RESUMEN
INTRODUCTION: The peripheral ossifying fibroma (POF) is a benign reactive lesion that exclusively arises from gingiva. The lesion may gain considerably large sizes and present peculiar clinical and radiographic features that would then allow it to be called a giant POF; in that case, its otherwise simple surgical extraction could create a challenge. Thus, we elect here, for the very first time, a plausible alternative for treating giant POF: piezosurgery followed by placement of platelet-rich fibrin (PRF). CASE PRESENTATION: A 31-year-old black male presented a large asymptomatic nodule on the lower gingiva; the lesion had caused vestibular displacement of teeth and had been present for 18 years. Following the diagnostic hypothesis of a giant POF, an excisional biopsy was performed under local anesthesia using piezosurgery (microvibration of 36,000 times/sec was used in a bone cortical working mode), which confirmed the diagnosis. The surgical procedure was facilitated with the use of piezosurgery followed by placement of PRF, being the trans- and postoperative periods occurred with no complications. One year after the treatment, the patient shows no signs of disease recurrence and remains under follow-up. CONCLUSIONS: Giant POF is a rare gingival reactive lesion that can reach large dimensions, causing teeth displacement, functional, and esthetic impairments. The lesion can be successfully managed with piezosurgery and PRF, as illustrated herein, avoiding extensive bone loss and damage to the surrounding soft tissues.
Asunto(s)
Fibroma Osificante , Enfermedades de las Encías , Piezocirugía , Fibrina Rica en Plaquetas , Adulto , Fibroma Osificante/terapia , Enfermedades de las Encías/terapia , Humanos , Masculino , Recurrencia Local de NeoplasiaRESUMEN
AIM: The objective of this prospective study was to investigate outcomes of a lip repositioning technique for the treatment of excessive gingival display. MATERIALS AND METHODS: Thirteen consecutively treated patients with excessive gingival display were treated with a modified lip repositioning technique. Treatment consisted of the removal of two strips of mucosa, bilaterally to the maxillary labial frenum and coronal repositioning of the new mucosal margin. The clinical dimensions of gingival display, upper lip and vermillion length were measured at baseline, 3 and 6 months post-operatively. Subjects completed surveys to evaluate satisfaction with outcomes. RESULTS: The baseline gingival display of 5.8 ± 2.1 mm significantly decreased to 1.4 ± 1.0 mm at 3 months (p < 0.0001) and was maintained until 6 months (1.3 ± 1.6 mm). The reduction in gingival display strongly correlated to the combined change in upper lip and vermillion length (r(2) = 0.60, p = 0.0018). Subjects were satisfied with their smile after surgery and would likely choose to undergo the procedure again (92%). The worst part of undergoing the procedure was the discomfort or the inability to move the lip during the early healing (69%). CONCLUSION: Treatment of excessive gingival display by means of a modified lip repositioning technique results in high level of patient satisfaction and predictable outcomes that are stable in the short term.