An unusual presentation of peripheral buttressing bone in anterior maxilla: Case report and management
A 14-year-old female reported to our clinic with the chief complaint of painless, hard swelling in the gums in relation to the upper front teeth. The swelling was present for 4 years. The patient had consulted a general dental practitioner 2 years back. Details of the treatment availed were not available. But the patient did not notice any improvement after treatment.\nOn clinical examination, a 1 × 1 cm. swelling was noticed in the marginal and attached gingiva in relation to 21. The tooth was slightly lingually placed. Gingiva over the swelling appeared normal and was clinically devoid of inflammation []. The swelling was bony hard in consistency. Mobility was absent. Probing depth of 10 mm was observed near the distolabial line angle of 21. Intraoral periapical radiograph in relation to 21 and 11 was normal []. Orthopantamograph showed haziness between 21 and 22. Since the clinical and radiographical pictures were inconclusive, it was decided to surgically explore the site.\nBlood profile was taken prior to surgery. All the values were within normal limits. Patient was free of systemic illnesses. After obtaining written consent for explorative surgery from the patient, a mucoperiosteal flap was elevated in relation to 11, 21 and 22. We noticed excessive thickening of the labial cortex in relation to 21 extending from the mesial to the distal aspect of the tooth. The thickened labial bone was elevated from the tooth surface, but the height of alveolar bone labially was not reduced. The thickened and elevated labial cortex enclosed an intrabony defect which measured 10 mm on the William's periodontal probe []. The inner surface of the flap contained thick fibrous granulation tissue and that made the gingival over the swelling appear thick. Histopathological examination of the soft tissue and hard tissue was done and was reported as granulation tissue and as normal bone, respectively. Therefore the clinical picture was suggestive of buttressing bone formation.\nTreatment involved osteoplasty in relation to 21 to reduce the thickened labial cortical bone. Cortical demineralised bone graft (Osseo +, Imtec Corp.) was placed in the bony defect []. Prior to suturing, thick fibrous granulation tissue on the inner side of the flap was dissected and removed and the flap was sutured. Patient was recalled after 10 days and sutures were removed. The swelling had reduced but the gingiva still appeared thick over that region. Gingivectomy and gingivoplasty was done subsequently after about a month to enhance the aesthetics in relation to 21. Frenectomy was also done to correct the gingival pull. The follow-up after 3 months and 1 year showed satisfactory esthetics and no evidence of any recurrence [].