clinical management of gingival enlargement
TRANSCRIPT
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Your Diagnosis Is Not The End But The Beginning Of Practise.
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CLINICAL MANAGEMENT OF GINGIVAL
ENLARGEMENT
DR. DEEPA PHILIPSUNDER THE GUIDANCE OF
DR. NYMPHEA PANDITDR. SHALINI GUGNANI, DR. DEEPIKA BALI.
DEPT OF PERIODONTICS, D.A.V DENTAL COLLEGE,YAMUNANAGAR
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DEFINITION
Increase in size of the gingiva. Overexuberant response to avariety of local and systemicconditions.
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EPULIS•Fibroma
•Pyogenic granuloma•Peripheral giant cell
granuloma•Peripheral ossifying
fibromaMETASTATIC
LESIONS
•DRUG INDUCED HYPERPLASIA
•LEUKEMIC INFILTRATE
•IDIOPATHIC ENLARGEMENT
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MAKING A DIFFERENTIAL DIAGNOSIS
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SOFT AND EDEMATOUS FIBROUS
SCALING AND
ROOT PLANING
SHRINKAGESURGERY
FLAP SURGERYGINGIVECTOMYMAINTENANCE
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• NO CLINICAL ATTACHMENT LOSS• NO BONE LOSS
• ABUNDANT KERATINISED TISSUE
• OSSEOUS DEFECTS • LIMITED KERATINISED
TISSUE
GINGIVECTOMY FLAP SURGERY
MAINTENANCE PHASE
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A CASE REPORT• Chief complaint of
swollen gums and bleeding from gums.
• Slow and progressively increasing in size .
• History excluded any epilepsy, physical or mental disorder.
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• ON EXAMINATION the enlargement was present on the left side involving maxilla and mandible which did not cross midline.
• The gingiva was pale pink, firm and of fibrous consistency and gave a pebbled appearance.
• It was pink in colour with a tendency to bleed and didn’t extend beyond the MGJ
• Grade III mobility present in relation to # 26 # 27.
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INVESTIGATIONS DONE.
• History to exclude drug intake.• Complete blood profile done to
exclude any malignancy.• Histopathology of the excised tissue.
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GENERALISED DIFFUSE IDIOPATHIC
ENLARGEMENT
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IDIOPATHIC ENLARGEMENT
• Etiology not known• Inheritance shows autosomal
dominant trait in many cases.• Begins before the age of 20 and is
correlate with the eruption of decidous and permanent teeth.
• Presence of teeth thought to be the “ INITIATING FACTOR”
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SURGICAL EXCISION
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AFTER HEALING
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Pre operativePre operative Post operative
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EXCISED TISSUE
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HISTOPATHOLOGY
• Tissue showed dense fibrocollagenous tissue infiltrated with intense acute and chronic inflammatory cells.
• Foci of necrosis and calcification also seen.
• Overlying epithelium showed thin elongated rete pegs extending into the fibrocollagenous tissue.
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HISTOPATHOLOGY
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LASER GINGIVECTOMY• Remarkable cutting ability.• Generates a coagulated tissue layer.• Greater accuracy in making incisions.• Minimal swelling and scarring.• Haemostasis.• Anticoagulant therapy patients.
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ELECTROSURGERY• Produces haemostasis.• Thermal necrosis of surrounding zone due to
production of latent heat.
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CONCLUSION
• Gingival enlargement may come to attention as a presenting complaint or an incidental finding.
• Its association with systemic diseases demands a diagnostic work up in a logical step wise approach.
• Cases of chronic inflammatory enlargement can just be treated by exquisite dental hygiene.
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• When it is medication related discontinuation or substituition is the gold standard.
• Idiopathic enlargement which persists despite aggressive oral hygiene needs to be considered for surgical reduction.
• THIS SHOULD BE CONSIDERED AS A LAST LINE MEASURE.
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Making a correct diagnosis is the first step in treating a case successfully……
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THANK YOU……