Atypical hard tissue formation around multiple teeth

Abstract

Over the preceding 4 months, a 36-year-old man had noticed an irritation of the gingiva in the upper left premolar and molar region with exposure of root surfaces. He did not complain of pain. Other than a history of smoking (20 cigarettes per day, 20 cumulative packyears), the patient did not present with any medical problems and was not taking any medications. The patient, who was a farmer, reported a trauma which had taken place 15 years earlier, in which a cow horn had perforated his left cheek. No dental trauma had been noted and no radiographs had been taken at that time. On clinical investigation, a flattening of the left cheek and a scar in the overlying skin were visible. No intraoral swelling or expansion was present. On the buccal side of the upper left first molar and in the interdental space next to the second premolar, extensive gingival recession with exposure of a brownish irregular hard dental structure was conspicuous (Fig. 1). The hard structure seemed to be fused to the roots. Periodontal pocket probing in the upper left jaw gave