08 January 2019

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Gingival swelling adjacent to the dental elements roots: a clinical case

Marco Berardini

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A male patient of 43 years comes to our observation, complaining about the presence of a roundish gingival excretion in the anterior area of ​​the upper jaw. The patient reports that he has already noticed the lesion for a long time (a few years) and that he has not visited a specialist examination due to negligence and a subsequent depressive symptomatology. He also reports that he has noticed a slow but progressive increase in the size of the lesion in question.

On intra-oral examination, the lesion appears as a swelling of diminutive consistency, of a pinkish color uniform, well bounded by surrounding healthy tissues and associated with elements 1.2 and 1.3 (figure 1). The size is about 1 cm and there are no signs of ulceration or purulent exudation. The intra-oral radiographic examination (fig. 2) also allows to exclude any involvement of the underlying hard tissues and, together with the clinical features, allows us to presume the absolute benignity of the lesion.

Obtained informed consent of the patient to treatment and given the clinical characteristics of presumed benignity (net margins, no bone involvement, soft consistency, uniform color, absence of ulceration and / or necrosis, clear delimitation with circus tissues - standing), we proceed with the total excision of the lesion with perilesional margins of 1 mm. The roots of the associated dental elements (1.2 and 1.3) are carefully cleaned and smoothed in order to remove the parodontal ligament cells which are likely to be at the origin of the lesion. The biopsy sample is immediately immersed in 4% formalin and sent to the laboratory for histological analysis (fig. 3). The periosteum around the area subject to removal is subdued with the blade of the scalpel in order to be able to pull the flap and avoid leaving the exposed bone tissue (fig. 4). The pathologist detects the presence of multinucleated giant cells distributed in an edematous and mucucinose stroma containing blood vessels and fibroblasts.

Based on the histological examination, a gigantocellular epulis is diagnosed. The etiology includes an irritative-inflammatory noxa that stimulates the abnormal proliferation (benign) of the cells of the periodontal bond. For complete recovery, treatment includes simple excision and removal of all local irritants. 

For additional information: 
Dental Cadmos n° 2/17 - https://doi.org/10.19256/d.cadmos.02.2017.04