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

INDIAN DENTAL ACADEMYINDIAN DENTAL ACADEMYLeader in continuing Dental EducationLeader in continuing Dental Education

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At the end of the lecture, students should be able to Describe clinical features, radiographic features ,

histopathologic features and treatment of –

1.Peripheral Ossifying Fibroma2.Central Ossifying Fibroma3.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



Radiographic Features- 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


Treatment & Prognosis-

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




Radiographic Features-In edentulous areas- superficial erosion of bone with pathognomonic

peripheral ‘cuffing’ of boneIn dentulous areas- superficial destruction of alveolar margin or crest of

interdental bone

Treatment & Prognosis- 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




Date post:	11-Apr-2017
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