An Extensive Denture-Induced Hyperplasia of Maxilla
A 51-year-old female patient visited the department of Oral Medicine and Radiology, Yenepoya Dental College, Mangalore with a complaint of pain while chewing since 1 year. She also gave a history of small soft tissue mass in relation to the upper arch which has developed to the present size over a 12-month period. The patient has been wearing upper removable complete denture for 6 years. Pain was moderate and intermittent. The patient used to wear the denture during night time also. Her denture had become loose over a period of time and teeth were attrited. Her medical and family history was noncontributory. She had no deleterious habit like tobacco chewing. Extra oral examination showed no abnormality. She was moderately built and nourished. Intraoral examination revealed multiple hyperplastic tissue folds in the right maxillary buccal vestibule extending from the right lateral incisor region to the third molar area with maxillary denture flange fitting in between the tissue folds []. There was an irregular ulcer measuring 2 × 1 cm in diameter on the surface of the lesion in relation to first molar covered with slough. The lesion was firm, nontender except in the area where ulcer was present. Palatal mucosa was normal and there was generalized recession of gingiva in the lower arch and bilaterally molars were missing. The denture hygiene was poor. On the basis of history and clinical examination a provisional diagnosis of denture-induced hyperplasia was made. The patient was instructed not to wear the denture. Hexigel ointment was prescribed to be applied on the ulcer. Oral prophylaxis was done in the lower arch. The patient was educated and motivated to maintain the oral hygiene. Seeing the extent of the lesion, a surgical resection was planned along the full length of the maxilla after reviewing the patient for any medical condition. The tissue was infiltrated with local anesthesia containing adrenaline 2% and posterior superior alveolar, infraorbital and greater palatine nerve blocks were given. Using a no. 15 surgical blade an outline for resection in a wedge shape was made along the length of the lesion. The resection was then carried out from the midline till the posterior tuberosity region. Hemostasis was achieved. The field was cleaned with betadine and saline solution. A primary closure was achieved using 3-0 vicryl suture material []. Postoperatively, antibiotics and analgesics were prescribed. The patient was instructed not to wear the denture and rinse the mouth with chlorhexidine mouthwash. The excised specimen [] was sent for histolopathological examination. It revealed hyperplastic epithelium in most of the areas, and the underlying connective tissue was fibrous, with moderate inflammatory infiltrate consisting of predominantly lymphocytes. The patient was recalled for follow-up after a week and the healing was satisfactory. The new denture was fabricated after 1 month []. The patient is on regular follow-up for 6 months and there was no recurrence of the lesion till date [].