Peripheral ossifying fibroma: dilemma in diagnosis.

1 of 2 DESCRIPTION Peripheral ossifying fi broma (POF) exclusively found on the gingiva and may be presented with randomly distributed calcifi cations, immature bone, separation of teeth and bone resorption. 1 Its prevalence in children is 1.9% with a mean age of 14 years and a higher predilection in females and maxillary incisor-cuspid region. 2 A 16-year-old boy reported with a soft tissue mass in right lower posterior teeth region since 1 year. The lesion was multi-lobular, exophytic along the lingual and buccal side, fi rm, pedunculated, non-tender, measuring approximately 3×2.5 cm in diameter, extending from distal surface of right lower canine to molar region with normal coloured, and non-ulcerated overlying mucosa ( fi gure 1 ). The case was provisionally diagnosed as long-standing pyogenic granuloma and the list of differential diagnosis includes peripheral fi broma, pyogenic granuloma, peripheral giant cell granuloma and focal fi brous hyperplasia. Radiographic views revealed a dystrophic trabecular bone formation with displacement of right lower premolars and marked interdental bone loss ( fi gure 2 ). Histopathological examination revealed irregular multiple foci of partly calcifi ed areas ( fi gure 3 ). Based on radiographic and histopathological fi ndings a fi nal diagnosis of POF was given. POF originates from cells of periodontal ligament 2 and most of lesions do not show radiographic characteristics of diffuse radiopaque calcifi cation, bone destruction and tooth separation, 3 in this condition, diagnosis of POF depends on histopathological analysis, while in our male patient, all these fi ndings were observed in premolar region. The purpose of this article is to inform the paediatric dentists about POF which clinically make a dilemma in diagnosis among reactive gingival hyperplastic lesions like peripheral fi broma, pyogenic granuloma, peripheral giant cell granuloma and focal fi brous hyperplasia. Images in...