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Gingival fenestration is a relatively uncommon soft tissue lesion in which the root apex is exposed in the oral environment after the destruction of the overlying buccal bone plate and mucosa. At present, no clear etiology or treatment guidelines exist for gingival fenestration. This article reports three successfully treated cases of gingival fenestration associated with chronic periapical infection and can help contribute to treatment guidelines for gingival fenestration. All cases were treated with apicoectomy in conjunction with a connective tissue graft (CTG), and the first steps of each case were as follows: endodontic therapy with root-end resection and retrograde filling, then regenerative surgical therapy. However, slightly different regenerative treatment methods were used during the operation according to the different patient conditions. In Case 1, gingival fenestration in the mandibular left first premolar was treated using a xenograft and CTG. In Case 2, gingival fenestration in the maxillary left lateral incisor was treated using advanced platelet-rich fibrin (A-PRF) and CTG. In Case 3, gingival fenestration in the mandibular left second premolar was treated using CTG. Endodontic treatment was combined with periodontal surgery to achieve predictable results. After 13 to 25 months of follow-up, all cases showed well-healed gingival fenestrations and no discomfort. These three cases show the possibility of using apical excision combined with a CTG and/or bone graft/A-PRF in the treatment of gingival fenestration. Reporting these three cases may help advance the field of gingival fenestration treatment.

Diode lasers are one of the most widely used modalities in soft tissue dental surgery. Recent advancements have expanded the clinically useful emission spectrum of diode lasers to include the blue light region, corresponding to wavelengths such as 445 and 450 nm. The melanin present in hyperpigmented gingiva acts as a chromophore and absorbs laser energy, thus facilitating the denaturing of melanin-containing cells in the gingiva. This paper presents a case of ethnicity-related gingival hyperpigmentation that was successfully treated using a 445 nm blue wavelength soft tissue diode laser by non-ablative technique. The treated area showed no recurrence of pigmentation up to 9 months postoperatively., Competing Interests: Competing interests: None declared., (© BMJ Publishing Group Limited 2024. No commercial re-use. See rights and permissions. Published by BMJ.)

Background: Subcutaneous emphysema related to dental procedures is well documented in literature. It usually occurs during or within minutes to hours after dental treatment and can be easily diagnosed by the presence of crepitus on palpation. Although it is self-limiting, it can develop to potentially life-threatening complications., Case Presentation: To the authors knowledge, this is the first report documenting the development of subcutaneous emphysema in a 22-year-old Egyptian female during lower surgical gingival depigmentation using NSK high speed, air driven handpiece operated at 0.25 MPa. Sudden swelling developed involving the right side of the face and immediate diagnosis of subcutaneous emphysema was made on the basis of the presence of crepitus during palpation of the swollen area. Intraoral examination revealed small tissue laceration of the loosely attached alveolar mucosa through which the pressurized air might have passed into the fascial spaces. Complete resolution of the swelling occurred after 7 days without further complications., Conclusion: Straightforward surgical procedures, such as gingival depigmentation, can be complicated by the development of subcutaneous emphysema. The crucial role of dentists is to be aware of its signs and to immediately diagnose and manage it to avoid further complication., (© 2024. The Author(s).)

Background: Pyogenic granulomas (PGs) are gingival enlargements which cause esthetic and functional problems that hinder chewing and maintaining oral hygiene. In this series consisting of six cases, we report the rehabilitation of PG using partly de-epithelialized gingival grafts., Methods: Following documentation of clinical measurements, a concurrent treatment plan of excision and reconstruction with partly de-epithelialized gingival grafts were followed for all the cases. Six months following procedures, clinical parameters were measured again and a short patient-reported outcome measures consisting of three questions were applied., Results: In histological evaluations, PG features were observed. In the fourth postoperative week, interdental papilla and attached gingiva were restored. Six months follow-up showed reduction in plaque and gingival indices, clinical attachment loss, and mobility. Mean keratinized tissue height was increased from 2.58 ± 2.20 to 6.66 ± 1.66 in the 6th month of operation. Oldest case was stable after 12 months of follow-up and no infection was found at grafting sites. Papillary coverage was achieved., Conclusion: If the PG is not completely removed due to esthetic reservations, a recurrence may occur. Within our limitations, we can suggest that the immediate esthetic rehabilitation with partly de-epithelialized gingival graft presents a compatible approach in the treatment of mucogingival defects after aggressive excision of PG., (© 2023 American Academy of Periodontology.)

Background: The ceramic soft tissue trimming bur (CeraTip™) was initially introduced for use in gingivoplasty but has recently been used for gingival depigmentation. The aim of this study is to compare the efficacy of depigmentation between the novel CeraTip™ and the gold-standard surgical scalpel technique., Methods: Eight healthy, nonsmokers with moderate to severe gingival hyperpigmentation in both arches were randomly assigned for CeraTip™ depigmentation in one arch as the test group (TG) and scalpel depigmentation in the opposite arch as the control group (CG). Pigmentation indices were used to assess clinical performance. Treatment time, pain level, and esthetic satisfaction were the parameters of patient experience. The assessments were performed at baseline, one week, one month, and three months., Results: At all assessment visits, pigmentation intensity represented by the Dummet oral pigmentation index (DOPI), and pigmentation distribution represented by the Hedin melanin index (MI), were significantly lower than those at baseline (p < 0.001) in both groups. When comparing the two groups, Scalpel depigmentation had better initial clinical outcomes, while CeraTip™ had less visible repigmentation, pain scores, treatment time, and greater esthetic satisfaction. However, none of the differences were statistically significant., Conclusion: Both techniques successfully removed gingival hyperpigmentation with comparable clinical performance. The patients preferred CeraTip™ depigmentation., Trial Registration: The study protocol was registered on 11/09/2023 on the www., Clinicaltrials: gov database (NCT06031116) after the approval of the Ethics Committee, Faculty of Dentistry, Ain Shams University (FDASU-Rec012124)., (© 2024. The Author(s).)

This report describes a case of generalized chronic periodontitis requiring periodontal regenerative therapy. The patient was a 56-year-old woman visiting the Tokyo Dental College Suidobashi Hospital with the chief complaint of swelling in the maxillary right gingiva. An initial examination revealed 34.0% of sites with a probing depth (PD) of ≥4 mm. The prevalence of sites with bleeding on probing was 32.7%. The plaque control record (PCR) score was 65.7%. Radiographic examination revealed angular bone resorption at #18 and 48. Horizontal absorption was also observed in other areas. The percent bone loss/age at #48 was 1.07. A clinical diagnosis of generalized chronic periodontitis (Stage III, Grade C) was made. Based on the clinical diagnosis of severe chronic periodontitis, initial periodontal therapy was performed. An improvement was observed in periodontal conditions at re-evaluation. The PCR score was 16.7%. Periodontal surgery was performed for teeth with a residual PD of ≥4 mm. Periodontal regenerative therapy using rhFGF-2 were performed on intrabony defects in #18 and 48. Open flap debridement was performed on #16, 26, and 27. Following evaluation, oral function was restored using all-ceramic crowns (#46). At 6 months postoperatively, the patient was transitioned to supportive periodontal therapy (SPT). During the 6-month SPT, stable periodontal conditions that facilitated a favourable level of plaque control were maintained.

This report describes a case of Stage III Grade C periodontitis requiring periodontal regenerative therapy. The patient was a 19-year-old woman who presented with the chief complaint of gingival recession in the incisor region. An initial examination revealed that 45.3% of sites had a probing depth of ≥4 mm and 45.8% bleeding on probing. Radiographic examination showed angular bone resorption in #25, 26, 31, 36, and 46 and horizontal resorption in other regions. Initial periodontal therapy was implemented based on a clinical diagnosis of Stage III Grade C periodontitis (generalized aggressive periodontitis). Occlusal adjustment was also performed at sites showing premature contact (#26 and 36) after suppression of inflammation. Periodontal regenerative therapy using recombinant human fibroblast growth factor (rhFGF) -2 was performed on #25, 26, and 46. Combination therapy with rhFGF-2 and deproteinized bovine bone mineral (DBBM) was performed on #31 and 36. A non-incised papillae surgical approach (NIPSA) was used on #31. Periodontal conditions were then re-evaluated and the patient placed on supportive periodontal therapy. Regenerative therapy using rhFGF-2 and DBBM with NIPSA yielded an improvement in clinical parameters and bone resorption. This improvement has been adequately maintained over a 12-month period. Continued care is needed to maintain stable periodontal conditions.

Background: Physiologic gingival hyperpigmentation is a common esthetic concern that affects individuals of various ethnicities, and can have a significant impact on individual's self-confidence and overall quality of life. Thus, this study aimed to clinically assess the effectiveness of intra-mucosal injection of vitamin C versus 980 nm diode laser for the management of physiologic gingival hyperpigmentation., Methods: Twenty-six healthy non-smoker individuals with physiologic gingival hyperpigmentation were randomly assigned to two groups. Group I received intra-mucosal injection of vitamin C (L-Ascorbic acid 1000 mg/5 ml), and group II was managed using diode laser (980 nm, 1.5 W, continuous wave mode). Clinical evaluation of pigmentation intensity and distribution was performed preoperatively, and at 1, 2 and 3 months postoperatively using two different color assessment indices; Dummett-Gupta Oral Pigmentation Index (DOPI), and Gingival Pigmentation Index (GPI). Additionally, the study assessed pain intensity and patients' satisfaction., Results: Pigmentation scores decreased significantly between pre-operative visit and different follow-up visits for both treatment modalities (p < 0.0001*). When compared to the vitamin C mesotherapy group, the laser group demonstrated significantly lower gingival pigmentation scores (p < 0.0001*). However, both treatment modalities were equally satisfying for the patients., Conclusions: Vitamin C mesotherapy and diode laser are both effective in the management of physiologic gingival hyperpigmentation. While diode laser yields better and earlier results, vitamin C mesotherapy offers a cost-effective, safe and minimally invasive approach that is equally satisfying for the patients seeking esthetic enhancements., Trial Registration: The study was registered on ClinicalTrials.gov (NCT05608057) on (01/11/2022)., (© 2023. The Author(s).)

This report describes a case of periodontitis treated with periodontal surgery including guided tissue regeneration (GTR) and recombinant human fibroblast growth factor (rhFGF)-2. The patient was a 54-year-old woman who visited the Tokyo Dental College Suidobashi Hospital with the chief complaint of swelling in the maxillary right gingiva. An initial examination revealed 30.4% of sites with a probing depth (PD) of ≥4 mm. The prevalence of sites with bleeding on probing was 57.7%. The plaque control record (PCR) score was 66.1%. Radiographic examination revealed vertical bone defects in the molar region. Based on these findings, the clinical diagnosis was generalized chronic periodontitis (Stage III, Grade C). Initial periodontal therapy yielded an improvement in periodontal conditions, with the PCR score reducing to 13.8%. Periodontal surgery was performed for teeth with a residual PD ≥4 mm. Guided tissue regeneration was performed on #37 and 47. A series of periodontal regenerative treatments comprising application of rhFGF-2 was performed on angular bone defects in #14, 15, 25, and 27. Open flap debridement was performed on #16, 17, 26, 36, and 46. Following evaluation, oral function was restored by placing all-ceramic crowns on #21 and 26. The patient was then placed on supportive periodontal therapy. In the present case of generalized chronic periodontitis, periodontal regenerative therapy with GTR and rhFGF-2 yielded stable periodontal conditions.

Background: The association between clinicopathologic characteristics and the relapse of fibrous gingival hyperplasia is unknown., Methods: The records of 211 consecutive patients with a clinicopathologic diagnosis of fibrous gingival hyperplasia were retrieved. Patients who experienced relapse after surgical excision of the lesion were considered case patients (n = 30). All control patients were informed that there was no recurrence (n = 181). Logistic regression was used to evaluate the associations among different characteristics and the recurrence. Stratified analyses on sex was applied to identify the different associations., Results: Binary logistic regression showed that patients with ulcer (odds ratio [OR], 3.23; 95% CI, 1.18 to 8.83) or mechanical stimulation (OR, 2.42; 95% CI, 1.03 to 5.68) had a higher risk of experiencing recurrence. Stratified analysis of sex identified significant association in females (ulcer: OR, 4.04; 95% CI, 1.14 to 14.34; mechanical stimulation: OR, 3.30; 95% CI, 1.15 to 9.42). No significant difference was observed in males (ulcer: OR, 2.44; 95% CI, 0.40 to 15.06; mechanical stimulation: OR, 1.62; 95% CI, 0.28 to 9.40). Male patients with larger epulides had fewer recurrence (OR, 0.13; 95% CI, 0.02 to 0.74). There was no significant difference in pathologic calcification between case and control patients (P > .05)., Conclusions: Patients with ulcer and mechanical stimulation may have a high risk of experiencing recurrent epulis., Practical Implications: More attention should be paid to patients with ulcer and mechanical stimulation. Apart from complete surgical removal, it is important to remove local stimulation to prevent recurrence of these lesions., (Copyright © 2022 American Dental Association. Published by Elsevier Inc. All rights reserved.)

Purpose: This article describes a novel, minimally invasive procedure called Er:YAG laser micro-keyhole surgery (EL-MIKS) that removes metal or amalgam tattoos in the gingiva adjacent to prosthetic teeth without gingival deformity and recession. We aimed to evaluate the clinical efficacy of EL-MIKS for removing metal tattoos and present its long-term treatment outcomes., Methods: The EL-MIKS procedure consists of several steps that are all performed under a microscope. First, a micro-keyhole (1-2 mm diameter) was prepared using an Er:YAG laser in the center of the metal pigmentation. The connective tissue was evaporated in the deep layer, where metal debris was deposited. Second, within the accessible range, the irradiation angle was changed in various directions to ablate the metal pieces and discolored connective tissue without enlarging the keyhole. Finally, after blood filled the space created by the tissue evaporation, the surface of the blood clot at the entrance of the micro-keyhole was thermally coagulated with defocus laser irradiation. Pigmentation that could not be successfully removed from a single micro-keyhole was treated by forming new micro-keyholes at a distance of 3 mm or more from each previously created hole. Depigmentation over an extended area was completed over a few sessions every 4 weeks without gingival recession after surgery., Conclusion: EL-MIKS, a novel depigmentation technique, was able to successfully remove an extended area of metal tattoos in the gingiva using a simpler, easier, and less invasive procedure than conventional periodontal plastic surgery. Esthetic restoration was successfully achieved without postoperative alteration of the gingival contour.

Background: Gingival hyper-pigmentation is an esthetics problem in patients with excessive gingival display. Laser ablation has been suggested recently as the most effective, pleasant, and reliable technique for gingival depigmentation compared to blade surgery., Aim: The present study aimed to identify and compare the effectiveness of two types of lasers, Er:YAG laser-2940 nm and Diode laser-980 nm, in gingival depigmentation in the maxilla and mandible., Patients/methods: 20 participants, 16 males, and 4 females, whose ages ranged between 18 and 35 years, were recruited using simplified random sampling. Oral pigmentation was measured at pre- and two postoperative follow-ups, 1 month, and 6 months, according to the oral pigmentation index. Furthermore, the study assessed postoperative intensity of pain using the Visual Analogue Scale, bleeding and healing process in both groups., Results: There was a significant decrease in the oral pigmentation index scores, 1 month (0.90 ± 0.64) and 6 months (1.55 ± 0.60) after the operation (P < .001). No significant differences were detected between the two study groups regarding the mean ranking on the oral pigmentation index pre-operatively (P = .547), 1 month after the operation (P = .154), and 6 months after the operation (P = .831)., Conclusions: The Er:YAG laser and Diode laser both significantly reduced gingival pigmentation with no significant differences between the effectiveness of the two types of laser in treating gingival hyper-pigmentation., (© 2020 Wiley Periodicals LLC.)

Purpose: Pigmentation of gingiva is an aesthetic problem. Until now, various methods have been introduced for removal of gingival pigmentation. The purpose of this study was to compare bur abrasion and CO2 laser methods in removing gingival pigmentation., Materials and Methods: Twelve patients aged 20-40 years old with the chief complaint of physiologic gingival pigmentation participated in this study. For these patients, gingival depigmentation was performed using two treatment modalities including bur abrasion and CO2 laser in a split-mouth design. Gingival depigmentation was performed in the right half of the anterior maxillary and mandibular sextants using bur abrasion method by means of diamond bur on a high-speed headpiece with vigorous water irrigation and the left half of the anterior maxillary and mandibular sextants using a CO2 laser. CO2 laser was set at: peak power 252 watts, repeat time 20 ms and pulse duration 200 microsecond which was used in a non-contact position. The area of pigmentation was calculated via gridlines in the Microsoft Paint software 1 and 6 months after the procedure. Gingival recession was also determined before, and at 1 and 6 months after the procedure., Results: The area of gingival pigmentation was not statistically significantly different between the two treatment modalities before the procedure (p = 0.452), 1 month (p = 0.443) and 6 months after the procedure (p = 0.202). There was no statistically significant difference in the variance of pigmented area at different times in the two methods. In both CO2 laser and bur abrasion methods, the mean area of pigmentation was statistically significantly different in the follow-up period (p < 0/001), in a way that the change in the area of pigmentation was statistically significant 1 month after treatment (p <0.001) and also 6 months after treatment (p < 0.001) compared to before. The change in the area of pigmentation between 1 and 6 months after treatment was not statistically significant in both CO2 laser (p = 0.157) and bur abrasion method (p = 0.150). No increase in gingival recession was observed in any of the patients., Conclusion: Both treatment modalities can effectively treat gingival pigmentation. No increase in gingival recession was observed. Conventional method and CO2 laser were not statistically significantly different during a follow-up period of 1 and 6 months.

Competing Interests: Competing interests: None declared.

Background: Plasma cell granuloma (PCG) is a rare benign pseudotumorous proliferation of unclear etiology that is mainly situated in the lungs. Gingival PCG is an even more peculiar lesion that usually occurs in middle-aged or elderly individuals and clinically manifests as a solitary entity., Case Report: A 15-year-old male with no underlying medical conditions presented with multiple gingival masses in the right maxilla, which were initially thought to be epulis. The lesions were resected completely and the excisional biopsies sent for histological examination. Immunohistochemical (IHC) stain revealed dense polyclonal plasma cell infiltration with positive expression of both kappa and lambda light chains, confirming a diagnosis of gingival PCG. Subsequently, the affected gingiva healed uneventfully, with no sign of recurrence over 2 years of follow-up., Conclusions: The present report depicts an extremely unusual case of gingival PCG occurring in a juvenile with multiple lesions, which is worth attention in clinical pediatric dentistry. Excisional-biopsy and histological investigations are imperative for a confirmative diagnosis and to exclude potential aggressive conditions. Complete resection of lesions seems to be a valid treatment, while long-term clinical follow-up is still needed., (© 2020 Clinical Pediatric Dentistry.)

Amalgam tattoos are a serious cosmetic problem for patients. A 35-year-old woman came to a private periodontal practice complaining of black pigmentation (amalgam tattoo) above temporary crowns on the lateral and central maxillary incisors and asked that the cosmetic problem be solved before the new permanent crowns were cemented into place. A full-thickness coronoapical incision was made to raise a thick flap; another incision parallel to the surface of the alveolar mucosa made it possible to remove the pigmented connective tissue, which was sent for histologic examination. Due to the fact that the pigmentation extended into the gingival epithelium, the gingiva of the lateral and central incisors was completely removed, with a horizontal incision in the alveolar mucosa from the ends of the distal releasing incisions. Therefore, partially denuded alveolar bone was used as the recipient site for a free gingival graft (FGG). The histologic analysis revealed the presence of amalgam fragments of different sizes in both connective tissue and epithelium. At 6 months, 3 years, and 24 years postoperatively, the periodontal tissues appeared healthy, and the treated area was pink, without pigmentation or scarring, and was perfectly integrated with the adjacent tissues. The patient was very pleased with her appearance. A one-stage procedure, namely an FGG, should be considered an effective treatment of amalgam tattoo providing positive morphologic and cosmetic outcomes over a 24-year follow-up period.

Ascher syndrome is characterized by double lip, blepharochalasis, and non-toxic goiter triad. This condition of unknown etiology usually occurs in patients younger than 20 years of age. In this case report, the authors present the diagnostic process of Ascher syndrome and surgical procedure of double lower lip in a female patient who applied to our clinic for prosthetic reasons. A 70-year old female patient was referred to our clinic with the chief complaint of incompatible dentures. The patient had been using the same complete dentures for 40 years. Extraoral clinical examination revealed protruded, bulged lower lip at rest and bilateral blepharochalasis, defined as atrophy of the upper eyelid skin. The upper lip and lower eyelids were not affected. Intraoral examination revealed complete edentation of both jaws and a double lower lip, an accessory fold of excess mucosae inside the vermillion border. Furthermore, epulis fissuratum was observed in the lower jaw. There was no family history of double lip. The patient stated that she had noticed another lip inside her lip for several years. As Ascher syndrome was suspected, the patient was referred to the endocrinology department for thyroid examination, and the non-toxic goiter diagnosis was confirmed. Surgical removal of the redundant tissues was necessary because of deficiencies in speech, chewing, and aesthetics. The excess tissues were excised by transverse ellipse incision technique. Dentists should be familiar with Ascher syndrome, as they may be the first physicians to encounter patients with double lip.

Oral focal mucinosis (OFM) is an extremely rare, benign oral soft tissue condition; less than 10 documented cases have been reported in the literature in patients under 18 years old. OFM has an unknown aetiology and predominantly presents in the fourth and fifth decades. The pathogenesis of OFM may be due to fibroblast overproduction of hyaluronic acid. Clinically, it remains almost impossible to diagnose definitively, due to its lack of pathognomonic features, therefore such lesions may have multiple differential diagnoses and histological analysis is essential to confirm OFM. We present an unusual presentation of OFM in a 14-year-old female patient. Following excision, focal myxoid degeneration of the connective tissue was apparent. This case highlights this rare condition for consideration in differential diagnosis of clinically similar lesions., Competing Interests: Competing interests: None declared., (© BMJ Publishing Group Limited 2020. No commercial re-use. See rights and permissions. Published by BMJ.)

Hyperpigmentation of the gums can be associated to several etiological factors. Although it is physiological in most cases it can cause esthetic concerns in some patients. The objective of our study was to evaluate the clinical efficacy and patient satisfaction with the treatment of gingival hyperpigmentation with picosecond alexandrite laser of 755 nm. We selected two patients with gingival hyperpigmentation on the anterior face of the upper and lower gums of years of evolution. Malignancy, drug ingestion, exposure to tobacco and underlying genetic and endocrine alterations were ruled out. Clinical photographs were taken before treatment and 2 weeks after the procedure. In both cases, anterior gingival areas were depigmented with satisfaction. The patients did not complain of severe pain or discomfort. Two weeks after the procedure the gingiva showed almost complete depigmentation. In conclusion, the 755-nm alexandrite picosecond laser seems to be safe and effective for the esthetic treatment of gingival hyperpigmentation.

Oral focal mucinosis (OFM) is the rare oral manifestation of cutaneous focal mucinosis. It is a diagnosis made histopathologically, as OFM remains clinically similar to other more common oral lesions, and radiographs do not provide any diagnostic information. This case is a report of a teenage female with left mandibular involvement of an elevated, rounded, asymptomatic, mucosa-coloured lesion in the facial and lingual gingiva between her left first and second mandibular molars. The cause was unclear, although the patient stated that she may have sustained a laceration in that area several months prior. An incisional biopsy revealed histopathological findings consistent with OFM, and complete surgical excision of the lesion was performed under a general anaesthetic, with no signs of recurrence for 2 months. The histological, clinical and accepted treatment methods on OFM will be discussed. Clinicians, including those serving paediatric populations, should consider OFM in their differential diagnoses when evaluating gingival lesions., Competing Interests: Competing interests: None declared., (© BMJ Publishing Group Limited 2019. No commercial re-use. See rights and permissions. Published by BMJ.)

Objective . To present 4 new cases of oral leiomyomatous hamartomas (OLH), describing its clinical, microscopical, and immunohistochemical features, and a literature review. Methods . The OLH cases were retrieved from the files of 2 Brazilian and 1 Peruvian oral pathology services. Clinical data were obtained from the pathology reports. Microscopical features were reviewed, and immunohistochemical reactions were performed. A review of the English-language literature about OLH was done. Results . The sample was composed of 3 females (4-, 10-, and 15-year-old) and 1 male (3-year-old). Three cases affected the dorsum of the tongue and one the incisive papilla, and all presented sessile or pedunculated smooth nodules. Microscopically, the lesions were composed of varying-size fascicles of smooth muscle fibers in a fibrous connective tissue background. Immunohistochemistry revealed positivity of the smooth muscle bundles for myogenic markers. The English-language literature review revealed 38 OLH cases reported, most were congenital or diagnosed up to 5 years old. The main locations were tongue and anterior maxilla. Conclusions . Although OLH is a rare lesion, it must be considered in the differential diagnosis of midline tongue or maxillary masses in newborns, infants, and youngsters.

Quite a few lesions of the oral cavity specifically of the gingiva have a greater inclination towards women and mostly occur during the first four decades of life, the cause of which may be credited to the changing levels of sex hormones. Out of all such lesions, one lesion whose aetiology is still unclear and which originats from the periosteum or periodontal ligament is central giant cell granuloma. Repeatedly, it is has been described as a reactive lesion, the cause of which may be secondary to local irritants or trauma, specifically plaque or calculus, which is not considered to be a true neoplasm. Here we present a case of a 51-year-old female patient with aggressive gingival growth within 10-13 months of hormonal replacement therapy. The aetiology, histological features and appropriate treatment are discussed in the light of current literature., Competing Interests: Competing interests: None declared., (© BMJ Publishing Group Limited 2019. No commercial re-use. See rights and permissions. Published by BMJ.)

Background: The aim of this study was to compare the clinical effects between traditional surgery and minimally invasive periodontal surgery in the treatment of epulis., Methods: A total of 33 cases of patients diagnosed with fibrous epulis were randomly divided into traditional surgery group and minimally invasive periodontal surgery group. After the different procedures, several parameters were detected to evaluate the effects of minimally invasive periodontal surgery., Results: Preoperative bleeding index and plaque index, adopt rank, and test showed no significant differences between the 2 groups. After 12 weeks, gingival papilla filling index in experiment group is statistically higher than control group, and shows the statistical differences (P < .05). The width of keratinized gingiva in experiment group grew more than that in control group, and showed the statistical differences (4.68 ± 0.30 vs 3.00 ± 0.28 mm, P < .05). No recurrence of fibrous epulis was found during the subsequent 6 months to 2 years follow-up after the surgeries., Conclusion: Minimally invasive periodontal surgery that reserved tumor epithelium could have a better effect than the traditional surgery in the selected patients.

Idiopathic gingival fibromatosis (GF), also known as gingivomatosis, is a rare condition in childhood, with an unknown aetiology. The oral manifestations of the condition are varied and depend on the severity and age of involvement. This paper describe the case of a 5-year-old male child with extensive gingival enlargement covering almost all the maxillary and mandibular teeth resulted in difficulty with speech, mastication and poor aesthetics. Clinical and radiographic examination along with haematological investigations ruled out any systemic association. The case was managed with conventional scalpel blade surgery along with electrocautery under general anaesthesia yielding good results without any recurrence after a 12-month follow-up. The results revealed that the oral manifestations of GF depend on its severity and the age of onset. Timely intervention can help to prevent associated complications in a growing child., Competing Interests: Competing interests: None declared., (© BMJ Publishing Group Limited 2019. No commercial re-use. See rights and permissions. Published by BMJ.)

Background : The aim of this study was to compare osmotic pressure (OP) 1 week after the gingival depigmentation in two diffeent methods: Er: YAG laser and Kirkland knife. Methods : This study included 20 patients, 13 women, and 7 men who had esthetic complaints of gingival melanin hyperpigmentation. The left side of the maxilla and mandible were depigmented with Er:YAG laser using air and water spray and the right side was removed with a Kirkland knife. Gingival biopsies were obtained from attached gingiva of operation sides with approximate dimensions of 2 mm × 2 mm before and 1 week after the depigmentation. The visual analog scale (VAS) was used to evaluate the pain level experienced by each patient. Results : Patients reported no pain at the gingivoplasty sides after 4 days and at the laser sides after 3 days. There were not statistical differences between laser and gingivoplasty groups according to values of OP ( P  > 0.05). Conclusion : According to results of wound healing, OP and VAS, two depigmentation procedures can be used safely and effectively.

Background: The term Pseudohypoparathiroidism indicates a group of rare conditions characterised by end-organ resistance to the action of parathyroid hormone (PTH). Ossifying epulis (OE) is a exophytic gingival lesion characterised by spontaneous bone formation beneath the mucosa, which may affect children and adults: the exophytic, calcified outgrowths can occur in any bone and generally have favorable prognosis. Drug therapy may normalise calcium serum levels, but not completely avoid the occurrence of peripheral ossifying epulis., Case Report: We report a representative case of a peripheral ossifying epulis in the mouth of a patient following a drug treatment protocol for her pseudohypoparathyroidism and to optimise serum markers. An 11-year-old girl was referred to our department, showing a bulky neoformation on the gingival margin of 0.6 mm diameter with sharp margins. The mass was completely excised. Histological analysis revealed distinctive features of a chronic and acute inflammatory microenvironment with plasma cells (positivity for CD38, MUM1, Lambda and Kappa chains) and bone tissue fragments with remodeling aspects referable to flogistic osteolysis. The biopsy result leads to hypothese a change in the patient's drug therapy. Multidisciplinary screening and individualised pharmacological treatment are strongly recommended in the clinical practice in order to improve the therapeutic results.

Pyogenic granuloma is a 'reactive lesion' in the oral cavity caused due to hormonal imbalance or poor oral hygiene. There are different methods to excise this lesion but most successful is treatment with lasers. Currently, there are different lasers available commercially and are used by clinicians to excise this lesion. In this case report, a 20-year-old female patient reported to the department with a complaint of overgrowth of gingiva on lower canine. It was excised by using neodymium-doped yttrium aluminium garnet laser and the patient was asked for regular follow-up after 1 week and 6 months. The excised lesion was sent to pathology where the lesion was confirmed to be pyogenic granuloma. The patient reported no pain, no blood loss during or postsurgery. Laser is a useful technique for excisional surgeries; it is safe, effective and reduces time of treatment as well as time of healing., Competing Interests: Competing interests: None declared., (© BMJ Publishing Group Limited 2018. No commercial re-use. See rights and permissions. Published by BMJ.)

The increasing melanin hyperpigmentation of dark skinned individuals is related to the high activity of melanocytes. A healthy 36-year-old female patient complained about unaesthetic gingiva and she had been smoking for over 17 years and also smoking reactive the melanocytes. Gingival depigmentation is a periodontal plastic procedure which has been carried out by various techniques. Hyperpigmentation of gingiva was observed on the labial surface of both maxilla and mandibula. Erbium, chromium-doped yttrium, scandium, gallium, and garnet (Er,Cr:YSGG) laser was used for depigmentation with wavelength of 2780 nm, frequency of 20 Hz, and pulse energy between 0 and 300 mJ. Topical anesthetic spray was applied and there was mild bleeding and pain in the operation area. The ablated regions were healed almost in 1 week. After 3-month and 6-month follow-up there were no repigmented areas. It may be concluded that the application of Er,Cr:YSGG laser appears to be a safe and an effective alternative procedure for the treatment of gingival melanin hyperpigmentation.

Laser ablation is recently suggested as a most effective and reliable technique for depigmentation of melanin hyperpigmented gingiva. To date, different lasers have been used for gingival depigmentation (CO 2 , diode, Nd:YAG, Er:YAG and Er,Cr:YSGG lasers). The use of Er:YAG laser for depigmentation of melanin hyperpigmented gingiva has gained increasing importance in recent years. The purpose of this study was to report removal of gingival melanin pigmentation using an Er:YAG laser in a literature review. The main outcomes, such as improvement of signs (clinical parameters of bleeding, erythema, swelling and wound healing), symptoms (pain) and melanin recurrence/repigmentation were measured. The literature demonstrated that depigmentation of gingival melanin pigmentation can be performed safely and effectively by Er:YAG laser resulting in healing and an esthetically significant improvement of gingival discoloration. Thus, Er:YAG laser seems to be safe and useful in melanin depigmentation procedure. However, the main issue in giving the final conclusion of the optimal Er:YAG laser use in melanin depigmentation is that, to date, studies are offering completely discrepant Er:YAG laser procedure protocols (complex settings of laser parameters), and different criteria for the assessment of depigmentation and repigmentation (recurrence), thus hampering the comparison of the results. Therefore, further studies are necessary to give an optimal recommendation on the use of Er:YAG laser in gingival melanin hyperpigmentation.

Gingival hyperpigmentation in the anterior region in people with a high smile line is an esthetic concern. Gingival depigmentation can be achieved through various procedures. Most techniques have shown successful short-term results; however, recurrence is observed in 50% of patients after 2 to 4 years. A 46-year-old woman presenting with a large black zone of gingival hyperpigmentation in the anterior maxilla was treated with scalpel blade excision. At 25 years after the depigmentation procedure, the patient displayed no recurrence.

Objective: To compare the 6-month clinical efficacy of Er:YAG laser and standard scalpel technique in treating gingival hyperpigmentation., Method and Materials: Patients requesting treatment for moderate to severe gingival hyperpigmentation in the maxilla were enrolled in this split-mouth study. The contralateral maxillary sides were randomly assigned to receive either Er:YAG laser (continuous wavelength of 2,940 nm) with a noncontact tip or the standard scalpel technique. Dummett oral pigmentation index (DOPI) and Hedin melanin index (HMI) were compared at the baseline and at 1 and 2 weeks, and 1, 3, and 6 months following the treatment. Bleeding Index, total treatment time, patient preference, pain perception at the first 3 days, wound healing, and level of satisfaction were also compared. Mann-Whitney test, Kruskal-Wallis test, and chi-square test were used to test the significance between variables. A P value of less than or equal to .05 was considered statistically significant., Results: Of the 22 patients enrolled, 20 completed this study. After assessing DOPI and HMI at 1 and 2 weeks, and at 1-, 3-, and 6-month follow-up appointments, both Er:YAG laser and scalpel were significantly effective in treating gingival hyperpigmentation when compared to baseline (P < .001) but with no statistically significant difference between the two treatment methods (P > .05). More patients preferred the scalpel technique as it was associated with slightly shorter treatment time and less postoperative pain when compared to Er:YAG laser, but with no statistical significance (P > .05). Er:YAG laser sites showed minimal bleeding and more rapid wound healing (P < .001)., Conclusion: Both Er:YAG laser and scalpel technique achieved similar outcomes regarding the efficacy of gingival depigmentation, postoperative pain perception, and the time required for the treatment. Laser therapy requires more advanced technology and is associated with higher financial costs. Therefore, the scalpel technique is still considered the gold standard treatment for gingival depigmentation.

Verruciform xanthoma (VX), a papillary or wart-like lesion of the mucosa, is histopathologically characterized by papillary projection of the epithelium and an aggregation of foam cells in the lamina propria. Here, we describe a case of VX in the posterior mandibular gingiva, initially suspected to be a benign lesion based on clinical findings and cytology prior to an excisional biopsy. The patient was a 62-year-old man who had visited a local dentist approximately 1 year earlier, presenting with a white lesion in the left posterior mandibular gingiva that resisted removal by scraping. The lesion was left untreated as there were no subjective symptoms. Thereafter, the surface of the lesion roughened and the patient was referred to our department for a comprehensive examination. A circumscribed, granular mass, 15-mm in diameter, with a red and white surface was observed in the left posterior mandibular buccal gingiva. Exfoliative cytology was performed. The diagnosis was a class III lesion. Excisional biopsy was performed under local anesthesia. Histopathological examination led to a diagnosis of VX. At 1 year postoperatively, the patient is making satisfactory progress without recurrence. Verruciform xanthoma is difficult to diagnose preoperatively, and is commonly resected under a clinical diagnosis of papilloma or benign tumor. A benign lesion was also initially suspected in the present case and cytological analysis performed to confirm absence of malignancy. The lesion could not be diagnosed as VX preoperatively. Verruciform xanthoma can be over-diagnosed based solely on cytological examination because it often involves cellular atypia reflecting its characteristic extension of rete pegs and keratinization of surface cells, indicating the need for care in arriving at a definitive diagnosis.

Objective: It is the aim of this study to evaluate if the CO 2 laser can beneficially be applied for excising epulides., Background Data: The standard procedure for treating epulides involves the excision of the hyperplastic tissue followed in most cases by the removal of parts of the underlying bone and the final closure of the wound by a flap. The use of the CO 2 laser for the treatment of epulides has been documented only in isolated case reports and very few case series., Patients and Methods: Ninety patients with different subtypes of epulides were treated with a CO 2 laser (Lasram, model OPAL 25, 25 W, 10.600 nm, gas laser); power setting 4 W, continuous wave. The surgery was performed only after a pretreatment could remedy any gingivitis or occlusal trauma. A new surgical way of working using a special applicator that allowed tangential application of the laser beam was applied for all patients. Patients were followed up to 3 years., Results: No perioperative complications or recurrences after 4 weeks could be found. Six patients were lost to further follow-up, whereas 84 patients were followed up to 36 months. In 71 cases there were no recurrences over the entire observation period. Thirteen patients developed a relapse, usually a fibroma/fibrosis according to histopathological evaluation., Conclusions: Overall CO 2 laser seems to be an adequate tool for minimally invasive excision of epulides, although the respective histopathological entity could possibly influence the recurrence rate and so should be considered.

The gingival cyst of the adult is a relatively rare, benign odontogenic cyst that maintains an insidious growth rate. This article describes a case of a diminutive fibrotic overgrowth arising on the labial interproximal gingiva between the mandibular right canine and first premolar in a 68-year-old woman. Within 1 year, the lesion had increased in size and appeared vesicular. The morphologic changes warranted surgical excision and histopathologic review. The lesion was diagnosed as a gingival cyst. At a 4.5-month recall appointment, there was no evidence of recurrence. Early lesional detection can potentially mitigate mucogingival defects and improve clinical outcomes.

Plasma cell granuloma (PCG) is an uncommon benign tumor of unknown etiology, primarily located in the lungs. We report a case of PCG on the gingiva mimicking benign and malignant tumors in a 56-year-old woman. Histopathological examination revealed a relatively sharp circumscribed inflammatory cell infiltration under the mucosa-containing plasma cells, predominantly those including Russell bodies. Plasma cells are stained by CD138 immunohistochemistry. Polyclonal status of the lesion was confirmed by kappa and lambda light chaining. The typical histopathological and immunohistochemical findings in combination with the clinical features were consistent with PCG, about which the literature reports very few cases.

Gingival hyperpigmentation and the condition known as gummy smile are very common dental cosmetic problems. Gingival hyperpigmentation arises due to the excess presence of melanin in certain regions of the gums. In the case of gummy smile, more than the required amount of gingival tissue is exposed upon smiling. An aesthetically pleasing smile should expose only a negligible amount of gingival tissue. Gummy smile and gingival hyperpigmentation can have detrimental effects on the aesthetic quality of a smile, and thereby a wide variety of treatment options must be taken into consideration depending patient outcome objectives. The use of a laser as a treatment modality is considered to be a promising option for such cases. We aim to explain the effects of using a laser on the gingiva and discuss the advantages and disadvantages of this type of treatment and the resulting alteration of the genetic composition of the gingival tissue. This article reviews the histological aspects and biological effects of a laser treatment for oral hyperpigmentation and gummy smile and analyzes the use of the laser as a modality to improve the smiles of people with hyperpigmentation and excessive gingival display. We also attempt to provide insight into the use of plasma as a novel technology for medical and dental research and its future implications with regard to, dental soft tissue procedures.

Today, innovative restorative materials and techniques allow for minimally invasive prosthetic procedures, which are paramount to the preservation of hard and soft dental tissues. An integrated approach combining dental and esthetic medical therapies could be useful to improve the quality of life of patients, improving function, esthetics, and self-confidence. Oral esthetics depends on several variables, including tooth visibility and proportions as well as healthy gingival tissues. Proper integration between teeth and periodontal tissues plays an important role in esthetic success, which is mainly represented by an appealing smile. The present case report was aimed at describing the multidisciplinary treatment of a woman who was unsatisfied with the shape of her central incisors and the dark gingival pigmentation displayed by a high smile line. The patient was treated with minimally invasive combined periodontal, prosthetic, and esthetic medical techniques. The described multidisciplinary approach based on surgical gingival depigmentation, adhesive ceramic veneers, and selective botulinum toxin injection was effective in solving the undesired high smile line and achieving patient satisfaction.

Soft tissue fenestrations are extremely rare in the natural dentition and have only recently been reported on dental implants. Although the pathogenesis of their formation is not completely understood, several predisposing risk factors have been identified, some of which may affect dental implants as well. This article presents a thorough review of the literature pertaining to gingival fenestration. It also describes the surgical management of lesions developed approximately six years following osseointegration of two dental implants.

Objectives: Aim of the present study was clinical and histopathological evaluation of a series of epulides to provide clinicians data to frequency distribution and biological behaviour of different underlying entities., Materials and Methods: Ninety-two cases of epulides removed by CO2-laser at the Department of Oral Surgery and Radiology, Medical University of Graz from 2000 to 2014 were studied retrospectively for clinical data and histopathological diagnosis., Results: In the presented study, histopathological examination revealed peripheral ossifying fibroma (32.6 %), fibroma/fibrosis (29.3 %), giant cell lesion (13.1 %) and granuloma pyogenicum (8.7 %) as the most frequent underlying entities. For the first time, hyperplastic squamous epithelium (7.6 %), granulation tissue (5.4 %) and peripheral odontogenic fibromas (3.3 %) were detected to clinically appear as epulides. Irrespective of the histological diagnosis, the mean age in our patients was 43.8 years. The majority of the lesions were found in the frontal region of both jaws. In all cases, the patients showed poor oral hygiene, local gingivitis and some of them an occlusal trauma., Conclusions: To identify different entities with different biological behaviour, to exclude malignant tumours and to identify new entities among epulides, histopathological examination is required. Poor oral hygiene and occlusal trauma seem to play an important role in the pathogenesis and could be risk factors for recurrences., Clinical Relevance: Frequency distribution of different entities in epulides is provided to clinicians, and new histopathological entities were detected to clinically appear as epulides.

Hamartoma is a tumour-like malformation appearing as a focal overgrowth of normal cells. Leiomyomatous hamartomas (LHs) are rare in the oral cavity and commonly seen in the Japanese and less than 40 cases have been reported in the Japanese and English literature. The clinical differential diagnoses are irritational (traumatic) fibroma and congenital epulis. It has to be differentiated histopathologically from its neoplastic counterparts and mesenchymomas. Hence, we report such a case of LHs, which presented as a sessile gingival growth occurring in the midline in a 15-year-old girl. The final diagnosis was based on the histopathological appearance which was confirmed by immunohistochemical staining of various markers. A review of the literature of previous cases was also carried out., (2016 BMJ Publishing Group Ltd.)