Gingival enlargement is a common form of periodontal tissue reaction to several irritating factors. The most common form is the
drug related
gingival hyperplasia--nevertheless the heredity
gingival fibromatosis and hematological cases can also occur and might impose a challenge to periodontists. After a short literature summary three Case reports are presented. The first case is a
drug related
gingival overgrowth in a young kidney transplant women who took
Cyclosporin-A. The excessive mass of fibrotic tissue was removed by a series of internal beveled incision and the oral and buccal gingival flaps were united with
sutures. The healing was uneventful and during the follow up patient's compliance and
oral hygiene was superb. The second case is a very severe
antihypertensive drug related
gingival overgrowth in a 62 years old man interfering with the closure of his lip and corrected with a combination of conventional
gingivectomy and internal reverse beveled incision both and Ca-channel blockers. The third case is a 42 years old woman with chronic idiopathic
hemolytic anemia who presented a sudden onset acute excessive generalized gingival enlargement accompanied with severe
pain and
fever. At admission she was suspect for
leukemia. After obtaining biopsy samples and having negative histology the soft tissue mass was removed under
general anesthesia with conventional
gingivectomy technique, but after a couple of days the severe
pain and gingival swelling recurred. With administering systemic
corticosteroid therapy (32 mg
Medrol), the gingiva healed in five days and the one year follow-up showed a stable hematological and periodontal status. Today the more conservative internal beveled incision is preferred over the conventional
gingivectomy in the most cases because it provides a more predictable healing and better esthetics. The recurrence of the
drug related
gingival hyperplasia can be anticipated by meticulous postoperative individual
oral hygiene and regular supportive
therapy.
CONCLUSION: The combined conservative and surgical
therapy leads to predictable postoperative result even in very severe systematically motivated gingival enlargements, nevertheless the successful patients management needs good cooperation with medical doctors and with the patients themselves.