Peripheral Ossifying Fibroma in the Anterior Mandibular Gingiva: A Case Report

Abstract

Peripheral ossifying fibroma (POF) is a benign, reactive gingival lesion whose clinical features may resemble those of other localised gingival enlargements. This case report describes the clinical, radiographic and histopathological findings, management and follow-up of POF involving the anterior mandibular gingiva of a 50-year-old woman. The patient presented with a painless swelling of 10 years’ duration that had gradually enlarged and interfered with speech and mastication. Examination revealed a pedunculated, firm lesion measuring 1.5 × 1.5 cm, arising between teeth 42 and 43, with tooth displacement, gingival recession and Grade II mobility of several mandibular anterior teeth. Intraoral periapical radiography demonstrated horizontal alveolar bone loss of approximately 3–6 mm but no radiographically visible calcification. The provisional diagnosis was reactive gingival overgrowth, and the differential diagnoses included irritation fibroma, peripheral odontogenic fibroma and POF. The lesion was surgically excised, followed by elevation of a mucoperiosteal flap and curettage of the lesion bed. Histopathological examination identified dense collagenous connective tissue, chronic inflammatory cell infiltration and immature bony trabeculae containing osteocytic lacunae, establishing the diagnosis of POF. Healing was satisfactory at four months, and no recurrence was reported during two years of follow-up. This case illustrates the importance of histopathological confirmation in gingival lesions with non-specific clinical features and absent radiographic calcification.