Inflammatory Fibrous Hyperplasia Research Articles

Beyond the screw: Exploring the recurrence of oral lesions

The integration of skeletal anchorage systems has revolutionized orthodontics, especially with the advent of mini-screws known for their ease of use and minimal invasiveness. The mandibular buccal shelf area, with its ample high-quality bone and low failure rates, has become a preferred extra-alveolar anchorage site. However, complications involving adjacent soft tissues are common with orthodontic bone screw placement. This case report describes the recurrence of reactive oral lesions following placement of orthodontic bone screws in the buccal shelf area. During the course of orthodontic therapy, the patient developed exophytic growths twice, at the same site, on the lower right back buccal mucosa. Diode laser was used in both instances for excision of the lesion and the specimen was sent for histo-pathological analysis. The first lesion was diagnosed as inflammatory fibrous hyperplasia, while the recurrent lesion was identified as pyogenic granuloma. At 12-months follow-up, no new lesions were detected. This report highlights the influence of lesion development time on its clinical and histological presentation. It is postulated that leaving the bone screw in place after initial biopsy could have contributed to its recurrence. Complete excision is the preferred treatment. Treatment options, including laser therapy, are available for such lesions.

Expression of epithelial growth factor receptor as a protein marker in oral reticular and erosive lichen planus

BackgroundOral lichen planus (OLP) is a chronic inflammatory mucosal disease that is classified as a premalignant condition. Epithelial growth factor receptor (EGFR) is associated with tumorigenesis and tumor progression and is overexpressed in several oral malignant disorders. Despite the association of EGFR overexpression with oral potentially malignant lesions, few studies have analyzed its expression in OLP, showing controversial results. This study aimed to compare the expression of EGFR as a protein marker in Reticular and Erosive OLP.MethodsThis descriptive-analytical cross-sectional was conducted on 15 paraffin blocks of reticular lichen planus lesions, 16 paraffin blocks of erosive OLP lesions, and 8 paraffin blocks of inflammatory fibrous hyperplasia lesions as the control group (39 in total). After immunohistochemical staining for EGFR, samples were simultaneously observed by two maxillofacial pathologist, and the percentage of stained cells, intensity of staining, pattern of staining, and the location of stained cells were obtained.ResultsThe Mann-Whitney-U test showed that there was no significant difference in the mean percentage of stained cells between erosive OLP and reticular OLP (P-value = 0.213) and between reticular OLP and control group (P-value = 0.137), but there was a significant difference between erosive OLP and control group (P-value = 0.035). Fisher’s exact test showed that there was no significant difference between the frequency distribution of staining patterns in three types of lesions (P-value = 0.90). Kruskal-Wallis test showed that there was no significant difference between the intensity of staining in the three groups (P-value = 0.19) and also there was no significant difference between the location of stained cells in different layers of the epithelium in the three groups (P-value = 0.90).ConclusionsThe results of this study showed that in comparison of reticular OLP, erosive OLP, and the control group there was a significant difference just between erosive OLP and control group in the percentage of stained cells.

Comparison of the analgesic efficacy of spray and tablet flurbiprofen for pain after soft tissue surgery.

The aim of this randomized clinical study was to assess the comparative efficacy of flurbiprofen in tablet and spray formulations for postoperative pain management in oral soft tissue wounds undergoing primary closure while investigating the feasibility of achieving optimal analgesia with reduced dosage and risk. Forty patients who underwent epulis fissuratum and frenulum excision for pre-prosthetic surgery were randomly assigned to receive either tablet or spray forms of flurbiprofen. The lesion dimensions were measured preoperatively, followed by excision and primary closure. The tablet group received oral tablets containing 100 mg of flurbiprofen twice daily, whereas the spray group received an oral spray containing 0.25% flurbiprofen, administered as two sprays thrice daily. Postoperative pain was assessed using the Numerical Rating Scale (NRS) until the 7th day. Lesion size, drug consumption, and rescue analgesic use were compared between the groups. There were no statistically significant differences in the lesion size between the groups. However, the mean NRS score in the spray group was significantly lower in the spray group compared to than that in the tablet group at 6th hour postoperatively (p = 0.037). Significant differences favoring the tablet group were observed in the first three doses of the drug (p = 0.001). No patients required rescue analgesics. The spray formulation of flurbiprofen demonstrated effective and safe pain relief in oral soft tissue wounds undergoing primary closure, with no reported adverse effects.

Denture-induced fibromatous hyperplasia - case report

<p><strong>Introduction.</strong> Denture-induced fibrous hyperplasia (DFH) is a reactive lesion that occurs as a result of chronic trauma caused by the denture on the oral mucosa.</p> <p><strong>Case report.</strong> A female patient, 56 years old, reported to the Specialist Center for Dentistry at the Faculty of Medicine in Foča for the fabrication of complete dentures. She wore previous complete dentures for about 25 years and complained about their age and discoloration. Clinically, both dentures were poorly retained and stabilized by short wings, with pronounced signs of wear. Denture hygiene was poor. Multiple folds of hyperplasic connective tissue were observed in oral cavity upper vestibule mucosa. The lesion folds were pink and firm, corresponding to denture edges. Based on the anamnesis and clinical examination, a temporary diagnosis of denture-induced hyperplasia was made. The patient was informed about clinical condition assessment as well as possible therapeutic procedures and gave written consent to accept the offered therapeutic procedures. She was advised not to wear dentures for four weeks and to maintain proper oral hygiene. After that, the hyperplasia was surgically removed under local anesthesia. A tissue sample was sent for pathohistological analysis. A new pair of total dentures was made. Removed tissue pathohistological examination confirmed the diagnosis: “Epulis fissuratum”.</p> <p><strong>Conclusion.</strong> Education and regular check-ups are essential for the prevention of DFH. Patients should be given detailed oral and written instructions on oral and denture hygiene maintenance, with special reference to possible changes in oral tissues and the importance of regular follow-ups.</p>

ORAL REHABILITATION IN A TOTAL EDENTULOUS PATIENT WITH INFLAMMATORY FIBROUS HYPERPLASIA: case report

Inflammatory fibrous hyperplasia or fissured epulis is a very common lesion in patients who use maladapted removable prostheses. It consists of a connective tissue overgrowth as a response to constant trauma in a specific area. Clinically, it is presented as an exophytic process or a well-defined elevation. It is generally, sessile-based and asymptomatic. Its consistency varies from firm to flaccid, with smooth surface or occasionally ulcerated, and its color is similar to the adjacent mucosa or erythematous. The most recommended treatment is surgical removal, however there are other methods such as cryotherapy, micro-abrasion and laser therapy. The aim of this work is to describe the stages of diagnosis and treatment, from the surgical technique for removing inflammatory fibrous hyperplasia to the patient's rehabilitation, with new prostheses. This is a case report of a 79-year-old female patient who attended the clinic at Faculdade Patos de Minas (FPM) reporting dissatisfaction with the loss of lip support and the aesthetics of her complete denture prosthetics. During the clinical examination, a nodular tissue growth was identified in the bottom region of the anterior maxillary vestibule’s sac. As a proposed treatment, an excisional biopsy was performed, confirming the diagnosis of inflammatory fibrous hyperplasia through histopathological analysis. After healing, new prostheses were produced, intending to meet the patient's requirements. The present study is expected to emphasize the importance of a thorough clinical examination, so that all changes in the patient are identified and, when necessary, perform a biopsy and histopathological analysis. In summary, it is essential to adjust or produce new prosthetic parts to prevent tissue trauma or cause negative consequences. The patient's postoperative period was uneventful, with favorable healing, and after the new prosthetic devices were put in place, function and aesthetics were restored.

Non-invasive management of massive epulis fissuratum using Nd:YAG lasers—a case report

Non-invasive management of massive epulis fissuratum using Nd:YAG lasers—a case report

Lipometaplasia in fibrous hyperplasia and inflammatory fibrous hyperplasia of the oral cavity.

Lipometaplasia in fibrous hyperplasia and inflammatory fibrous hyperplasia of the oral cavity.

CLINICAL PATHOLOGIC EVALUATION OF GINGIVAL LESIONS: A RETROSPECTIVE STUDY IN A NORTHEASTERN BRAZILIAN REGION

Objective This study aimed to identify main gingiva lesions, diagnosed by the State of Ceará Cancer Screening (SESA). Study Design This is a retrospective observational study, where the histopathological reports of SESA were collected, between the years 2009 and 2019. Sociodemographic and clinical data of the lesion were collected. The data were tabulated in Microsoft Excel and exported to SPSS v20.0; the analyzes were performed adopting a 95% confidence level. Results Absolute and percentage frequencies were calculated using the chi-square test. A total of 920 reports were collected, most of whom were female (63.9%), aged 40-60 years (34.1%), and mixed race (52.2%). Benign lesions were the most prevalent (90.9%). Likewise, inflammatory fibrous hyperplasia was the most common (41.6%), while among malignant lesions, Squamous Cell Carcinoma (SCC) was the most predominant (5.8 %). Dentists showed a higher percentage of correct diagnoses in female patients (p<0.01) and brown patients (p<0.02). In addition, dentists found it easier to diagnose benign lesions (p<0.01). Conclusion It can be concluded that there is a higher frequency of benign lesions, but among the malignant ones, SCC was the most commonly found, affecting mainly women and adults. This study aimed to identify main gingiva lesions, diagnosed by the State of Ceará Cancer Screening (SESA). This is a retrospective observational study, where the histopathological reports of SESA were collected, between the years 2009 and 2019. Sociodemographic and clinical data of the lesion were collected. The data were tabulated in Microsoft Excel and exported to SPSS v20.0; the analyzes were performed adopting a 95% confidence level. Absolute and percentage frequencies were calculated using the chi-square test. A total of 920 reports were collected, most of whom were female (63.9%), aged 40-60 years (34.1%), and mixed race (52.2%). Benign lesions were the most prevalent (90.9%). Likewise, inflammatory fibrous hyperplasia was the most common (41.6%), while among malignant lesions, Squamous Cell Carcinoma (SCC) was the most predominant (5.8 %). Dentists showed a higher percentage of correct diagnoses in female patients (p<0.01) and brown patients (p<0.02). In addition, dentists found it easier to diagnose benign lesions (p<0.01). It can be concluded that there is a higher frequency of benign lesions, but among the malignant ones, SCC was the most commonly found, affecting mainly women and adults.

ORAL FIBROLIPOMA IN THE BUCCAL MUCOSA

A 71-year-old female patient, totally edentulous, presented an asymptomatic lesion in the right buccal mucosa, close to the mandibular branch. Clinically the lesion showed a pedunculated nodule with a smooth surface, normal coloring, softened consistency, measuring approximately 2cm x 2cm. The patient reported a slow growth, with a 4-year evolution. No ulcerations were observed in the region. According to these characteristics, the clinical diagnostic hypotheses were inflammatory fibrous hyperplasia, fibroma, or lipoma. Therefore, the tumor was excised under local anesthesia, and the specimen was submitted to histopathological analysis. Microscopically, we observed a nodular limited lesion with dispersed mature adipocyte proliferation in a dense collagenous fibrous stroma, and lined with hyperplastic and hyperkeratotic squamous epithelium. Given these characteristics, the lesion was diagnosed as fibrolipoma, a histopathological variant of lipoma that is rare in the buccal mucosa. The treatment was concluded with surgical excision and, currently, the patient has shown no recurrence. A 71-year-old female patient, totally edentulous, presented an asymptomatic lesion in the right buccal mucosa, close to the mandibular branch. Clinically the lesion showed a pedunculated nodule with a smooth surface, normal coloring, softened consistency, measuring approximately 2cm x 2cm. The patient reported a slow growth, with a 4-year evolution. No ulcerations were observed in the region. According to these characteristics, the clinical diagnostic hypotheses were inflammatory fibrous hyperplasia, fibroma, or lipoma. Therefore, the tumor was excised under local anesthesia, and the specimen was submitted to histopathological analysis. Microscopically, we observed a nodular limited lesion with dispersed mature adipocyte proliferation in a dense collagenous fibrous stroma, and lined with hyperplastic and hyperkeratotic squamous epithelium. Given these characteristics, the lesion was diagnosed as fibrolipoma, a histopathological variant of lipoma that is rare in the buccal mucosa. The treatment was concluded with surgical excision and, currently, the patient has shown no recurrence.

EVALUATION OF THE ROLE OF ANGIOGENESIS IN THE DEVELOPMENT AND PROGRESSION OF ORAL CANCER

Objective To evaluate the microvascular density (MVD) associated to the progression of oral epithelial dysplasia (OED) towards oral squamous cell carcinoma (OSCC) using immunostaining with alpha-smooth muscle actin (α-SMA). Study Design Eighty cases of OED were selected, in which 41 were low-risk epithelial dysplasia (LRED), and 39 were high-risk epithelial dysplasia (HRED). The group of non-neoplastic epithelium (NNE) consisted of 34 cases of inflammatory fibrous hyperplasia, while the group of neoplastic epithelium contained 36 cases of OSCC. All cases were submitted to immunohistochemical reaction with anti-α-SMA antibody. The MVD in the connective tissue was determined by the average number of immunostained vessels. Results The MVD values for the NNE group (14.07±4.79) were statistically lower (Kruskal-Wallis/Dunn´s Test, P≤0.05) than for OED (18.67±8.25) and OSCC (29.78±23.08) cases. No statistical difference was observed between HRED and LRED cases (Mann-Whitney Test). Conclusion The increase in MVD present in malignant and pre-malignant lesions suggests a possible role of angiogenesis in the progression of these lesions. To evaluate the microvascular density (MVD) associated to the progression of oral epithelial dysplasia (OED) towards oral squamous cell carcinoma (OSCC) using immunostaining with alpha-smooth muscle actin (α-SMA). Eighty cases of OED were selected, in which 41 were low-risk epithelial dysplasia (LRED), and 39 were high-risk epithelial dysplasia (HRED). The group of non-neoplastic epithelium (NNE) consisted of 34 cases of inflammatory fibrous hyperplasia, while the group of neoplastic epithelium contained 36 cases of OSCC. All cases were submitted to immunohistochemical reaction with anti-α-SMA antibody. The MVD in the connective tissue was determined by the average number of immunostained vessels. The MVD values for the NNE group (14.07±4.79) were statistically lower (Kruskal-Wallis/Dunn´s Test, P≤0.05) than for OED (18.67±8.25) and OSCC (29.78±23.08) cases. No statistical difference was observed between HRED and LRED cases (Mann-Whitney Test). The increase in MVD present in malignant and pre-malignant lesions suggests a possible role of angiogenesis in the progression of these lesions.

Surgical and Prosthodontic Management of Denture Induced Hyperplastic Lesion in Maxillary Arch – A Case Series

Denture irritation hyperplasia is a hyper plastic lesion of the oral mucosa which results from chronic irritation as a result of wearing poorly adapted dentures. It is most commonly seen in maxillary arch with female patients being mostly effected. The lesion varies in size from only a few millimeters to extending to involve the entire quadrant. The clinical management of denture induced hyperplasia depends upon the size of lesion and involves the elimination of causative factors, excision of excess fibrous tissue accompanied by an appropriate prosthetic rehabilitation. This case series presents the management of denture induced hyperplastic lesion of varying sizes present in maxillary arch by providing appropriate tissue rest and tissue conditioning as well as by surgical excision followed by new denture fabrication to achieve acceptable function for patients. KEYWORDS: Denture hyperplasia, Epulis fissuratum, Tissue conditioning, Prosthesis

Revolutionizing oral surgery: The benefits of diode laser for soft tissue lesion removal

Epulis fissuratum is a condition where the tissues in the mouth become overgrown due to long-term irritation caused by poorly fitting dentures

Inflammatory fibrous hyperplasia – A case report

Gingival enlargement, the currently accepted terminology for an increase in the size of the gingiva, is a common feature of gingival disease. Local and systemic factors influence the gingival conditions of the patient. These factors results in a spectrum of diseases that can be developmental, reactive and inflammatory to neoplastic. In this case report, the history, etiology, clinical features, treatment strategies and preventive protocol of inflammatory hyperplasia are discussed.

Inflammatory Cells Can Alter the Levels of H3K9ac and γH2AX in Dysplastic Cells and Favor Tumor Phenotype.

Oral potentially malignant disorders (OPMD) are clinical presentations that carry an increased risk of cancer development. Currently, epithelial dysplasia grade is based on architectural and cytological epithelial changes and is used to predict the malignant transformation of these lesions. However, predicting which OPMD will progress to a malignant tumor is very challenging. Inflammatory infiltrates can favor cancer development, and recent studies suggest that this association with OPMD lesions may be related to the etiology and/or aggressive clinical behavior of these lesions. Epigenetic changes such as histone modifications may mediate chronic inflammation and also favor tumor cells in immune resistance and evasion. This study aimed to evaluate the relationship between histone acetylation (H3K9ac) and DNA damage in the context of dysplastic lesions with prominent chronic inflammation. Immunofluorescence of "low-risk" and "high-risk" OPMD lesions (n = 24) and inflammatory fibrous hyperplasia (n = 10) as the control group was performed to assess histone acetylation levels and DNA damage through the phosphorylation of H2AX (γH2AX). Cell co-culture assays with PBMCs and oral keratinocyte cell lines (NOK-SI, DOK, and SCC-25) were performed to assess proliferation, adhesion, migration, and epithelial-mesenchymal transition (EMT). Oral dysplastic lesions showed a hypoacetylation of H3K9 and low levels of γH2AX compared to control. The contact of dysplastic oral keratinocytes with PBMCs favored EMT and the loss of cell-cell adhesion. On the other hand, p27 levels increased and cyclin E decreased in DOK, indicating cell cycle arrest. We conclude that the presence of chronic inflammation associated to dysplastic lesions is capable of promoting epigenetic alterations, which in turn can favor the process of malignant transformation.

Macrophages CD163+ and Factor XIIIa+ Provide a First-Line Defence against Proliferative Verrucous Leukoplakia Antigens

This study aimed to evaluate the density of the dendritic cells (DCs) and macrophages in oral leukoplakia (OL) and proliferative verrucous leukoplakia (PVL) by immunohistochemical analysis. We analysed paraffined tissue samples of PVL (n = 27), OL (n = 20), and inflammatory fibrous hyperplasia (n = 20) as the control group using the immunomarkers for DCs (CD1a, CD207, CD83, CD208 and CD123) and macrophages (CD68, CD163, FXIIIa and CD209). A quantitative analysis of positive cells in the epithelial and subepithelial areas was determined. Our results showed a reduction in CD208+ cells in the subepithelial area of the OL and PVL compared to the control. Additionally, we found a higher density of FXIIIa+ and CD163+ cells in the subepithelial area in PVL compared to the OL and control. Four-way MANOVA revealed a relationship between increased CD123+ cell density in the subepithelial area of "high-risk" samples regardless of disease. Macrophages provide the first line of defence against PVL antigens, suggesting a distinct pattern of innate immune system activation in PVL compared to OL, which may contribute to the complexity and the high rate of malignant transformation in the PVL.

Inflammatory Fibrous Hyperplasia Associated with Chondroid Metaplasia - Report and Morphological Analysis of Five Cases

Inflammatory fibrous hyperplasia (IFH) is a common reactive lesion in dental prostheses users that may be associated with chondroid metaplasia (CM). Metaplasia is an adaptive cellular process that may be caused by trauma. We reported here five cases of IFH associated with CM and analyzed morphologically the deposition of collagen in these lesions. Patients had a mean age of 58.8 years-old and were ill-fitting dental prostheses users. They presented nodular lesions located in the anterior maxilla. Microscopically, it was observed hyperplastic fibrous connective tissue with chronic inflammatory infiltrate and hyaline cartilage. No morphological differences were observed in collagen deposition under light microscopy, but quantitative analysis revealed a significantly higher collagen deposition at the connective tissue near CM (p = 0.015). IFH associated with CM affects ill-fitting dental prostheses users. The presence of CM is not significant to the lesion prognosis. However, its formation and the higher collagen deposition near it reinforces the IFH reactive origin.

INFLAMMATORY/REACTIVE HYPERPLASIA'S: A REVIEW

The reactive lesions are comparatively common in the oral cavity that dentist face during routine examination because of the frequency with which the tissues are injured. They frequently result from a well-known provocation or injury such as plaque, calculus, or foreign bodies. Diagnosis and development of a treatment plan is difficult if dentists are not aware of the prevalence and clinical symptoms of these lesions. The aim of this article was to review the clinical features of various reactive hyperplastic lesions of the oral cavity. The most commonly found lesions are irritational fibroma, pyogenic granuloma, epulis fissuratum, peripheral giant cell granuloma.

Epulis fissuratum: Treatment with combined excision and vestibuloplasty

Background: A common and sometimes irritating consequence of ill-fitting denture is denture fissuratum. Different methods are used to diagnose, treat, and prevent this health condition, but there are a variety of challenges and issues with surgical management. Case Presentation: Two cases were discussed involving combined surgical excision and vestibuloplasty which, when done carefully, produced satisfactory outcomes and considerably improved the patient\&amp;apos;s health. Combining prosthetic vestibuloplasty with patient&amp;apos;s denture support simultaneously with fissuratum excision improves vestibule depth and ridge height, potentially reducing recurrence of this irritative hyperplasia. Conclusion: Avoiding uncomfortable denture sequelae like denture fissuratum requires thorough monitoring of edentulous patients and avoiding poorly fitted dentures. Working together as a team and using multiple dental techniques greatly improves the procedure\&amp;apos;s outcome.

Quantification of mast cells in oral reactive lesions - an immunohistochemical study.

Reactive lesions (RLs) are the most common oral mucosal lesions that are benign in nature and are more likely to reoccur if the lesion or local irritants at the site are not completely removed. The histopathology is usually determined by the stage of the lesion, which includes neovascularization, inflammation, and fibrosis etc. Aim: To evaluate and compare mast cell counts in different reactive lesions with normal gingiva (NG) and to determine the correlation between mast cell count and inflammation, fibrosis, and angiogenesis using immunohistochemistry. 10 pyogenic granulomas (early and late), 10 irritational fibromas, 5 inflammatory fibrous hyperplasia, and 5 peripheral cemento-ossifying fibromas 5 normal gingiva were evaluated. Mast cell counts were compared. ANOVA and t-tests were used to analyze the data. Spearman correlation was used to compare the mast cell count to the inflammation, fibrosis, and vascular components. A p-value of 0.05 was considered statistically significant. The mean number of mast cells were increased in oral reactive lesions when compared to NG. Although mast cells were significantly higher in IFH and IF, there was no correlation found among mast cells and fibrosis/inflammation/vascularity. Reactive process involves multiple interactions among mast cells, endothelial cells, fibroblasts, and other immune cells, among which the role of mast cells has been evaluated. Mast cell count increases in these reactive lesions, possibly reflecting an important role in microenvironment modification, but it is not the sole cause of these lesions' pathogenesis.

Management of Epulis Fissuratum of Mandibular Anterior Region By Maintaining The Vestibular Depth. A Case Report

OBJECTIVES Epulis Fissuratum or Denture-induced hyperplasia is benign tumor-like hyperplasia of fibrous connective tissue, which develops usually in association with an ill-fitting complete or partial denture. The aim of this report is to present a case showing the treatment of Epulis fissuratum in relation to an ill-fitting denture with a Simple but innovative technique. The epulis was removed with the conventional surgical approach in which the excision of the epulis was carried out by a split-thickness flap approach in which the wound healing is achieved by secondary closure. The existing denture was relined with a soft tissue conditioner to maintain the depth of the vestibule by preventing the post-surgical wound contracture during healing and to prevent further surgery for vestibulopathy. In addition, the patient continued using the existing denture for functional and aesthetic purposes. After two weeks of wound healing, the vestibular depth was maintained by the relined existing denture. Then the new dentures were fabricated accordingly. After one month of follow-up, no signs of recurrence of epulis fissuratum were noticed.