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Table of Contents
Year : 2022  |  Volume : 9  |  Issue : 1  |  Page : 18-20

Peripheral cemento-ossifying fibroma

1 Associate Professor, Department of Oral and Maxillofacial Surgery, Azeezia Dental College, Kollam, Kerala, India
2 Senior Lecturer, Department of Paediatric and Preventive Dentistry, Noorul Islam College of Dental Sciences, Trivandrum, Kerala, India
3 Dental surgeon, Dr Arun's Dental Speciality Centre, Azeezia Dental College, Kollam, Kerala, India

Date of Submission03-Mar-2022
Date of Acceptance07-Mar-2022
Date of Web Publication24-Mar-2022

Correspondence Address:
Dr. U Roopesh
Department of Oral and Maxillofacial Surgery, Azeezia Dental College, Meeyyannoor, Kollam, Kerala
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/ijpcdr.ijpcdr_6_22

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The gingiva is frequently the spot of localized growths that are problematic to diagnose clinically besides can only be distinguished as a distinct entity by consistent histomorphology. The peripheral ossifying fibroma is a type of fibro-osseous benign tumor that can recur even after it has been removed. Clinical as well as histologic features are discussed, in addition to differential diagnosis, treatment, and follow-up recommendations. Clinically, it is tough to distinguish amid most reactive gingival lesions, especially in the early phases, so it is critical to rule out causative aspects as well as histological examination of the tissue for confirmation.

Keywords: Gingiva, peripheral cement-ossifying fibroma, reactive lesions

How to cite this article:
Roopesh U, Ambika S, Usha AM, Kumar A. Peripheral cemento-ossifying fibroma. Int J Prev Clin Dent Res 2022;9:18-20

How to cite this URL:
Roopesh U, Ambika S, Usha AM, Kumar A. Peripheral cemento-ossifying fibroma. Int J Prev Clin Dent Res [serial online] 2022 [cited 2022 Aug 17];9:18-20. Available from: https://www.ijpcdr.org/text.asp?2022/9/1/18/340845

  Introduction Top

Trauma, microorganisms, plaque, calculus, and dental restorations, in addition to dental appliances, can all cause localized reactive lesions on the gingiva. The preponderance of these locally located gingival lesions is “reactive proliferative lesions,” not true neoplasms.

Peripheral cemento-ossifying fibroma (PCOF) is defined as a fibrous tissue lesion with inconstant volumes of mineralized material similar to bone (ossifying fibroma), cementum (cementofying fibroma), or both that is well demarcated and occasionally encapsulated.[1]

PCOF is responsible for 3.1% of all oral tumors along with 9.6% of gingival lesions.[2]

It can strike regardless of age; nonetheless, it is furthermost communal in the second as well as third eras. Females are more influenced than males, with an average age of around 28 years.[3] Because the recurrence rate of PCOF is described to be amid 8% and 20%, close postoperative monitoring is necessary.

  Case Report Top

A female patient of 11 years consulted to our outpatient department having a concern about painless growth in the upper posterior left back region in the past 1 year. Initially, she noticed a small swelling in 65 regions that progressively enlarged to the existing size instigating difficulty in mastication. The patient exhibited with no relevant contributory medical history. On examination, reddish proliferative-like growth measuring 0.8 cm × 0.5 cm × 0.3 cm was seen over 65 [Figure 1]. On palpation, the growth was nontender, palpable, soft in consistency as well as slightly movable. Other intraoral findings include grossly decayed 75 which was impinging the growth. Oral prophylaxis was performed, and excisional biopsy was carried out after taking informed consent. Microscopic findings showed parakeratinized stratified squamous epithelium with the underlying connective tissue shows dense chronic inflammatory cell infiltrates chiefly lymphocytes along with plasma cells [Figure 2]. The deeper connective tissue appears fibrocellular with plump fibroblasts, spheroidal basophilic cementum-like calcification, and reactive bone formation diagnosed to be PCOF. The surgical site gave the impression to be healing fine on the 10th day postoperatively. The patient was followed up at consistent periods, as well as oral hygiene was emphasized. After 6 months, the patient was reviewed and found that 25 was erupting without any abnormality [Figure 3].
Figure 1: Pre-operative view

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Figure 2: Microscopic picture of biopsy

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Figure 3: Post operative view

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  Discussion Top

Fibrous dysplasia, reactive lesions (periapial cemento-osseous dysplasia, focal cemento-osseous dysplasia, as well as florid cemento-osseous dysplasia), in addition to fibro-osseous neoplasms are the three main types of benign fibro-osseous lesions. Since 1992 WHO classification, PCOF has been classified as a fibro-osseous dysplasia which has been classified as a nonodontogenic tumor.[1] Although the etiopathogenesis of PCOF is unknown, cells from the periodontal ligament have been proposed as a source. The explicit manifestation of PCOF in the gingiva, the immediacy of gingiva to the periodontal ligament, as well as the incidence of oxytalan fibers inside the mineralized matrix of the similar lesions are all reasons to consider a periodontal origin for PCOF.[4] Gingival injury, gingival irritation, subgingival calculus, or a foreign body in the gingival sulcus cause excessive proliferation of mature fibrous connective tissue. Chronic irritation of the periosteal and periodontal membrane leads to connective tissue metaplasia and, as a result, bone formation irritation or dystrophic calcification. The calcification and/or ossification of a PCOF is explained by the statistic that it is firmer besides is less crumbly than other lesions having a longer course.[5]

Primarily asymptomatic, the tumor grows in size to the state where it originates pain and functional impairment. The lesion was red, firm, and nontender on palpation, having a proliferative surface along with a broad attachment base in this case. Assumed the higher frequency of PCOF among females, growing rate in the second decade, in addition to diminishing frequency after the third decade, hormonal influences might play a part.[6] Kumar et al.[4] reported the occurrence of a lesion at an edentulous site in a 49-year-old woman in an isolated case of multicentric PCOF, which raises more questions about the pathogenesis of this type of lesion.

The clinical characteristics directed to a differential diagnosis of irritation fibroma, pyogenic granuloma, or PGCG in this case. As the clinical appearance of these lesions can be strangely analogous, they are classified built on their discrete histologic variances. According to Eversole and Rovin, these lesions could merely be different histologic responses to irritation.[7] POF cellular connective tissue is so distinctive, according to Gardner, that a histologic diagnosis can be made with certainty irrespective of the existence or absenteeism of calcification.[8]

The occurrence of giant cells in connective tissue stroma was not detected on histopathology, proscription the prospect of a peripheral giant-cell granuloma. The eradication of etiological factors, scaling adjacent teeth, as well as destructive surgical excision are all part of PCOF treatment. Complete initial removal, repeated injury, and/or the continuance of local irritants have all been blamed for the recurrence.[9],[10]

  Conclusion Top

To permit precise patient estimation as well as management, the detection of any reactive lesions necessitates the devising of a differential diagnosis. Confirmation of the diagnosis requires radiological and histopathological examination. POF is a pathological entity with a wide range of clinical and pathological manifestations. When compared to other reactive lesions, surgical excision is considered curative but has a high recurrence rate.

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form the patient (s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.

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Conflicts of interest

There are no conflicts of interest.

  References Top

Waldron CA. Fibro-osseous lesions of the jaws. J Oral Maxillofac Surg 1993;51:828-35.  Back to cited text no. 1
Delbem AC, Cunha RF, Silva JZ, Soubhia AM. Peripheral cemento-ossifying fibroma in child. A follow-up of 4 years. Report of a case. Eur J Dent 2008;2:134-7.  Back to cited text no. 2
Buchner A, Hansen LS. The histomorphologic spectrum of peripheral ossifying fibroma. Oral Surg Oral Med Oral Pathol 1987;63:452-61.  Back to cited text no. 3
Kumar SK, Ram S, Jorgensen MG, Shuler CF, Sedghizadeh PP. Multicentric peripheral ossifying fibroma. J Oral Sci 2006;48:239-43.  Back to cited text no. 4
Neville BW, Damm DD, Allen CM, Bouquot JE. In: Text Book of Oral and Maxillofacial Pathology. 2nd ed. Philadelphia: W.B. Saunders Co.; 2004. p. 451-2.  Back to cited text no. 5
Kenney JN, Kaugars GE, Abbey LM. Comparison between the peripheral ossifying fibroma and peripheral odontogenic fibroma. J Oral Maxillofac Surg 1989;47:378-82.  Back to cited text no. 6
Eversole LR, Rovin S. Reactive lesions of the gingiva. J Oral Pathol 1972;1:30-8.  Back to cited text no. 7
Gardner DG. The peripheral odontogenic fibroma: An attempt at clarification. Oral Surg Oral Med Oral Pathol 1982;54:40-8.  Back to cited text no. 8
Cuisia ZE, Brannon RB. Peripheral ossifying fibroma – A clinical evaluation of 134 pediatric cases. Pediatr Dent 2001;23:245-8.  Back to cited text no. 9
Rossmann JA. Reactive lesions of the gingiva: Diagnosis and treatment options. Open Pathol J 2011;5:23.  Back to cited text no. 10


  [Figure 1], [Figure 2], [Figure 3]


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