Epulis - Commonly Misdiagnosed Entity: A Report of 2 Cases

Singh, Devika; Pranab, A; Mishra, Neha; Sharma, Aruna; Kumar, Satish; Gupta, Pansi

doi:10.4172/2376-032x.1000230

Cited by 3 publications

(4 citation statements)

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“…1 Bone resorption is relatively uncommon. 5 Histologically, fi brous epulis shows hyperplastic epithelium that overlies fi brous connective tissue. 1 Mineralized tissue, if present, consists of trabeculae or droplike metaplastic bone.…”

Section: ■ Clinical Recognition and Diagnosismentioning

confidence: 99%

“…The differential diagnosis includes pyogenic granuloma, peripheral giant cell granuloma, fi broma, peripheral odontogenic fi broma, fibrosarcoma, and squamous cell carcinoma. 1,3,5 A slowly growing mass on the interdental papilla with local irritations and calcifi cations detected by computed tomography should raise suspicion of fi brous epulis. 3 However, distinguishing fi brous epulis from the other conditions listed above may be diffi cult, and thus, histopathologic study is crucial.…”

Section: Fibrous Epulismentioning

confidence: 99%

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Fibrous epulis: A tumorlike gingival lesion

Ohta

Yoshimura

2021

CCJM

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Fibrous epulis: A tumorlike gingival lesionA 40-year-old woman presented with a 1-year history of an enlarging mass on the maxillary gingiva. The mass had been resected 4 years ago but had grown back. She said that she was otherwise in good health.Examination revealed a nodule-wellcircumscribed, smooth, elastic, hard, measuring 20 mm by 18 mm-on the left maxillary anterior gingiva (Figure 1). In addition, the left maxillary second incisor was hypermobile, with poor-quality dental restorations. Examination of the neck found no cervical lymphadenopathy.Computed tomography showed a welldemarcated, rim-enhanced soft-tissue mass in the left maxillary anterior gingiva with slight bone resorption at the left maxillary second incisor (Figure 2).Biopsy was performed, and histopathologic study revealed keratin ized epithelium overlying fi brous connective tissue with infi ltration of infl ammatory cells.Based on these fi ndings, we diagnosed recurrent fi brous epulis, resected the nodule, and extracted the loose tooth. At follow-up 20 months later there was no evidence of recurrence.

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Section: ■ Clinical Recognition and Diagnosismentioning

confidence: 99%

Section: Fibrous Epulismentioning

confidence: 99%

Fibrous epulis: A tumorlike gingival lesion

Ohta

Yoshimura

2021

CCJM

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“…The recurrence is generally attributed to incomplete surgical removal and/or failure to identify and eliminate the local and/or systemic irritant/etiological factor 12 . Fibrous epulis can be misdiagnosed for other periodontal lesions or gingival growths and benign tumors 13–16 . Costa et al in a recent systematic review described the diagnosis of gingival lesions as a dilemma and indicated that the patient's medical history is an important factor in determining the exact type of gingival lesions 17 .…”

Section: Introductionmentioning

confidence: 99%

“… 12 Fibrous epulis can be misdiagnosed for other periodontal lesions or gingival growths and benign tumors. 13 , 14 , 15 , 16 Costa et al in a recent systematic review described the diagnosis of gingival lesions as a dilemma and indicated that the patient's medical history is an important factor in determining the exact type of gingival lesions. 17 The management is complete surgical excision together with periodontal debridement and gingival recontouring as well as control of any local irritating factors to avoid recurrence.…”

Section: Introductionmentioning

confidence: 99%

Management of hormonal induced recurrent ulcerative fibrous epulis with osseous metaplasia: A case report

Bakr,

Al‐Ankily,

Khzam

2023

Clinical Case Reports

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Key Clinical MessageUnderstanding the role of hormones in periodontitis is important. Periodontal microscopic surgery approach in the treatment of fibrous epulis is not indicated. Wider flap access with root planning is indicated to control the lesion in one phase.AbstractWe present a case of a 40‐year‐old female who presented with a gingival hyperplastic lesion around the maxillary left permanent central and lateral incisors. Patient's medical history reveals a recent pregnancy, hypothyroidism, ulcerative colitis, and schizoaffective disorder. All medical conditions were controlled by medications. The lesion was excised using a minimally invasive periodontal surgical technique, and the biopsy results confirmed a diagnosis of ulcerative fibrous epulis with osseous metaplasia. No curettage or local debridement was done under the assumption that the patient's oral hygiene was satisfactory and due to aesthetic concerns of gingival recession and creation of black triangles. The lesion recurred after 3 months and was removed using a traditional more invasive surgical technique. The patient was followed up for 2 years, and there was no further recurrence due to the complete excision of the lesion in the second surgery and the disappearance of the hormonal‐related factors post‐pregnancy that could have contributed to the gingival hyperplasia. The unique component of the case we are presenting is the comparison between two different surgical techniques and the conduction versus absence of local periodontal debridement after surgical excision as well as the possible correlation between oral supplements and the calcific nature of the lesion(s) reported. The case we present demonstrates that a more invasive traditional surgical approach together with local periodontal therapy provide an optimum treatment outcome in conjunction with elimination of any associated etiological factors. We also propose that hormones are more important as an etiological factor in developing fibrous epulis lesions than medical conditions and medications.

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Modified coronally advanced flap technique in the treatment of fibrous epulis: A case report with 1‐year follow‐up

Zheng,

Zhang

2024

Clin Adv Periodontics

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BackgroundCurrently, the treatment of epulis is primarily surgical excision, which would greatly affect the aesthetics of patients if happened in the anterior region. It's challenging for clinicians to balance the aesthetic after surgery and less surgical trauma. To overcome this disadvantage, the authors propose the modified coronally advanced flap technique which applies the principles of minimally invasive surgery to provide satisfactory therapeutic results in fibrous epulis.MethodsWe report a case of an 18‐year‐old female with the chief complaint of a gingival swelling in the right upper anterior region. After the initial periodontal therapy, the modified surgical approach was applied to this patient. Unlike conventional coronally advanced flap technique, an additional incision was made, and the free portion was rotated into the adjacent space to completely cover the trauma, which avoided the use of the second operative zone.ResultsThe gingiva recovered with normal color, contour, and consistency after surgery, the papilla filled up the proximal space well and was in good harmony with the adjacent papillae. The surgical results remained stable during the follow‐up period.ConclusionsThe use of modified coronally advanced flap technique allows the clinician to successfully resume the natural appearance of gingiva in the treatment of fibrous epulis, as well as simplify the surgical approach, shorten the operative time, and demonstrate no tendency of recurrence.Key PointsWhy is this case new information? This novel technique not only removes the epulis, but also takes into account the postoperative aesthetics of the surgery at the same time. This minimally invasive surgical technique reduces operative time and increases patient comfort. Keys to successful management of this case are as follows: (i) Adequate preoperative assessment of the location of the additional incision; (ii) tension‐free coronal flap advancement.What are the primary limitations to success in this case? Clinical studies with long‐term outcomes of this approach are needed. This procedure may be limited to larger gingival tumors.

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Epulis - Commonly Misdiagnosed Entity: A Report of 2 Cases

Cited by 3 publications

References 0 publications

Fibrous epulis: A tumorlike gingival lesion

Fibrous epulis: A tumorlike gingival lesion

Management of hormonal induced recurrent ulcerative fibrous epulis with osseous metaplasia: A case report

Modified coronally advanced flap technique in the treatment of fibrous epulis: A case report with 1‐year follow‐up

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