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Clinical Characteristics of Peripheral Ossifying Fibroma: a Series of 20 Cases

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Clinical Characteristics of Peripheral Ossifying Fibroma: a Series of 20 Cases Received: 19 Apr. 2014 Accepted: 18 Oct. 2014 Clinical characteristics of peripheral ossifying fibroma: A series of 20 cases Mohammad Reza Zarei DDS, MD 1, Nader Navabi DDS, MD 2, Goli Chamani DDS, MD 1, Sepideh Pour-Monajemzadeh DDS 3 Original Article Abstract BACKGROUND AND AIM: Peripheral ossifying fibroma (POF) is a reactive chronic localized hyperplastic gingival lesion. The present case-series was undertaken to determine the clinical variations in a series of different cases of oral POF. METHODS: Demographic and clinical data including age, gender, location, color, clinical diagnosis, size, consistency and radiographic view of the lesions were studied among clinical records at school of dentistry in Kerman, Iran, from 1998 to 2012. RESULTS: A total of 20 POF cases was subjected to clinical analyses, in equal numbers of men and women. The total frequency of POF was 2.5%, and 11 cases (55%) had occurred in the maxilla. POF showed a greater frequency of pink color (60%), anterior location (55%), firm consistency (85%) and a size of 1-1.5 cm (60%). Bone resorption and calcification were found in 35% and 25% of cases, respectively. CONCLUSION: In comparison with previous studies, despite investigation of similar clinical features of POF in the present study, findings also showed that characteristics such as age, gender and location cannot help in the differential diagnosis of POF from pyogenic granuloma. KEYWORDS: Peripheral Ossifying Fibroma, Fibroma, Gingiva, Oral Cavity Citation: Zarei MR, Navabi N, Chamani G, Pour-Monajemzadeh S. Clinical characteristics of peripheral ossifying fibroma: A series of 20 cases. J Oral Health Oral Epidemiol 2014; 3(2): 92-7. eripheral ossifying fibroma (POF) is including subgingival accumulation of a relatively uncommon fibrous plaque and calculi, dental appliances, and P lesion of the gingiva. The lesion tooth restorations which have low quality. 1-3 have named differently by different However, some investigators believe that authors, including fibrous epulis, calcifying hormones might have a role in the lesion fibroblastic granuloma or peripheral fibroma because prepubertal patients are rarely with calcification. 1 The etiology of the lesion, affected, and the disease incidence decreases which is considered a non-neoplastic lesion significantly after 30 years of age. 2 of the gingival tissue, is attributed to POF appears as an exophytic lesion on the irritation and trauma. Despite the fact that gingiva and enlarges slowly, most often this lesion is thought to be relatively measuring < 2 cm; however, some lesions common, it accounts for less than 1% of all might be larger. It occurs in the gingival the oral biopsies. 2,3 interdental papilla, with a sessile or POF is widely believed to originate from pedunculated base; the color might be similar underneath the periodontium from the to gingiva or somewhat reddish and the inflammatory hyperplasia of the periodontal lesion surface might exhibit ulcerations. 4-6 In ligament and due to locally irritating factors, the majority of the studies, the anterior 1- Associate Professor, Department of Oral Medicine, School of Dentistry, Kerman University of Medical Sciences, Kerman, Iran 2- Assistant Professor, Department of Oral Medicine, School of Dentistry, Kerman University of Medical Sciences, Kerman, Iran 3- General Dentist, Private Practice, Kerman, Iran Correspondence to: Nader Navabi DDS, MD Email: [email protected] 92 J Oral Health Oral Epidemiol/ Summer & Autumn 2014; Vol. 3, No. 2 http://johoe.kmu.ac.ir, 6 July 20 cases of peripheral ossifying fibroma Zarei et al. maxillary involvement was more than reported the frequencies of various types of mandible. 6 The lesion mainly affects women reactive hyperplastic lesions of the oral cavity and has a predilection for the second decade and none of them focused on POF in their of life. 7 Treatment consists of surgical researches. excision and laboratory examination to The clinical behavior of POF is somehow confirm the diagnosis. 8 varying from the other oral reactive Review of the literature revealed that hyperplastic lesions, for example its high mostly of published articles about POF were percentage of recurrence after treatment and reports of one case and only five studies in differential diagnosis of a serious malignancy which more than one case have been reported which is called osteogenic sarcoma from POF (Table 1). 1-27 must be considered. Moreover in the cases of delayed correct diagnosis, adjacent tooth loss Table 1. Published articles about reporting POF1-27 and alveolar bone resorption would be the Authors Number of case(s) 1 consequences. Therefore, dentists should be Moon et al. 1 informed about POF, which clinically poses a Dahiya et al. 2 1 Passos et al. 3 1 dilemma for the diagnosis among reactive Chaudhari and Umarji 4 1 gingival hyperplastic lesions, especially Silva et al. 5 1 pyogenic granuloma. 3,32 Increasing 6 Prasad et al. 1 knowledge about the specialized 7 Kumar et al. 1 epidemiologic data would be a practical tool Walters et al. 8 3 Pradeep et al. 9 1 for better diagnosis, and this study is the first Nazareth et al. 10 1 case series for illustration of clinical features Sacks et al. 11 1 of POF in Iran. Mishra et al. 12 1 Luvizuto et al. 13 1 Methods Trasad et al. 14 1 The present study is a case series. The Poonacha et al. 15 1 Das and Azher 16 1 materials included all the biopsy specimen Yadav and Gulati 17 1 records of the department of oral medicine, Farquhar et al. 18 1 school of dentistry, Kerman University of Garcia de marcos et al. 19 4 20 medical sciences, Kerman, Iran, between 1998 Shetty et al. 22 and 2012. The records were reviewed for Chaturvedy et al. 21 1 Barot et al. 22 1 demographic data and clinical data including Khan et al. 23 1 sex, age, patient chief complaints, the type, Childers et al. 24 1 size, location, duration, diagnosis, and Rallan et al. 25 1 26 histological characteristics of the lesions. To Verma et al. 4 minimize recurrence, excisional biopsy down Cuisia and Brannon 27 134 POF: Peripheral ossifying fibroma to the bone had been carried out for all the lesions; hence, the medical charts of patients In study of Cuisia and Brannon,27 a clinical with confirmed histopathological diagnosis evaluation was made for pediatric cases, and of POF were selected. The paraffin blocks of Garcia De Marcos et al. 19 demonstrated all the 20 cases were separately analyzed by immunohistochemical features of four cases two oral pathologists again for of POF, however, it seems that in their study re-confirmation of the initial diagnoses. The POF was analyzed only from histological clinical and histopathological diagnoses of point of view. In Iran, four research works POF were made based on the Modified carried out by Zarei et al., 28 Ala et al., 29 World Health Organization classification. 26 Amirchaghmaghi et al. 30 and Naderi et al. 31 At the end, the session was held between J Oral Health Oral Epidemiol/ Summer & Autumn 2014; Vol. 3, No. 2 93 http://johoe.kmu.ac.ir, 6 July 20 cases of peripheral ossifying fibroma Zarei et al. the two pathologists and those cases, which Table 2. The patient demographics and they had a disagreement on diagnosis were statistical data obtained in this study determined. Then an agreement was reached Variable Category n (%) < 30 10 (50) Age (year) regarding these cases after discussion and ≥ 30 10 (50) consultation with another expert pathologist. Male 10 (50) Gender We also selected the blocks of cases with the Female 10 (50) Maxilla 11 (55) final diagnosis of pyogenic granuloma and Jaw giant cell granuloma from the mentioned Mandible 9 (45) Anterior 11 (55) Location academic archive and these blocks also were Posterior 9 (45) reviewed by the two pathologists because of Pink 12 (60) Color differential diagnosis with POF. Radiologic Red 8 (40) evaluation for the presence of calcification POF 10 (50) PG 8 (40) within the lesions was also confirmed by one Clinical diagnosis oral and maxillofacial radiologist. Data were Irritation fibroma 1 (5) GCG 1 (5) evaluated by means of descriptive statistics. Mobility 9 (45) Patient’s data were all kept confidential. Adjacent teeth Diastema 7 (35) Both 2 (10) Results < 1 4 (20) A total of 20 conclusive cases of POF was Size (cm) 1-1.5 12 (60) > 1.5 4 (20) diagnosed in patients during the research Firm 17 (85) period out of 800 total lesions, clinical and Consistency Bony hard 2 (10) histopathologically diagnosed. The total Rubbery 1 (5) frequency of POF in this study was 2.5%. Of Bone resorption 7 (35) all the 20 cases of POF studied, half of the Radiographic view Calcification 5(25) cases had occurred in females and half in Both 3 (15) POF: Peripheral ossifying fibroma; PG: Pyogenic granuloma; males. The age range of the patients GCG: Giant cell granuloma diagnosed with POF was 11-49 years (Table 2); the mean age was 28.85 years with and a history of rapid growth was reported a standard deviation of ± 12.874. Of all the from only 1 patient. patients with POF, the prevalence of POF All the cases were followed up for 2 years was similar between the patients under 30 after the surgical treatment; hence three cases and over 30 years of age; 11 cases had reported that their lesion had recurred in this occurred in the maxilla and 11 cases had period. Almost all the patients were appeared in the region anterior to canines. systemically healthy and only three patients The surface of 12 lesions (60%) was smooth, were medically compromised (one ischemic and the remainders had ulcerated surfaces. heart disease case, one diabetes mellitus case According to the documented histories, in 13 and one asthma case).
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