An unusual case of idiopathic gingival fibromatosis
A 15-year-old male patient accompanied by his father reported to the Department of Periodontics with a chief complaint of enlarged gums in upper and lower arches which caused difficulties in speech, mastication, and complete closure of lips, thereby leading to esthetic impairment.\nHistory revealed that enlargement was present since birth and has progressed slowly since then. He did not appear to have any mental impairment and his weight and height were within normal limits. His medical and family history was also non-contributory.\nIntraoral examination revealed generalized severe gingival overgrowth involving both the maxillary and mandibular arches []. The enlarged gingiva totally or partially covered the crowns of permanent teeth with only the incisal and occlusal surfaces visible. The gingiva was firm, dense, and fibrous in consistency. No bleeding and suppuration were noticed. Pseudopockets ranging from 7 mm to 10 mm were observed. Malpositioning of teeth was also noted. Orthopantomograph revealed presence of retained deciduous canine in maxillary left region [].\nTreatment consisted of sextant-by-sextant surgical excision of the enlarged gingiva under local anesthesia. Transgingival probing revealed the bony overgrowths on the buccal aspects of mandibular posterior region, which was subsequently confirmed with the surgical exposure. Internal bevel gingivectomy was performed on the buccal/labial aspects of both arches. Ledge and wedge procedure was done to remove gingival overgrowth over the palatal aspect of maxillary posterior region. On the mandibular posterior region, ledge and wedge procedure combined with internal bevel gingivectomy followed by ostectomy and osteoplasty was done in order to remove the overgrowth of bone wherever present. The excised tissue [] was sent for histopathological examination. Patient was recalled after 1 month for check-up. Gingivoplasty was performed quadrant wise under local anesthesia during four sittings over 4 consecutive weeks. Patient was asked to maintain good oral hygiene.\nHistopathology of the excised gingival tissues showed a bulbous increase in the amount of connective tissue that was relatively avascular and consisted of densely arranged collagen bundles and numerous fibroblasts. The surface epithelium was thickened and acanthotic with elongated rete pegs []. All these features are consistent with idiopathic gingival fibromatosis. Recall appointments were scheduled after every 6 months and after 2 years of follow-up no recurrence of enlargement was seen [].