Unusual Gingival Enlargement: A Rare Case Report

This is an atypical case report of a 20-year-old male patient who suffered from unusual unilateral, gingival enlargement together with rapidly progressive alveolar bone loss. The enlarged gingiva completely covered his left posterior teeth in both arches. The patient was diagnosed with gingival fibromatosis and aggressive periodontitis based on the clinical, histological, and radiographic findings. The gingival enlargement was treated by conventional gingivectomy under local anaesthesia. The postoperative result was uneventful. 1. Introduction Gingival fibromatosis, gingivomatosis [1], diffuse fibroma [2], familial elephantiasis [3], idiopathic fibromatosis, hereditary gingival hyperplasia, gigantism of gingiva, and hypertrophic gingiva are slowly progressive fibrous enlargements of the maxillary and mandibular gingiva. Gingival fibromatosis may be an inherited condition as in hereditary gingival fibromatosis or may be associated with medications or may be idiopathic. It may also be caused by inflammation or leukemic infiltration. The gingival fibromatosis may occur as an isolated finding or be associated with one of several hereditary syndromes, for example, Rutherford’s Syndrome, Jones’ Syndrome, Murray-Puretic-Drescher Syndrome, Laband Syndrome, Ramon’s Syndrome, hypothyroidism, and so forth [4]. The syndromic characteristic most commonly seen in association with hereditary gingival fibromatosis is hypertrichosis [5]. It is characterized by massive gingival enlargement that appears to cover the tooth surfaces. The enlargement may be associated with one or more teeth, involve one or more quadrants, or may be generalized. The cause of enlargement is unknown but there appears to be a genetic predisposition. Gingival hyperplasia produces conditions favorable for the accumulation of plaque and materia alba by accentuating the depth of gingival sulcus and by interfering with effective hygiene measures. The secondary inflammatory changes further increase the size of the preexisting gingival hyperplasia [6]. Aggressive periodontitis is a genetically inherited disease that represents a severe and rapidly progressive form of periodontitis [7]. This form of periodontitis presents peculiar clinical presentation, occurring around puberty with an apparent lack of local factors such as heavy amounts of plaque and calculus in patients with reasonably good oral hygiene. Aggressive periodontitis is characterized by the following major common features:(1)early age of clinical manifestation,(2)noncontributory medical history,(3)rapid attachment loss and bone