Peripheral ossifying fibroma: A case report
A 30-year-old female patient reported with the complain of discomfort during chewing and speaking due to a growth in the left lower posterior region of the jaw, which started as a small papule approximately 8 months ago and gradually increased in size with time to attain present size. There was no associated history of bleeding or pain. Her medical history was non-significant and no h/o any medication at that time. She had a habit of chewing smokeless tobacco, since many years.\nIntraoral examination revealed an approximately 2 cm × 2 cm sessile, non-tender, firm, pale pinkish growth present on the interdental gingiva in relation to the mandibular left canine-premolar region [Figures and ]. The lesion was extending from mesial of left lateral incisor to the mesial of left first premolar and up to the level of the occlusal surface, causing occlusal interference. Pathologic migration of mandibular left canine was present as mesial and buccal migration. Radiographically, there was angular bone loss in relation to mandibular left canine and premolar with displacement of mandibular left canine [].\nThe differential diagnosis included irritation fibroma, pyogenic granuloma and POF. Based on the clinical and radiographic findings, the provisional diagnosis of irritation fibroma was made.\nThe periodontal treatment plan included patient education and motivation for oral hygiene instructions and quitting the habit, scaling and root planing, reevaluation and surgical excision of the lesion under local anesthesia. Scaling and root planing was performed for elimination of local etiological factors. After 1 week of scaling and root planing, a reevaluation and surgical excision down to the periosteum were performed [] and periodontal dressing was placed []. Patient was given post-operative instructions and was prescribed with analgesic (tablet ibuprofen-400 mg tds every 4-6 h as needed for pain) and antimicrobial rinse (0.2% chlorhexidine gluconate twice-a-day for 1 week). She was recalled, after 1 week for follow-up. The excised tissue [] was placed in 10% neutral buffered formalin and sent for the histopathologic examination.\nBiopsy specimen microscopically consisted of hyperplastic parakeratinized stratified squamous epithelium with thin, long and anastomosing rete ridges and fibrous connective tissue containing several irregularly shaped trabeculae of bone, droplets of basophilic cementum-like material and numerous plump fibroblasts []. Histopathologic diagnosis was POF.\nAt 1 week post-operative visit, patient presented for periodontal dressing removal and follow-up examination. Recovery was uneventful with a satisfactory healing []. Patient is on regular follow-up at 6 months post-operative without any recurrence [].