This document describes a case report of a peripheral ossifying fibroma (POF) in a 22-year-old female patient. POFs are non-neoplastic reactive lesions of the gingiva caused by local irritants like plaque or food impaction. Histopathological examination showed fibrous connective tissue with bony trabeculae and dystrophic calcification, consistent with POF. Treatment involves complete surgical excision to remove the lesion and any remaining irritants in order to reduce the risk of recurrence.

2. INTRODUCTION :
First description of ossifying fibroma was given by Menzel in
1872 while the term was given by Montgomery in 1927. It was
first described as relatively uncommon, solitary, nonneoplastic
gingival growth by Eversol and Robin.
Ossifying fibroma
- Central
- peripheral

3. • POF are reactionary lesion defined as any solitary growth
on the gingiva thought to arise from the PDL; most
commonly at the region of the interdental papilla.
• Exuberance of tissue is caused by an initiating factor
such as calculus, or a food particle that becomes lodged in
the sulcus ,creating an initial irritation.

4. CASE REPORT :
A 22-year-old female patient , with a chief complaint of
swelling on the upper front region of mouth since last 6
months ,the swelling was insidious in onset. Initially, it was
small peanut sized and progressively increased to present
size. Occasionally, it was associated with pain. Patient did
not give any history of trauma, injury, or food impaction and
there was no significant medical history.

7. • The gingival growth was nontender, firm to hard in consistency,
nonreducible, noncompressible and fixed to underlying structures.
No bleeding on probing was seen. Pathological migration and
midline diastema ,
? Pyogenic granuloma
? Inflammatory gingival hyperplasia and POF

11. FIBROCELLULAR CONNECTIVE TISSUE CONSISTING OF DENSE
COLLAGEN FIBERS INTERSPERSED WITH BONY TRABECULAE AND
AREAS OF DYSTROPHIC CALCIFICATION

13. DISCUSSION :
POF – Gingiva , 1 st and 2 nd decade of life , Female ,maxillary incisor-
cuspid region ,pink to red ,slow growing asymptomatic ,firm to hard .
Trauma and chronic irritation from subgingival plaque and calculus
are considered to be the most common etiologic agent for POF. It is
thought to be originating from PDL.
Exclusively seen on gingiva mostly interdental, lesion are in close
proximity to PDL, within some lesions oxytalan fibers can be seen, and
fibrocellular response which is similar to other gingival lesions of PDL
origin.

14. • Pathogenesis is still unclear. Certain hypothesis that has been given
are - since these are clinically and histologically similar to pyogenic
granuloma, some author thought it to be originating secondary to
fibrosis of granulation tissue. Similarly, these have a high
predilection for female and the 2 nd decade of life hormones are
thought to play an important role. Most widely accepted hypothesis
states that the presence of local irritants such as plaque, calculus,
overhanging restoration, and ill-fitting denture can lead
inflammatory reaction which in turn leads to inflammatory
hyperplasia of cells of periodontium and PDL.

15. • Radio graphically, it appears as radio-opaque flecks or patches.
Sometimes, separation of the adjacent teeth and occasionally
resorption of the adjacent teeth may occur.
• Surgical excision is considered to be treatment of
choice.Recurrence rate of POF is high and varies from 7% to
45%.The lesion is removed from periosteum, and the adjacent
teeth should be scaled to remove any remaining irritants. This
helps in reducing the rate of recurrence. Furthermore, ill-fitting
dental appliance and rough restoration if any should be removed.

16. • Cases can be misdiagnosed as pyogenic granuloma, peripheral giant
cell granuloma, or odontogenic tumors, and therefore
histopathological examination is essential for accurate
diagnosis.Literature shows that most of the cases of POF have a
range of 1 st -2 nd decades, more common in females and maxillary
anterior region. Same were the finding of the present case.
Hormonal changes were thought to be main etiological agent for
the present case; however, minimal plaque could be seen in the
region. Therefore, along with surgical excision of lesion removal of
risk factor was considered as the treatment of choice.

17. CONCLUSION :
• A slowly growing soft tissue mass with speckled
calcifications in the anterior oral cavity of young adults or
children should raise a suspicion of a reactive gingival
lesion such as POF. Histopathological examination is
essential for accurate diagnosis. Once diagnosed, POF
should be treated by total excision to prevent recurrence.