clinical management of gingival enlargement
TRANSCRIPT
Your Diagnosis Is Not The End But The Beginning Of Practise.
CLINICAL MANAGEMENT OF GINGIVAL
ENLARGEMENT
DR. DEEPA PHILIPSUNDER THE GUIDANCE OF
DR. NYMPHEA PANDITDR. SHALINI GUGNANI, DR. DEEPIKA BALI.
DEPT OF PERIODONTICS, D.A.V DENTAL COLLEGE,YAMUNANAGAR
DEFINITION
Increase in size of the gingiva. Overexuberant response to avariety of local and systemicconditions.
EPULIS•Fibroma
•Pyogenic granuloma•Peripheral giant cell
granuloma•Peripheral ossifying
fibromaMETASTATIC
LESIONS
•DRUG INDUCED HYPERPLASIA
•LEUKEMIC INFILTRATE
•IDIOPATHIC ENLARGEMENT
MAKING A DIFFERENTIAL DIAGNOSIS
SOFT AND EDEMATOUS FIBROUS
SCALING AND
ROOT PLANING
SHRINKAGESURGERY
FLAP SURGERYGINGIVECTOMYMAINTENANCE
• NO CLINICAL ATTACHMENT LOSS• NO BONE LOSS
• ABUNDANT KERATINISED TISSUE
• OSSEOUS DEFECTS • LIMITED KERATINISED
TISSUE
GINGIVECTOMY FLAP SURGERY
MAINTENANCE PHASE
A CASE REPORT• Chief complaint of
swollen gums and bleeding from gums.
• Slow and progressively increasing in size .
• History excluded any epilepsy, physical or mental disorder.
• ON EXAMINATION the enlargement was present on the left side involving maxilla and mandible which did not cross midline.
• The gingiva was pale pink, firm and of fibrous consistency and gave a pebbled appearance.
• It was pink in colour with a tendency to bleed and didn’t extend beyond the MGJ
• Grade III mobility present in relation to # 26 # 27.
INVESTIGATIONS DONE.
• History to exclude drug intake.• Complete blood profile done to
exclude any malignancy.• Histopathology of the excised tissue.
GENERALISED DIFFUSE IDIOPATHIC
ENLARGEMENT
IDIOPATHIC ENLARGEMENT
• Etiology not known• Inheritance shows autosomal
dominant trait in many cases.• Begins before the age of 20 and is
correlate with the eruption of decidous and permanent teeth.
• Presence of teeth thought to be the “ INITIATING FACTOR”
SURGICAL EXCISION
AFTER HEALING
Pre operativePre operative Post operative
EXCISED TISSUE
HISTOPATHOLOGY
• Tissue showed dense fibrocollagenous tissue infiltrated with intense acute and chronic inflammatory cells.
• Foci of necrosis and calcification also seen.
• Overlying epithelium showed thin elongated rete pegs extending into the fibrocollagenous tissue.
HISTOPATHOLOGY
LASER GINGIVECTOMY• Remarkable cutting ability.• Generates a coagulated tissue layer.• Greater accuracy in making incisions.• Minimal swelling and scarring.• Haemostasis.• Anticoagulant therapy patients.
ELECTROSURGERY• Produces haemostasis.• Thermal necrosis of surrounding zone due to
production of latent heat.
CONCLUSION
• Gingival enlargement may come to attention as a presenting complaint or an incidental finding.
• Its association with systemic diseases demands a diagnostic work up in a logical step wise approach.
• Cases of chronic inflammatory enlargement can just be treated by exquisite dental hygiene.
• When it is medication related discontinuation or substituition is the gold standard.
• Idiopathic enlargement which persists despite aggressive oral hygiene needs to be considered for surgical reduction.
• THIS SHOULD BE CONSIDERED AS A LAST LINE MEASURE.
Making a correct diagnosis is the first step in treating a case successfully……
THANK YOU……