nature. The etiology of exostosis this type the enlarged gingiva have a normal color which is unknown. It may be present as a nodular, flat or is firm in consistency with stippled surface texture. pedunculated protuberance located on the alveolar Buccal and lingual tissues in both the maxilla and the surface of maxillary and mandibular bones. In the jaws, mandible can be involved. There can be mild to severe depending on the anatomic location they are named as degree of enlargement. It usually begins with eruption of torus palatinus, torus mandibularis (lingual premolar the primary or permanent dentition and rarely present at area), or buccal bone exostoses (BBE). BBE are found birth. The gingival overgrowth leads to effects like less commonly than tori. BBE occurs along the buccal diastemas, malpositioning of teeth and long term aspect of the maxilla or mandible, usually in the premolar retention of primary teeth. More severe lesions causes and molar areas. These exostoses are usually found at the both esthetic and functional problems because of time of periodontal diagnosis and treatment. Buccal coverage of crowns of teeth. 2 The enlarged tissue to may exostoses may be traumatized and interfere with oral get traumatized during mastication. Sever growth usually hygiene procedures. Also, Buccal exostoses are leads to an abnormal swallowing pattern, speech significant with regards to prosthodontics because they impediments and difficulty in mastication. All these may interfere with denture insertion. 5 factors will favour the accumulation of plaque and material alba and cause interference with maintenance of Here we report a case of an 18-year-old male patient with oral hygiene, which further complicates the existing non syndromic hereditary gingival fibromatosis (HGF) hyperplastic tissue. 3 Gingival fibromatosis may present in with maxillary buccal alveolar bone exostosis with its some genetic disorders like Hurler syndrome, Sturge management. How to cite this article: Sonia, Bharti V, Singla M, Sharma H. An Unusual Presentation of Hereditary Gingival Fibromatosis with Maxillary Buccal Alveolar Bone Exostosis: A Case Report. Int J Oral Health Med Res 2016;2(5):119-121 International Journal of Oral Health and Medical Research | ISSN 2395-7387 | JANUARY-FEBRUARY 2016 | VOL 2 | ISSUE 5 119

CASE REPORT Nisal S et al.: Management of Pier Abutment Using Non Rigid Connector CASE REPORT An 18-year-old- male reported to the Department of Periodontics, Govt. Dental College and hospital, Patiala, with complaint of swollen gums, speech and masticatory difficulty and poor esthetics. According to the patient gingival enlargement had started at the time of eruption of permanent dentition with slow increase in size; which leads to delayed eruption of permanent dentition. He did not give any history of drugs intake, fever, anorexia, weight loss, seizures, hearing loss, nor having any physical or mental disorder. His family history was of Figure 2: Panormic radiograph showing retained deciduous canines significance since, according to the patient, his father, and in maxilla his nephew had the gingival enlargement but both of these cases did not report to the hospital for treatment. for complete excision was planned. Modified gingivectomy technique followed by osteoplasty of Examination buccal alveolar exostosis was done under local Extraoral examination revealed a convex profile. anaesthesia quadrant wise on maxillary arch and retained An intraoral examination revealed generalized deciduous canines were extracted at the same time which enlargement of gingiva with involvement of both the were present buccally to the permanent canines and maxillary and mandibular arches. The gingiva was pink, modified gingivectomy technique was performed on with a firm and dense consistency and covered more than mandibular arch. The biopsy samples of the gingival half of the crown surfaces. The enlargement had tissue was submitted for histologic evaluation. The influenced the position of his teeth, in such a way that the gingival histopathology revealed moderately dense dentition appeared with diastema and malpositioning collagenous connective tissue with collagen bundles [Figure 1]. Transgingival probing revealed the bony arranged in a haphazard manner. Connective tissue was overgrowth on the buccal aspect of the maxillary relatively avascular along with few inflammatory cell posterior region. infiltrate. The overlying epithelium was hyperplastic with elongated rete ridges [Figure 3], and bone histopathology shows normally looking bony trabeculae and calcification. The histopathologic features were suggestive of hereditary gingival fibromatosis with maxillary buccal alveolar bone exostosis. Figure 1: Preoperative photograph showing generalized gingival enlargement Investigations A panoramic radiograph was taken, which revealed normal bone height and retained deciduous canines in maxillary right and left region [Figure 2]. Routine blood investigations were done which showed normal results. Figure 3: Histologic Section showing thick parakeratinized Treatment stratified squamous epithelium with dense collagenous connective tissue (H & E, 10x) After explaining the patient the potential risks and benefits, the informed consent was obtained. Post-surgical healing was uneventful. The patient was recalled at 1, 3, 6 and 12 months post-surgery. During Keeping in mind the desire of the patient for better this period, no recurrence was seen [Figure 4]. At the esthetics and his unpleasant situation, surgical treatment International Journal of Oral Health and Medical Research | ISSN 2395-7387 | JANUARY-FEBRUARY 2016 | VOL 2 | ISSUE 5 120