Management Of Peripheral Ossifying Fibroma- A Relatively Uncommon Growth In The Oral Cavity- A Case Report

Among various types of gingival enlargements, Peripheral ossifying fibroma (POF) is a rare entity, which is nonneoplastic in nature and arises due to trauma, plaque, calculus, restorations and dental appliances. The term peripheral ossifying gingival growth was coined by Eversole and Rovin. Various synonyms are used for this gingival growth, like peripheral cementifying fibroma, ossifying fibro epithelial polyp, peripheral fibroma with calcification, peripheral fibroma with osteogenesis, peripheral fibroma with cementogenesis, calcifying or ossifying fibrous epulis and calcifying fibroblastic granuloma. This lesion commonly arises from the interdental papillae and is thought to arise from the periodontal ligament. Clinically, the appearance of POF is similar to a nodular mass which is either sessile or pedunculated that emanates from interdental papilla. Usually the colour of the lesion is same as that of the oral mucosa or may be slightly reddened. The surface can be ulcerated or intact.Probably, the growth begins typically as an ulcerated lesion and the older lesions demonstrate healing of ulcer and an intact surface. Most lesions are < 2cm in size, although larger lesions occasionally may occur. POF can occur at any age group but it exhibits a peak incidence between the second and third decades. However, in a retrospective study of 2,439 cases in chinese population by Zhang et al (2007), it was found that the mean age of occurrence of POF was 44 years, which is contradictory to the earlier published literature. Some cases have been reported in children too. Abstract: Peripheral ossifying fibroma is a comparatively uncommon growth which is slow growing in nature and mainly affects the free gingival margin. The commonest site involved is the anterior maxillary arch. Usually the lesion is observed in 2 nd and 3 rd decades of life and it has a strong female predilection. The etiology is related to trauma and irritation from dental appliances and calculus. The appearance of this lesion is reactive and solitary in nature rather than benign or malignant. Confirmative diagnosis is based on definite histopathological examination along with determination of presence of focal calcifications. Treatment options include electro surgery, scalpel and laser surgery. Since this lesion has a high recurrence rate, the excision requires proper surgical intervention that ensures thorough excision of the lesion involving periosteum and periodontal ligament. Since oral hygiene maintenance is a key factor in preventing the recurrence, proper scaling and root planing is required for meticulous plaque control. A case report of peripheral ossifying fibroma is presented that was managed by surgical excision.