Pdf here, we present a case report of peripheral ossifying fibroma pof in an adult lady in her fourth decade of life. 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. 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. 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. The term ossifying fibroma includes lesions with similar histological compositions and different forms of clinical behavior.
Peripheral ossifying broma occurs mostly in craniofacial bones and categorized into two types central and peripheral. The peripheral ossifying fibroma consists of disbursed segments of calcified material that is probably from the periodontal ligament or periosteum. Additionally, cemento ossifying fibroma may have areas of cementum, appearing as psammoma bodies embedded in a benign fibrous stroma. The sheer number of names used for fibroblastic gingival. 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. 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.
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. May become irritation fibroma pregnancy tumor may disappear after birth of baby 6. Peripheral ossifying fibroma pof is a reactive gingival overgrowth which is relatively uncommon in nature. Furthermore, the pof has a propensity to occur in the incisor cuspid area affecting maxilla more than the mandible. Peripheral ossifying fibroma europe pmc article europe. Multicentric peripheral ossifying fibroma request pdf. Intraoral ossifying fibromas have been described in the literature since the late 1940s.
Because of its overwhelming incidence on the gingiva, the condition is associated with two other diseases, pyogenic granuloma and peripheral ossifying fibroma. Peripheral ossifying fibroma pof is usually a fibroma of the gingival which shows areas of calcification or ossification. 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. Ossifying fibroma an overview sciencedirect topics. 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. 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. 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. Osteoid and calcified material varying from dystrophic calcification to spicules of lamellar bone may be found in.
It has been described with various synonyms and is believed to arise from the periodontal ligament comprising about 9% of all gingival growths. Such is the case with the peripheral ossifying fibroma. These three diseases are associated because they appear frequently on gingiva. Basically, ossifying fibromas may be divided into two types. 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 fibroma pof is a relatively uncommon, probably reactive gingival overgrowth. Though the etiology of pof remains unknown, some investigators consider it an inflammatory or reactive process, while others suggest it is a neoplastic process. There was considerable confusion in the terminology used in the literature until it was distinguished. He also suggested that the name peripheral ossifying fibroma should be retained for this lesion. Cemento ossifying fibroma is a benign fibroosseous maxillary tumor belonging to the same category as fibrous dysplasia and cement ossifying dysplasia. The peripheral ossifying fibroma pof is a relatively uncommon reactive lesion of the gingiva, associated with mineralization and. 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. Peripheral ossifying fibroma is one such reactive lesion which shows areas of calcification or ossification.
Pdf intraoral ossifying fibromas have been described in the literature since the late 1940s. A peripheral ossifying fibroma usually grows on a section of gum between two teeth. American journal of pharmacology and pharmacotherapeutics peripheral ossifying fibroma mimicking pyogenic granuloma a case report sivakumarashankari, gaurav, jayanthi k and kamala r dept. Peripheral cemento ossifying fibroma is a relatively rare tumour classified between fibroosseous lesions. Who classification of head and neck tumours, 4th edition, 2017 odontogenic fibroma. Case report fibrous epulis misdiagnosed for combined. Pofs consist of one or more mineralized tissues, including bone, cementumlike material, or dystrophic calcification within a matrix of cellular fibroblastic tissue. However, certain authors have stated that peripheral ossifying fibroma is a variant of central ossifying fibroma and, therefore, a neoplastic process.
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 occurs mostly in craniofacial bones and categorized into two types central and peripheral. The peripheral ossifying fibroma pof is a nonneoplastic reactive gingival overgrowth occurring frequently in the anterior maxilla region. Peripheral ossifying fibroma a clinical and histological. Clinically differentiating one from the other as a specific lesion is often difficult and requires histopathology examination. Pofs comprises of, one or more mineralized tissues, including bone, cementum like material or dystrophic calcification, within a matrix of cellular fibroblastic tissue 2. 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. Peripheral ossifying fibroma pof is one of the few reactive lesions of the gingiva which are clinically similar in presentation.
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. Its origin is still controversial, though periodontal ligament is considered to be. 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. 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. The size and appearance can vary, but typically the tumor is not very large. Peripheral ossifying fibroma pof is characterized by reactive gingival hyperplasia, and it is prevalent in adolescents, but rare in infants.
The peripheral ossifying fibroma pof is a reactive gingival overgrowth occurring frequently in the anterior maxilla. Peripheral ossifying fibroma pof is a reactive overgrowth occurring frequently in anterior maxilla originating from connective tissue or periodontal ligament. Case report peripheral ossifying fibroma after natal tooth. Peripheral ossifying fibroma is a gingival growth, usually arising from interdental papilla and occurring frequently in the anterior maxilla. Peripheral ossifying fibroma a case report international journal of. The etiology and the treatment modality is very different when compared to the pyogenic granuloma. Peripheral giantcell granuloma pgcg is an oral pathologic condition that appears in the mouth as an overgrowth of tissue due to irritation or trauma.
Females are more commonly affected than males, and the anterior maxilla is the most common site of occurrence. Commonly, the growth appears to have an open sore, or ulcer, on its surface. Peripheral ossifying fibroma is a rejuvenation of the reactive gingiva, usually occurring in the anterior maxillary gingiva. Peripheral ossifying fibroma pof represents a rare separate entity of reactive benign lesion of connective tissue origin, not being the soft. Microscopic findings confirmed the diagnosis of pof. Peripheral ossifying fibroma is thought to be either reactive or neoplastic in nature 2,3. Shipra arora et al treatment of peripheral ossifying. Peripheral cemento ossifying fibroma is a gingival lesion of reactive nature and unknown etiology. Menzel rst described the lesion ossifying broma in, but its terminology was given by montgomery in.
Pof typically presented as a solitary, slow growing nodular mass that is either pedunculated or sessile. Peripheral ossifying fibroma of the anterior maxillary. Peripheral ossifying fibroma pof is one such entity the confirmatory diagnosis of which is made by histopathological features. Peripheral ossifying fibroma pof is a focal reactive overgrowth occurring in young adults. The peripheral ossifying fibroma pof is a reactive gingival overgrowth occurring frequently in the anterior maxilla in teenagers and young adults. 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. 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. Peripheral ossifying fibroma pof is usually a fibroma. The present case report describes a 20 year old male, who visited the department of periodontology with the chief compliant of. What is peripheral ossifying fibroma peripheral ossifying fibroma is a benign swelling of the gum, most commonly seen in teenagers and young adults.
We report a case of a venezuelan female patient with a gigantic peripheral ossifying fibroma in the anterior mandibular region, sized 5. Lesions with histological features similar to pof have been given various. Jof originates from periodontal ligament and ranges 2% of oral tumours in children. Peripheral ossifying fibroma pof is a common solitary gingival growth thought to arise from the periodontal ligament. 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. The lesion occurs over a wide age range with females being affected more often than males. It originates in the cells of the periodontal ligament and is more common in children and young adults. Mostly it is seen as an asymptomatic swelling predominantly in female patients and is rarely encountered in postmenopausal years. The gingival is often the site of localized growths that are considered to be reactive rather than neoplastic in nature. It represents upto 2% of all lesions that are biopsied. A fibroma can be pink or red, with a rough or smooth surface, and it arises from a thin stalk or a wide base.
Peripheral ossifying fibroma is a relatively common gingival growth of reactive rather than neoplastic in nature. The concept of fibroosseous lesions of bone has evolved over the last several decades and now includes two major entities. They are firm, nodular, slow growing, spherical non neoplastic tumors. Peripheral odontogenic fibroma is more common than central odontogenic fibroma peripheral odontogenic fibroma. Peripheral ossifying fibroma a clinical report scielo. Histologically, peripheral ossifying fibroma demonstrates a proliferation of plump fibroblasts in a characteristic stroma of delicate, interlacing collagen fibrils. Other terms used to describe this lesion include peripheral ossifying fibroma, peripheral cementifying fibroma and calcified or ossified fibrous epulis. Many of these lesions are difficult to be identified as specific entity only on the basis of typical and consistent histomorphology. Peripheral ossifying fibroma represents a separate clinical entity rather than a transitional form of pyogenic granuloma, peripheral giant cell fibroma and irritational. Peripheral ossifying fibroma is such a gingival lesion with a high recurrence rate. It is almost impossible to distinguish between ossifying. It is derived from cells of the periodontal ligament and is usually classified as a reactive hyperplasia but sometimes as a benign neoplasm. Gigantic peripheral ossifying fibroma of the mandible.
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