Giant Peripheral Ossifying Fibroma Treated With Piezosurgery and Platelet‐Rich Fibrin: A Rare Case Report

Abstract

Introduction The peripheral ossifying fibroma (POF) is a benign reactive lesion that exclusively arises from gingiva. The lesion may gain considerably large sizes and present peculiar clinical and radiographic features that would then allow it to be called a giant POF; in that case, its otherwise simple surgical extraction could create a challenge. Thus, we elect here, for the very first time, a plausible alternative for treating giant POF: piezosurgery followed by placement of platelet‐rich fibrin (PRF). Case Presentation A 31‐year‐old black male presented a large asymptomatic nodule on the lower gingiva; the lesion had caused vestibular displacement of teeth and had been present for 18 years. Following the diagnostic hypothesis of a giant POF, an excisional biopsy was performed under local anesthesia using piezosurgery (microvibration of 36,000 times/sec was used in a bone cortical working mode), which confirmed the diagnosis. The surgical procedure was facilitated with the use of piezosurgery followed by placement of PRF, being the trans‐ and postoperative periods occurred with no complications. One year after the treatment, the patient shows no signs of disease recurrence and remains under follow‐up. Conclusions Giant POF is a rare gingival reactive lesion that can reach large dimensions, causing teeth displacement, functional, and esthetic impairments. The lesion can be successfully managed with piezosurgery and PRF, as illustrated herein, avoiding extensive bone loss and damage to the surrounding soft tissues.

Peripheral ossifying fibroma: A 20-year retrospective study with focus on clinical and morphological features

“…Several surgical approaches such as subepithelial connective tissue graft, free gingival autograft, enamel matrix derivatives, guided tissue regeneration, and coronally advanced flaps can be used to try to augment the excised tissue ( 27 ). Other treatment modalities include the use of Nd:YAG laser or removal of the lesion with piezosurgery ( 27 , 28 ). The literature reports recurrence rates to range from 8% to 20% ( 4 ).…”

Preserving periodontal tissue in the treatment of a large peripheral ossifying fibroma: a case study

“…Most lesions are less than 2 cm, although larger ones sometimes occur. Large, atypical dimensions can cause facial asymmetry and tooth displacement without root resorption, not generally seen in conventional lesions [ 12 ]. In addition to speech, chewing, swallowing and aesthetics, the size of the lesion can also affect mouth closure [ 13 ], as can be seen in our case.…”

“…This approach has been a standard method and is typically carried out using scalpels and curettes. Cases have also been reported where diode laser or piezosurgery have been used to treat POF [ 11 , 12 , 14 ]. In the presented case, the mass was excised with the classical method using 15c and microsurgical scalpels and thin blunt-tipped elevators to avoid tearing of the fragile gingiva.…”

Giant peripheral ossifying fibroma with coincidental squamous cell carcinoma: a case report

“…Giant POFs have several common clinical features, including large, atypical dimensions that may cause facial asymmetry and teeth displacement with no root resorption. Ectopic eruption, migration, and separation of teeth have been reported, as well as bone destruction [ 8 , 24 – 26 ]. In our case, bone destruction was seen, although the patient was edentulous.…”