American journal of pharmacology and pharmacotherapeutics peripheral ossifying fibroma mimicking pyogenic granuloma a case report sivakumarashankari, gaurav, jayanthi k and kamala r dept. It is derived from cells of the periodontal ligament and is usually classified as a reactive hyperplasia but sometimes as a benign neoplasm. The lesion occurs over a wide age range with females being affected more often than males. Peripheral ossifying fibroma pof is usually a fibroma. Menzel rst described the lesion ossifying broma in, but its terminology was given by montgomery in. A peripheral ossifying fibroma usually grows on a section of gum between two teeth. Many names have been given to similar lesions, such as epulis,1 peripheral fibroma with calcification,1 peripheral ossifying fibroma,2,3 calcifying fibroblastic granuloma,4 peripheral cementifying fibroma, peripheral fibroma with cementogenesis5. There was considerable confusion in the terminology used in the literature until it was distinguished. Osteoid and calcified material varying from dystrophic calcification to spicules of lamellar bone may be found in. Peripheral ossifying fibroma pof is a relatively uncommon, probably reactive gingival overgrowth.
The peripheral ossifying fibroma pof is a nonneoplastic reactive gingival overgrowth occurring frequently in the anterior maxilla region. Peripheral ossifying fibroma represents a separate clinical entity rather than a transitional form of pyogenic granuloma, peripheral giant cell fibroma and irritational. Lesions with histological features similar to pof have been given various. Cemento ossifying fibroma is a benign fibroosseous maxillary tumor belonging to the same category as fibrous dysplasia and cement ossifying dysplasia.
We report a case of a venezuelan female patient with a gigantic peripheral ossifying fibroma in the anterior mandibular region, sized 5. Peripheral ossifying fibroma, also known as ossifying fibrous epulis, is a gingival nodule which is composed of a cellular fibroblastic connective tissue stroma which is associated with the formation of randomly dispersed foci of mineralised products, which consists of bone, cementumlike tissue, or a dystrophic calcification. Peripheral ossifying fibroma pof has been cited in the literature under various names such as cemento ossifying fibroma, peripheral fibroma with osteogenesis, peripheral odontogenic fibroma, calcifying fibroblastic. Peripheral ossifying fibroma pof is one of the few reactive lesions of the gingiva which are clinically similar in presentation. Mostly it is seen as an asymptomatic swelling predominantly in female patients and is rarely encountered in postmenopausal years.
These three diseases are associated because they appear frequently on gingiva. The gingival is often the site of localized growths that are considered to be reactive rather than neoplastic in nature. Histologically, peripheral ossifying fibroma demonstrates a proliferation of plump fibroblasts in a characteristic stroma of delicate, interlacing collagen fibrils. Peripheral giantcell granuloma pgcg is an oral pathologic condition that appears in the mouth as an overgrowth of tissue due to irritation or trauma.
Here, we present a case involving a 1dayold boy with pof, diagnosed after the analysis of a soft tissue mass with a calcified structure that was found after the extraction of a natal tooth, and. Peripheral ossifying fibroma is such a gingival lesion with a high recurrence rate. Peripheral ossifying fibroma is thought to be either reactive or neoplastic in nature 2,3. It originates in the cells of the periodontal ligament and is more common in children and young adults. Case report fibrous epulis misdiagnosed for combined periodonticendodontic lesion khzam 1n, shah mansouri r2, poli a3, bakr mm4 abstract fibrous epulis or peripheral ossifying fibroma is a reactive nonneoplastic condition that affects the gingiva as a result of chronic irritation. In the current article a case of gingival over growth, which was thought to be pubertyinduced gingivitis was seen in the lower anterior maxillary gingiva.
Peripheral ossifying fibroma a gingival nodule which is composed of a cellular fibroblastic connective tissue stroma which is associated with the formation of randomly dispersed foci of mineralised products, which consists of bone, cementumlike tissue, or a dystrophic calcification. Multicentric peripheral ossifying fibroma request pdf. Peripheral ossifying fibroma is an inflammatory growth of the gums developing in response to plaque and other associated local factors favoring plaque accumulation and originating from the cells. However, certain authors have stated that peripheral ossifying fibroma is a variant of central ossifying fibroma and, therefore, a neoplastic process. Peripheral ossifying fibroma a case report international journal of. May become irritation fibroma pregnancy tumor may disappear after birth of baby 6. It is almost impossible to distinguish between ossifying.
Case report peripheral ossifying fibroma after natal tooth. The present case report describes a 20 year old male, who visited the department of periodontology with the chief compliant of. The etiology and the treatment modality is very different when compared to the pyogenic granuloma. Peripheral cemento ossifying fibroma is a gingival lesion of reactive nature and unknown etiology. Juvenile ossifying fibroma jof appears at an early age and in 79% of the patients are diagnosed before the age of 15 2,3,10. Peripheral ossifying fibroma pof is usually a fibroma of the gingival which shows areas of calcification or ossification. Commonly, the growth appears to have an open sore, or ulcer, on its surface. Its origin is still controversial, though periodontal ligament is considered to be. Pofs consist of one or more mineralized tissues, including bone, cementumlike material, or dystrophic calcification within a matrix of cellular fibroblastic tissue. It represents upto 2% of all lesions that are biopsied. Peripheral ossifying fibroma pof exclusively found on the gingiva and may be presented with randomly distributed calcifications, immature bone, separation of teeth and bone resorption. Additionally, cemento ossifying fibroma may have areas of cementum, appearing as psammoma bodies embedded in a benign fibrous stroma. They are firm, nodular, slow growing, spherical non neoplastic tumors.
Pof typically presented as a solitary, slow growing nodular mass that is either pedunculated or sessile. Many of these lesions are difficult to be identified as specific entity only on the basis of typical and consistent histomorphology. Peripheral ossifying fibroma pof is characterized by reactive gingival hyperplasia, and it is prevalent in adolescents, but rare in infants. Peripheral ossifying fibroma a clinical report scielo. Peripheral ossifying fibroma is a gingival growth, usually arising from interdental papilla and occurring frequently in the anterior maxilla. The peripheral ossifying fibroma consists of disbursed segments of calcified material that is probably from the periodontal ligament or periosteum. Peripheral ossifying fibroma of the anterior maxillary.
Females are more commonly affected than males, and the anterior maxilla is the most common site of occurrence. The peripheral ossifying fibroma pof is a reactive gingival overgrowth occurring frequently in the anterior maxilla. The peripheral ossifying fibroma pof is a relatively uncommon reactive lesion of the gingiva, associated with mineralization and. This lesion tends to occur in the second to fourth decades of life, commonly found in females than in males, and has a predilection for mandible than maxilla. He also suggested that the name peripheral ossifying fibroma should be retained for this lesion. Considerable confusion has prevailed in the nomenclature of peripheral ossifying fibroma with various synonyms being used, such as peripheral cementifying fibroma, ossifying fibroepithelial polyp, peripheral fibroma with osteogenesis. A fibroma can be pink or red, with a rough or smooth surface, and it arises from a thin stalk or a wide base.
Gigantic peripheral ossifying fibroma of the mandible. The size and appearance can vary, but typically the tumor is not very large. Pofs comprises of, one or more mineralized tissues, including bone, cementum like material or dystrophic calcification, within a matrix of cellular fibroblastic tissue 2. Shipra arora et al treatment of peripheral ossifying. Peripheral ossifying fibroma a clinical and histological. Intraoral ossifying fibromas have been described in the literature since the late 1940s. The concept of fibroosseous lesions of bone has evolved over the last several decades and now includes two major entities. Peripheral ossifying fibroma pof is a reactive overgrowth occurring frequently in anterior maxilla originating from connective tissue or periodontal ligament. Such is the case with the peripheral ossifying fibroma. The condition is often clinically ambiguous when diagnosed on the basis of gingival hyperplastic lesions such as focal fibrous hyperplasia, peripheral giant cell granuloma, peripheral fibroma and pyogenic granuloma because peripheral ossifying fibroma has a. Peripheral ossifying fibroma europe pmc article europe. Peripheral ossifying fibroma pof is a focal, reactive, nonneoplastic tumorlike growth of the soft tissue occurring frequently in the maxillary anterior region, mainly affects females, predominating in the second decade of life. Peripheral ossifying fibroma pof is one such entity the confirmatory diagnosis of which is made by histopathological features. Furthermore, the pof has a propensity to occur in the incisor cuspid area affecting maxilla more than the mandible.
Peripheral odontogenic fibroma is more common than central odontogenic fibroma peripheral odontogenic fibroma. Pdf intraoral ossifying fibromas have been described in the literature since the late 1940s. The varying clinical presentations of peripheral ossifying fibroma. The peripheral ossifying fibroma pof is a reactive gingival overgrowth occurring frequently in the anterior maxilla in teenagers and young adults. Peripheral cemento ossifying fibroma is a relatively rare tumour classified between fibroosseous lesions. Though clinically similar to pg, it is important to differentiate the lesions based on the histopathological findings that facilitate the management of the lesion, which is diverse in nature when compared to pg. Case report fibrous epulis misdiagnosed for combined. Many names have been given to similar lesions, such as epulis, peripheral fibroma with calcification, peripheral ossifying fibroma, calcifying fibroblastic granuloma, peripheral cementifying fibroma, and peripheral fibroma with cementogenesis. Peripheral ossifying fibroma occurs mostly in craniofacial bones and categorized into two types central and peripheral. Clinically differentiating one from the other as a specific lesion is often difficult and requires histopathology examination. Ossifying fibroma an overview sciencedirect topics. Peripheral ossifying fibroma pof is a reactive gingival overgrowth which is relatively uncommon in nature. Peripheral ossifying fibroma is a rejuvenation of the reactive gingiva, usually occurring in the anterior maxillary gingiva. The term ossifying fibroma includes lesions with similar histological compositions and different forms of clinical behavior.
Peripheral ossifying fibroma pof is a common solitary gingival growth thought to arise from the periodontal ligament. It has been described with various synonyms and is believed to arise from the periodontal ligament comprising about 9% of all gingival growths. Central ossifying fibroma cof is a benign fibroosseous lesion that demonstrates a welldemarcated proliferation of cellular fibrous tissue with osseous products that include bone and cementumlike material. Peripheral ossifying fibroma is one such reactive lesion which shows areas of calcification or ossification. Who classification of head and neck tumours, 4th edition, 2017 odontogenic fibroma. Ossifying fibromas are benign asymptomatic neoplasms of the maxillae that generally have slow growth and present proliferation of fibrous cell tissue, with a varying quantity of bone products that include bone, cement or a combination of these. What is peripheral ossifying fibroma peripheral ossifying fibroma is a benign swelling of the gum, most commonly seen in teenagers and young adults. Microscopic findings confirmed the diagnosis of pof. The sheer number of names used for fibroblastic gingival. Such a lesion can either interfere with normal tooth eruption or become a factor in plaque development, which usually results in caries formation in newly erupted teeth. Though the etiology of pof remains unknown, some investigators consider it an inflammatory or reactive process, while others suggest it is a neoplastic process. Peripheral ossifying fibroma pof is a focal reactive overgrowth occurring in young adults.
Peripheral ossifying fibroma is a relatively common gingival growth of reactive rather than neoplastic in nature. Because of its overwhelming incidence on the gingiva, the condition is associated with two other diseases, pyogenic granuloma and peripheral ossifying fibroma. Jof originates from periodontal ligament and ranges 2% of oral tumours in children. Pdf here, we present a case report of peripheral ossifying fibroma pof in an adult lady in her fourth decade of life. The central type of ossifying fibroma arises from the endosteum or the periodontal ligament pdl adjacent to the root apex and expands from the medullary cavity of the bone, and the peripheral type occurs on the soft tissues. Basically, ossifying fibromas may be divided into two types. Other terms used to describe this lesion include peripheral ossifying fibroma, peripheral cementifying fibroma and calcified or ossified fibrous epulis. American journal of pharmacology and pharmacotherapeutics. Peripheral ossifying fibroma pof represents a rare separate entity of reactive benign lesion of connective tissue origin, not being the soft. Conservative surgical excision for pregnancy tumor, wait until after birth, if possible may recur if original cause infection, trauma is not removed peripheral ossifying fibroma peripheral cementifying ossifying fibroma. Peripheral ossifying broma occurs mostly in craniofacial bones and categorized into two types central and peripheral.
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