Gingival Lesions Research Articles

ГИСТОПАТОЛОГИЧЕСКИЕ ИЗМЕНЕНИЯ В ДЕСНЕ НА ПРЕДИМПЛАНТАЦИОННОМ ЭТАПЕ: АНАЛИЗ СЕРИИ КЛИНИЧЕСКИХ СЛУЧАЕВ

An inflammatory process in the gingival and/or periodontal tissues prior to implantation seems to be a significant risk factor contributing to impaired osteointegration with implant rejection in the early or late stages due to the development of periimplantation mucositis followed by periimplantitis. In this regard, the task of searching for highly informative markers, both morphological and laboratory, as well as molecular genetic markers, remains extremely relevant, allowing predicting the risk of developing periimplantitis in various populations. An equally urgent task is the search for effective means of adjuvant therapy and prevention of inflammatory complications after dental implantation. The aim of this study was a comprehensive histopathological assessment of the state of the gingiva by biopsy at the stage before implantation in a clinical case series.
 In a clinical case series (25 patients), using a descriptive histological method, a histopathological analysis of gingival biopsy samples obtained at the stage of implant placement was performed. The data of the descriptive histological analysis were supplemented by the results of an immunohistochemical study for the expression of vitamin D receptors (VDR) in the gingival tissues and inflammatory infiltration cells.
 According to the results of a descriptive histopathological analysis, in 7 out of 25 cases (28%) in the gingival tissues of the edentulous area of the jaw in the area of the included defect of the dentition, the phenomenon of less or more pronounced chronic inflammation was revealed, manifested in lymphocytic or mixed lymphohistiocytic infiltration. Other significant histopathological changes were presented by the changes in the gingival epithelium, as well as disorders in the vessels of the microvasculature. Immunohistochemical analysis demonstrated the presence of a strong nuclear and/or cytoplasmic expression of VDR both in the epithelium and cells of the inflammatory infiltrate, regardless of the age and gender of the patients or the severity of inflammatory changes in the gingival tissues.
 The results of the pilot analysis of clinical case series are of interest for further study of pre-implantation gingival or periodontal lesions, and may help identify biomarkers of the subsequent development of periimplantitis, as well also provide a fundamental rationale for the use of vitamin D as a prophylactic or therapeutic adjuvant.

Increased apoptosis of gingival epithelium is associated with impaired autophagic flux in medication-related osteonecrosis of the jaw

ABSTRACT Macroautophagy/autophagy has both negative and positive aspects in the development of many diseases. Yet, its exact role and specific mechanism in the onset of medication-related osteonecrosis of the jaw (MRONJ) is still not fully understood. Retarded gingiva healing is the primary clinical manifestation in patients with MRONJ. In this study, we aimed to explore the relationship between autophagy and apoptosis in MRONJ gingival epithelium and search for a method to prevent this disease. First, we examined clinical samples from patients diagnosed with MRONJ and healthy controls, finding that autophagy-related markers MAP1LC3/LC3 and SQSTM1/p62 synchronously increased, thus suggesting that autophagic flux was suppressed in MRONJ. Moreover, mRNA sequencing analysis and TUNEL assay showed that the process of apoptosis was upregulated in patients and animals with MRONJ, indicating autophagy and apoptosis participate in the development of MRONJ. Furthermore, the level of autophagy and apoptosis in zoledronic acid (ZA)-treated human keratinocytes cell lines (HaCaT cells) was concentration dependent in vitro. In addition, we also found that RAB7 (RAB7, member RAS oncogene family) activator ML098 could rescue MRONJ gingival lesions in mice by activating the autophagic flux and downregulating apoptosis. To sum up, this study demonstrated that autophagic flux is impaired in the gingival epithelium during MRONJ, and the rescued autophagic flux could prevent the occurrence of MRONJ. Abbreviations: ACTB: actin beta; Baf-A1: bafilomycin A1; CASP3: caspase 3; CASP8: caspase 8; CT: computed tomography; DMSO: dimethyl sulfoxide; GFP: green fluorescent protein; HaCaT cells: human keratinocytes cell lines; H&E: hematoxylin and eosin; MAP1LC3/LC3: microtubule-associated protein 1 light chain 3; MRONJ: medication-related osteonecrosis of the jaw; PARP: poly(ADP-ribose) polymerase; RAB7: RAB7, member RAS oncogene family; RFP: red fluorescent protein; SQSTM1/p62: sequestosome 1; TEM: transmission electron microscopy; ZA: zoledronic acid.

Diagnosis and antidiastole of leukemia-associated gingival lesions

Leukemia is a heterogeneous group of hematological disorders that arises from a hematopoietic stem cell characterized by a disordered differentiation and proliferation of neoplastic cells. The prevalence of leukemia is high in juveniles and adults under 35 years. Gingival manifestations of leukemia include gingiva bleeding, enlargement, pallor, petechial, ulceration, which may be the first clinical signs of leukemia. In the dental clinic, identification of leukemia-associated gingival lesions, referring patients to hematologists without delay will improve the prognosis of leukemia. Diagnosis and antidiastole of leukemia-associated gingival lesions have been discussed with reference to the related cases.

Investigation of Biopsied Non-Plaque-Induced Gingival Lesions in a Turkish Population: A 5-Year Retrospective Study.

The study aimed to analyze the distribution and frequency of individuals diagnosed with histopathologically non-plaque-induced gingival lesions and categorize them according to the non-plaque-induced gingival disease classification published at the 2017 World Workshop of Periodontology. Clinical features of the gingival lesion with histopathological diagnosis data in the period 1998-2003 were retrospectively analyzed . The lesions were classified as reactive lesions, malignant neoplasms, premalignant neoplasms, autoimmune disorders, benign neoplasms, hypersensitive reactions, and genetic lesions. Their distribution according to age, gender, histopathological diagnosis, and oral sites was examined. Variables were analyzed using descriptive statistics. Among a total of 217 biopsied gingival samples, the most frequent pathologic nature of biopsied non-plaque gingival lesions were reactive lesions (n=80, 36.87%) and premalignant neoplasms (n=64, 29.49%). In addition, the 5 most frequent types of all cases included pyogenic granuloma (n=45, 20.74%), epithelial dysplasia (n = 40, 18.43%), papilloma (n = 33, 15.21%), epithelial hyperplasia (n = 24, 11.06%), and calcifying fibroblastic granuloma (n = 13, 5.99%). In a Turkish population, the most frequently biopsied non-plaque-induced gingival lesions were reactive lesions and premalignant neoplasms. This study shows that the types of lesions that clinicians, in gen- eral, especially periodontologists, can expect to encounter in their practice are the most frequently applied gingival lesions.

LOCALIZED JUVENILE SPONGIOTIC GINGIVAL HYPERPLASIA: A CASE REPORT

Localized juvenile spongiotic gingival hyperplasia (LJSGH) is a gingival lesion with distinct clinicopathologic features that may represent an isolated exteriorized junctional patch. This study showed a 7-year-old male patient presenting a well-circumscribed, erythematous overgrowth on the anterior maxillary gingiva. He had a history of several traumas in deciduous dentition in the same region. Intra-oral evaluation demonstrated easy bleeding upon manipulation of the lesion. Periapical and panoramic radiography showed no alterations. An incisional biopsy was performed and the histopathological and immunohistochemical analysis revealed prominent spongiosis in a hyperplastic epithelium, exocytosis by neutrophils, and immunopositivity to CK19. These findings correspond to an epithelium, similar to junctional areas, that does not occur in facile gingiva, establishing the diagnosis of LJSGH. The patient remains in follow-up with no recurrence of the lesion. Localized juvenile spongiotic gingival hyperplasia (LJSGH) is a gingival lesion with distinct clinicopathologic features that may represent an isolated exteriorized junctional patch. This study showed a 7-year-old male patient presenting a well-circumscribed, erythematous overgrowth on the anterior maxillary gingiva. He had a history of several traumas in deciduous dentition in the same region. Intra-oral evaluation demonstrated easy bleeding upon manipulation of the lesion. Periapical and panoramic radiography showed no alterations. An incisional biopsy was performed and the histopathological and immunohistochemical analysis revealed prominent spongiosis in a hyperplastic epithelium, exocytosis by neutrophils, and immunopositivity to CK19. These findings correspond to an epithelium, similar to junctional areas, that does not occur in facile gingiva, establishing the diagnosis of LJSGH. The patient remains in follow-up with no recurrence of the lesion.

Clinical Characterisation of Caudal Traumatic Malocclusions and Treatment Outcomes in Cats (2018-2022).

Caudal malocclusions in cats may result in a variety of traumatic lesions affecting the soft tissues of the ipsilateral mandible such as fovea, gingival cleft, and proliferative lesions. Fifty-one cats diagnosed with a traumatic caudal malocclusion were compared with a control hospital population and evaluated for prevalence with respect to breed and sex. Twenty-two cats that were treated had radiographic, clinical findings, and the outcome of treatment (extraction or odontoplasty) recorded. Maine Coon, Persian, and male neutered cats were overrepresented while Domestic Shorthairs were underrepresented within the study population. Radiographically, 50% of the fovea lesions had an area of decreased bone density in the region of the lesion and none of these had evidence of periodontal disease. All gingival cleft lesions had radiographic changes consistent with periodontal disease. 15.4% of proliferative lesions presented with radiographic changes, with only half of those presenting with both radiographic and clinical evidence of periodontal disease. Eleven cats were treated by odontoplasty and eleven by extraction. One cat treated by odontoplasty developed new lesions caudally, and another had persistence of the initial lesions. Two cats in the extraction group developed new lesions rostral to the extracted teeth. In most instances, odontoplasty or extraction resulted in successful soft tissue lesion resolution. In rare cases, additional treatment was necessary due to either persistence or development of new lesions.

Peripheral ossifying fibroma-Case report

Peripheral ossifying fibroma is a reactive lesion arising from periodontal cells in response to local irritation with females in second decade of their life are more affected and with maxillary anterior region predilection. Clinical appearance with erythmatous or pink in colour with large lesions are generally smooth. Lesion usually not exceed 1.5 cm. Underlying bone sometimes shows loacalized bone erosion. Treatment usually involves exicision of the lesion with histopathological examination. Chances of recurrence after complete removal is higher. 19 year old female patient came with complain of swelling of gingiva at 43 44 region with clinical examination reveal 1cm × 1cm lesion with pink in colour and smooth surface and radiographic examination showing localized bone loss. After complete phase 1 therapy, exision of the lesion was performed and excised lesion was tranferd in 10% formalin for histopathological examination immediately. Hyperplastic stratified parakeratinized epithelium with connective tissue stroma havind osteocytes and osteoblasts and cementum like material lead to diagnosis of Peripheral Ossifying Fibroma(POF). POF is a third most common gingival reactive lesion. Histopathological and clinical examination require to confirms the diagnosis.

AN UNUSUAL PRESENTATION OF SOFT TISSUE FIBRO-OSSEOUS LESION: A CASE REPORT

Diagnosis of peripheral oral exophytic lesion is quite challenging. Pathologic growth protruding above the normal contour of the oral mucosa is referred to as an oral exophytic lesion. The most frequent lesions found in patients are gingival lesions, and the majority of these are reactive hyperplasia's linked to a variety of persistent irritant stimuli. Nodules of inammatory brous hyperplasia are very common. Irritation broma, pyogenic granuloma, peripheral ossifying broma, and peripheral giant cell granuloma are some of the reactive lesions of the gingiva. The lesions are typically mucosal in colour but can occasionally include localised ulceration. Presenting a case of 30-year-old female with swelling in the anterior Maxillary gingiva, the clinical presentation of which differs from the usual presentation with no radiographic changes

Aggressive pyogenic granuloma mimicking a malignant lesion: Case report and review.

A pyogenic granuloma is a reactive hyperplastic inflammatory lesion that arises as a result of various stimuli such as low-grade local irritation, trauma, hormones, and certain medications. In the oral cavity, it is a relatively common gingival soft tissue lesion, which originates as an expansile growth of the mucous membrane. It could exhibit aggressive behaviour mimicking that of malignant lesions with different presentations. This article aims to present the case of a patient who attended the dental clinic while complaining about a large and rapidly growing intraoral mass with aggressive behaviour, which had manifested as a fast-growing lesion causing rapid expansion of the buccal and palatal bone, bleeding, and alveolar bone destruction associated with mobile teeth. The article also aims to compare this case with current reported cases of aggressive pyogenic granuloma in the literature.

The prevalence of oral and maxillofacial pathologic lesions in pathology centers of Zanjan (Iran) over a 5-years period (2014-2020)

Background and objectives: The oral and maxillofacial region is exposed to many harmful agents and can be affected by a wide range of reactive, infectious, cystic, precancerous, and neoplastic lesions. This study aimed to determine the prevalence of oral and maxillofacial pathological lesions in pathology laboratories in Zanjan. 
 Method: This retrospective descriptive study was conducted in the period 2014 -2020 by referring to the hospitals and laboratories with pathologists in Zanjan. Information about patients with histopathological lesions of oral and maxillofacial region was extracted, and studied in terms of age, gender, location and histopathological type of lesion. Finally, the collected data were entered into SPSS software version 22 and statistically analyzed (P <0.05).
 Results: A total of 176 histopathological lesions were investigated. Of them, 120 cases (58%) were female and 74 (42%) were male. The mean age of the patients was 39.4 years. The most prevalent lesion was periapical cyst (14.8%).In terms of tissue involved, the most lesions were related to soft tissue (67%) and in terms of anatomical location, the most lesions were gingival mucosal lesions (35.2%).
 Conclusion: The prevalence of pathological lesions was higher in females than in males. Soft tissue lesions were more than hard tissue lesions. Gingival mucosal lesions were the most prevalent and lesions of the floor of the mouth and nasal vestibule lesions were the least prevalent ones. Given the histopathologic nature of lesions, periapical cyst was the most prevalent lesion.

Multifocal Gingival Squamous Cell Papilloma: A Case Report and Literature Review

Squamous Cell Papilloma (SCP) is a benign, asymptomatic, exophytic cauliflower-like growth of mucosal mass. It is mostly associated with Human Papilloma Virus (HPV) subtypes 6 and 11, and has a very low virulence and infectivity rate. The papillomas are commonly known as warts or verrucas when found on the skin. The typical lesion is a single mass with finger-like extensions, resembling a soft, pedunculated growth supported by a stem or stalk. If keratin, a skin protein, accumulates around the lesion, the projections can be long and pointed or short and rounded. Intraorally, the most common sites of occurrence are the tongue, lips, buccal mucosa, palate, and uvula. Hereby, the author present a case report of 25-year-old male patient with a 4x9 mm exophytic growth exhibiting a pebbled surface in the upper left first premolar region, with no signs of radiographic bone loss. Additionally, smaller pinpoint lesions were observed bilaterally in the interdental region of the first and second maxillary molars. A nevus on the right side of the face was also noted. Histological analysis confirmed the diagnosis of SCP. The presence of multifocal gingival squamous papilloma, along with an extraoral nevus, represents a novel finding that warrants reporting. The gingival lesion in the maxillary left first premolar region was surgically excised, along with 1 mm of healthy surrounding gingiva. This resulted in complete healing, and no recurrence was observed during the 12-month follow-up period.

Association of periodontal disease with oral lichen planus: A systematic review and meta analysis.

Gingival lesions in oral lichen planus can indirectly increase the risk of plaque-induced periodontal disease when symptoms associated with such lesions hamper the proper oral hygiene maintenance by the patients and can increase the risk of periodontal tissue destruction. This systematic review analyses the existing evidence on the association between oral lichen planus and periodontal disease. This systematic review of case-control studies aimed to analyse the association between periodontal disease and oral lichen planus. An electronic database search for randomised controlled trials, experimental studies, case-control studies, and cohort studies published in peer-reviewed Journals in the English language was conducted from the following databases: PubMed, EBSCOHost, Science Open, EMBASE, and Google Scholar. A total of 12,507 were identified on an electronic database search. Only eight studies fulfilled the eligibility criteria and were included for quantitative analysis. A data extraction sheet was prepared, and studies were analysed. Bleeding on Probing and Probing depth were seen to be significantly associated with Oral Lichen Planus. The symptoms in Oral Lichen Planus impede efficient oral hygiene maintenance by a patient and predispose them to the occurrence of long-term Periodontal Disease.

Gingival and alveolar mucosal reactive hyperplastic lesions: a retrospective clinical and histological study of 996 cases.

gingival/alveolar mucosal reactive hyperplastic lesions (GRHL), including fibrous hyperplasia (FH), pyogenic granuloma (PG), peripheral ossifying fibroma (POF) and peripheral giant cell lesion (PGCL), are a common group of oral diseases. The aim of the present study was to access the frequency and distribution of the clinical and histological features of these disorders in a Brazilian population. all specimens diagnosed as GRHL in three Oral Pathology laboratories were selected for the study. Clinical information was retrieved from the laboratory biopsy forms and hematoxylin and eosin stained histological slides were reviewed for analysis of the histological characteristics. final sample was composed of 996 specimens, including 463 FH (47%), 280 PG (28%), 183 POF (18%) and 70 PGCL (7%). Females were more affected by FH, PG, and POF, and most cases affected adults with mean ages ranging from 40 to 53 years. FH, PG, and POF were more common in the upper gingiva/alveolar mucosa. Most PG, POF and PGCL were pedunculated, in contrast with FH (p<0.001). PG, FH and POF were mostly red or normal mucosal in color, while PGCL were mostly red/purple (p<0.001). PGCL were larger, followed by POF, FH and PG (p<0.001). Some histological features were characteristically found in some conditions, but they were also encountered in other lesions with variable frequencies. Oral medicine specialists, oral pathologists and periodontists are usually the professionals in contact with patients presenting GRHL and it is of upmost relevance that they should be familiarized with their clinical and histological profile.

Refractory multiple myeloma presenting as oral gingival mass

Multiple myeloma (MM) is a disseminated multifocal hematologic malignancy characterized by the proliferation of a single clone of abnormal plasma cells in the bone marrow (BM) and/or extramedullary sites. Maxillofacial manifestations in patients with MM are common but frequently misdiagnosed. In the present case, a 65-year-old male with MM presented with a maxillary gingival mass lesion on the left side of the oral cavity. Fine-needle aspiration cytology (FNAC) and microscopic nodule examination revealed tumor cells (plasmablasts). Being vigilant about oral metastatic lesions in a known case of MM suggested starting a workup for MM relapse, and subsequent BM workup and serum immunofixation confirmed MM relapse. This case emphasized the oral cavity lesions in the known case of MM, the utility of the FNAC, and an interdisciplinary approach to such lesions for early diagnosis and initiation of treatment.

Gingival lichen planus: A clinical and pathological study

BackgroundOral lichen planus (OLP) is a common immune-mediated chronic inflammatory disease affecting the oral mucosa. It is most likely to occur in adults, particularly in women. The most commonly affected areas are the buccal mucosa, tongue and gingiva, either alone or in combination. The aim of this study was to analyse the clinicopathological characteristics of gingival lichen planus in a series of patients diagnosed between 2000 and 2019. Materials and methodFiles of 190 patients with histopathologically confirmed gingival lichen planus were retrieved from the archives of the Laboratory of Oral and Maxillofacial Pathology of the Geneva University Hospitals. We analysed the demographic characteristics of the patients, the location, clinical presentation and histopathological characteristics of the lesions, and the presence of symptoms. ResultsThe majority of the patients were women (74.2%). The age ranged between 12 and 88 years of age, with a mean of 58.6 years. 79 cases (41.6%) of gingival lichen planus were confined to the gingiva. In the remaining cases, the gingival lesions were associated with other localisations, mostly the buccal mucosa and the tongue, as well as other intraoral and extra-oral sites. 38.7% of the patients presented mixed form of OLP, 27.8% keratotic form and 22.4% erythematous/erosive form. The mixed and the erythematous/erosive forms were the most symptomatic lesions. The majority of gingival lichen planus were active atrophic. A total of seven malignant transformation were found (3.7% of the cases). ConclusionGingival lichen planus is a chronic disease that can have many different clinical and histological presentations. Long-term regular follow-up of gingival lichen planus is recommended to detect signs of malignant transformation.

Reactive Gingival Lesions, Investigations, And Treatment Modalities: Review Article

Background and Objectives: Reactive gingival lesions (RGLs) are benign solitary swellings frequently responding to chronic inflammation of gingiva precipitated by local irritation. The research article was designed to discuss clinical and pathological features, and treatment options of RGLs. These lesions are generally clinically similar but histologically different. Various treatment modalities have been used, including surgical blade excision, laser surgical techniques, electrosurgery and cryosurgery. Laser surgeries present more benefits, especially for the hemorrhagic and vascularized lesions in comparison to others. Conclusions: The incidence of RGLs are secondary precipitated to tissue damage and local irritating factors which are like benign rather than malignant masses. Clinical and histological investigations are designated to classify the nature of RGLs. Improvement of oral health, besides complete removal of local irritants through professional periodic care and maintaining oral cleaning measures, is necessary to avoid the recurrence of these lesions.

Chronic Ulcerative Stomatitis (CUS) as an Interdisciplinary Diagnostic Challenge: A Literature Review.

Chronic ulcerative stomatitis (CUS) is a rarely reported disease affecting the oral cavity, most often affecting middle-aged Caucasian females. The aim of the present study is to present the diagnosis, differentiation, and interdisciplinary treatment of this rare disease. CUS is characterized by the presence of an oral erosive or ulcerative lesion. The autoimmune pathogenesis of CUS includes affecting the antigen's activity by DNA-breaking and protein-hydrolyzing enzymes. The stratified epithelium-specific antinuclear antibodies (SES-ANA) are associated with CUS development. Clinically, the lesions presented in oral mucosa might resemble an erosive form of oral lichen planus, whereas gingival lesions seem to be similar to desquamative gingivitis related to dermatological diseases manifested in the oral cavity. Patients often report subjective symptoms related to oral mucosa and general symptoms. Histopathological presentation of CUS is often non-specific and includes sub-epithelial separation from underlying connective tissue, atrophic epithelium, and inflammatory infiltrate with an increased number of plasma cells and lymphocytes. Direct immunofluorescence (DIF) might be used in CUS diagnostics. CUS generally remains nonsusceptible to corticosteroid treatments; however, antimalarial drugs and calcineurin inhibitors are more effective. Further research should be conducted in order to implement a diagnostic protocol and observe the long-term results of CUS management.

Population-based cohort study to assess the gingival lesions in 1319 patients with lichen planus.

Oral lichen planus (OLP) is a chronic immune disease. In this paper, we evaluated the overall characters, clinical presentation, and outcome of gingival lesions in OLP Italian patients. A retrospective cohort study was accomplished: a total of 1319 charts were investigated, of whom 922 were female (69.9%): 617 patients (46.8%) manifested white lesions and 702 red ones (53.2%). While most patients had several oral sites of involvement, the gingiva was the unique location in 103 cases. Symptoms were reported in 480 patients (36.4%): 286 patients with erosive OLP, 103 with atrophic form, and 91 with a white form. Long-lasting surveillance showed that only 40 patients (3.03%) had a total clinical signs remission. Regarding OLP medical treatment provided, patients attending less frequently a dental office underwent more often a specific therapy. To the best of our knowledge, this is the biggest collections of patients with gingival OLP ever described; exclusive gingival lesions are, however, rare and unlikely to undergo a malignant transformation. Moreover, gum lesions seemed to anticipate the appearance of oral lesions and a higher rate of OLP therapy was observed in patients with less frequent dental check-ups and oral hygiene instructions.

Rare Nodular Lesion on Gingiva - Peripheral Odontogenic Fibroma

Peripheral odontogenic fibroma (POF) is a rare lesion, the extraosseous counterpart of the odontogenic fibroma, an odontogenic tumor of ectomesenchymal origin. Clinically it resembles as the reactional processes and has slow growth. The purpose of the study is to present a clinical case of posterior maxillary POF mimicking inflammatory periodontal disease in a 42-year-old woman who, after complete surgical excision, is followed up every six months without recurrence of the lesion. POF is a lesion characterized by fibroblast proliferation containing portions of apparently inactive odontogenic epithelium. The surgical treatment, when well performed, presents a very favorable prognosis, with a rare chance of relapse. It is important to emphasize that all the gingival lesions should be submitted to the anatomopathological examination, and the radiographic examination of the region is fundamental to evaluate the extent of the lesion.

Conventional surgical excision for the treatment of Peripheral Cemento-Ossifying Fibroma Posterior Maxilla: Case report

Background: Peripheral Cemento-Ossifying Fibroma (PCOF) usually presents as epulis, represents 3.1% of all oral tumors and 9.6% of gingival lesions, is difficult to distinguish clinically and radiographically, requires anatomic histopathological confirmation, peaking in the 2nd and 3rd decades, high recurrence 8-20%. Objective: To report the case management of Peripheral Cemento-Ossifying Fibroma in posterior maxilla with conventional surgery excision surgery, curettage, extraction, and ostectomy. Case: A 42-year-old woman came to the Oral Surgery Clinic at RSUD Haji East Java Province Hospital, complaining of a lump in left maxillary gingiva since 2 years ago, with discomfort, often bitten, initially small, gradually enlarged and never shrinking, does not bleed easily, no lumps elsewhere, with sharp remnants of roots, loose teeth, and a history of vertigo. Discussion: The results of FNAB is Fibromatous Epulis, panoramic radiographic view of the loose periodontal ligament of tooth 27, radiolucent mixed radiopaque clearly demarcated in the distal portion of 27, no visible image of tooth 28. Calculus was cleaned before surgery. Treatments with conventional surgery were excision using a scalpel, curettage, ostectomy, and tooth extraction 27, 38. Histopathological results of postoperative anatomy showed bone trabeculae and “cementum like” tissue in accordance with cemento-ossifying fibroma. The patient was evaluated within 6 months, with no recurrence. Results: Treatment of peripheral cemento-ossifying fibroma with conventional surgery with excision, curettage, ostectomy, and extraction of the causative tooth was successful.