Benign connective tissue tumors 2/ dental implant courses by Indian dental academy

INDIAN DENTAL ACADEMYINDIAN DENTAL ACADEMY
Leader in continuing Dental EducationLeader in continuing Dental Education
www.indiandentalacademy.com

 At the end of the lecture, students should be able to
 Describe clinical features, radiographic features ,
histopathologic features and treatment of –
1.Peripheral Ossifying Fibroma
2.Central Ossifying Fibroma
3.Peripheral Giant Cell Granuloma

 A common gingival lesion
 Characterized by high degree of cellularity,
 Showing bone formation,
 Occasionally cementum-like material,
 Rarely dystrophic calcification
Peri. Ossi. Fibroma

 Peripheral giant cell granuloma,
 Giant cell fibroma,
 pyogenic granuloma,
 Fibroma,
 Peripheral ossifying fibroma

Clinical Features:
 Age- can occur at any age,
- more common in children & young adults
 Female sex predilection- F:M 2:1 to 3:2
 Equal distribution in maxilla & mandible
 Anterior to molar area
 Well demarcated focal mass of tissue on gingiva
Peri. Ossi. Fibroma

 Sessile or pedunculated base
 Color- same as that of normal mucosa or
slightly reddened
 Surface- intact or ulcerated
 Commonly originates from interdental papilla

Radiographic Features-
 No apparent underlying bone involvement
 Rarely superficial erosion of bone

Histopathlogic Features-
 Surface- ulcerated SSE or intact
 exceedingly cellular mass of C.T.
 Large nos. of plump proliferating fibroblasts
 intermingled throughout very delicate fibrillar
stroma
 Characteristic high degree of cellularity
 Vascularity not prominent

Histologic Features- contd..
 Calcifications- several forms, varying in amount from
 Single or multiple interconnecting trabeculae of bone or
osteiod OR
 Globules of calcification resembling acellular
cementum OR
 Diffuse granular dystrophic calcification
 Occasional multinucleated giant cells
Peri. Ossi. Fibroma

Treatment & Prognosis-
 Surgical excision
 Lesions recur sometimes

 Intraosseous Neoplasm
 They are two separate benign tumors, identical in
nature
 Except for the cell undergoing proliferation------
 Osteoblast with bone formation -Central ossi. F.
AND
 Cementoblast with cementum formation –Central C.
F.
 They represent simply two facets of the same basic
tumor
Central Ossi. Fibroma

Clinical Features:
 Age predilection- Young adults, mean age- 33 years
 predilection for mandible,
 Female sex predilection, High incidence in Blacks
 Generally asymptomatic, swelling & mild deformity
 Displacement of teeth an early clinical feature
 Relatively slow growing tumor

 Variable appearance depending upon stage of
development
 Well circumscribed & demarcated
 Early stages- radiolucent with no evidence of radio-
opacities as tumor bone matures- flecks of
radio-opacities appear late stages-
lesion appears as uniform radiopaque mass
 Displacement of adjacent teeth
 Impingement upon other adjacent structures

Radiopaque mass

Histopathologic Features-
 Many delicate interlacing collagen fibers rarely in
bundles
 Interspersed by numerous active, proliferating
fibroblasts
 Many small foci of irregular bony trabeculae
 As the lesion matures, islands of ossification increase
in number, enlarge & ultimately coalesce

Foci of calcification
Proliferating fibroblasts

 Conservative excision
 Rare recurrence

 Etiology- unknown
 local irritation due to dental plaque or calculus,
 periodontal disease,
 poor dental restorations,
 ill-fitting dental appliances,
 dental extractions
Peri. Giant Cell Granuloma

Clinical Features:
 Age :- 4th
to 6th
decades, Female : Male 2:1
 Generally asymptomatic, relatively rapid
growth rate
 Gingiva or alveolar process, anterior to molars
 Slight predilection for mandible
 Pedunculated or sessile mass, Size- variable
 Dark red, vascular or hemorrhagic in
appearance, Surface ulceration common

Peripheral giant cell granuloma

Clinical Features- contd..
In edentulous patient-
 Lesion- vascular, ovoid or fusiform swelling of crest
of alveolar ridge
 1-2 cm in diam.
 Granular mass of tissue growing from tissue covering
slope of alveolar ridge
 Dark red, vascular or hemorrhagic in appearance
 Ulceration less common

Histopathologic Features-
 Nonencapsulated mass of tissue
 Delicate reticular & fibrillar C.T. stroma
 Large nos. of ovoid or spindle shaped young C.T.
cells
 Multinucleated giant cells-
 Numerous capillaries particularly around periphery of
lesion
 Foci of hemorrhage, with liberation of hemosiderin
pigment, subsequent ingestion by mononuclear
phagocytes

In edentulous areas-
 superficial erosion of bone with pathognomonic
peripheral ‘cuffing’ of bone
In dentulous areas-
 superficial destruction of alveolar margin or crest of
interdental bone
 Complete surgical removal- curative
 Excellent prognosis
 Recurrence rate of 10-15%

 Clinical features, radiographic features , histopathologic features and treatment of – -
Peripheral Ossifying Fibroma
Central Ossifying Fibroma
Peripheral Giant Cell Granuloma

Benign connective tissue tumors 2/ dental implant courses by Indian dental academy

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