The varying clinical presentations of peripheral ossifying fibroma: a report of three cases

Abstract

Purpose: Gingival growths are one of the most frequently encountered lesions in the oral cavity. Most of these lesions are innocuous, but some do have malignant potential. Different lesions with similar clinical presentations make it difficult to arrive at a correct diagnosis. One of the infrequently occurring gingival lesions is peripheral ossifying fibroma (POF). Lesions with histological features similar to POF have been given various names, adding to the confusion. We report the varied clinicopathological features of 3 cases of POF, discuss the contentious nomenclature and investigate the possible etiopathogenesis of this disease.Case description: Three cases of gingival growths (POF) are reported. Two of the lesions occurred in the maxillary anterior region, while the third occurred in the mandibular posterior region. Two of the cases showed radiographic evidence of bone loss. An excision biopsy was performed in all three cases.Conclusion: Because the rate of recurrence for peripheral ossifying fibroma is 8% to 20%, close postoperative monitoring is required. It is also necessary to use consistent and specific nomenclature in the literature to avoid confusion and the loss of important data.Key words: Fibroma; gingival overgrowth; peripheral ossifying fibroma ResumoObjetivo: Crescimentos gengivais são uma das doenças mais frequentemente encontradas na cavidade oral. A maioria dessas lesões são inócuas, mas alguns têm potencial maligno. Lesões diferentes com apresentações clínicas semelhantes tornam difícil um diagnóstico correto. Uma das lesões gengivais que ocorre raramente é o fibroma ossificante periférico (FOP). Lesões com características histológicas semelhantes ao FOP têm nomenclatura diferente, aumentando a confusão. Este artigo relata as características clinico-patológicos de 3 casos de fibroma ossificante periférico.Descrição do caso: Três casos de FOP são relatados. Duas das lesões ocorreram na região anterior da maxila, enquanto a terceira localizava-se na região posterior da mandíbula. Dois dos casos apresentaram evidências radiográficas de perda óssea. Biópsia excisional foi realizada em todos os três casos.Conclusão: Como a taxa de recorrência para FOP é de 8% a 20%, o monitoramento pós-operatório é necessário. Deve-se utilizar nomenclatura consistente e específica na literatura para evitar confusão e perda de dados importantes.

Large peripheral ossifying fibroma: Clinical, histological, and immunohistochemistry aspects. A case report

“…3 For instance, we could mention peripheral ossifying fibroma which has a complex diagnosis as it shares clinical and histological characteristics which are common to other conditions. 4 Basically, ossifying fibromas may be divided into two types: central and peripheral. 5 Reports of intraoral peripheral ossifying fibroma started in the late 40's, 2 and nowadays it is a relatively common lesion corresponding to 9.6% of gingival biopsies.…”

“…6 As regards to pathogenesis, it seems to be related to periodontal ligament, 7 once it exclusively develops in the gingival portion of the maxilla, because of proximity of periodontal ligament and gum, and because of the presence of oxytalan fibers inside the mineralization of some lesions. [3][4][5][6][7][8] In addition, the presence of trauma or chronic irritation is especially related to the etiology of these gingival conditions, for instance, presence of calculus, plaque, orthodontic braces, restorations and maladjusted prosthesis. 1 In the specific case of peripheral ossifying fibroma, many authors consider it as a focal, reactive, non-neoplastic lesion of soft tissue 2-9 which usually develops from interdental papilla.…”

“…1 In the specific case of peripheral ossifying fibroma, many authors consider it as a focal, reactive, non-neoplastic lesion of soft tissue 2-9 which usually develops from interdental papilla. [4][5][6][7] Regarding clinical aspects, peripheral ossifying fibroma is usually presented as a single sessile-or pedunculated-based nodule covered by mucosa which has a color that ranges from pink to red, 6 and its surface may be ulcerated or not, flat or uneven. [2][3][4][5][6][7] The most frequent location of this lesion is the portion of upper incisor teeth 4 and the size of most lesions does not exceed 1.5 cm.…”

“…[4][5][6][7] Regarding clinical aspects, peripheral ossifying fibroma is usually presented as a single sessile-or pedunculated-based nodule covered by mucosa which has a color that ranges from pink to red, 6 and its surface may be ulcerated or not, flat or uneven. [2][3][4][5][6][7] The most frequent location of this lesion is the portion of upper incisor teeth 4 and the size of most lesions does not exceed 1.5 cm. 5,6,10 However, when we are dealing with gingival lesions, clinical characteristics are insufficient for a final diagnosis once they are common to several lesions, therefore, histopathological examination is always necessary to determine the diagnosis.…”

Peripheral Cemento-Ossifying Fibroma

“…Most of these lesions, such as irritational fibroma, pyogenic granuloma, peripheral ossifying fibroma and peripheral giant cell granuloma, are innocuous and rarely present with aggressive features [1] Ossifying fibroma is a benign neoplasm arising in craniofacial bones, composed of proliferating fibroblasts with osseous products that include bone and ovoid calcifications; these lesions are well demarcated from the adjacent bone. There are two types of ossifying fibromas: the central type and the peripheral type.…”