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Hereditary gingival fibromatosis (HGF), also known as idiopathic gingival hyperplasia, is a rare condition of gingival overgrowth. [1] HGF is characterized as a benign, slowly progressive, nonhemorrhagic, fibrous enlargement of keratinized gingiva. It can cover teeth in various degrees, and can lead to aesthetic disfigurement. [2]
A peripheral ossifying fibroma, also known as ossifying fibrous epulis, is “a gingival nodule which is composed of a cellular fibroblastic connective tissue stroma which is associated with the formation of randomly dispersed foci of mineralised products, which consists of bone, cementum-like tissue, or a dystrophic calcification.
When gingival hyperplasia is confined to one area of the jaw, this is when it is termed an epulis fibrosa, caused by an increase in collagenous tissue with varying cellularity. [12] It may be sessile or pedunculated and is composed of fibrosed granulation tissue. Fibrous epulides are firm and rubbery, and pale pink in color.
In theory, gingival fibers are the protectors against periodontitis, as once they are breached, they cannot be regenerated.When destroyed, the gingival sulcus (labelled G in the diagram) increases in depth apically, allowing more debris and bacteria to remain in intimate contact with the delicate sulcular and junctional epithelia for longer times.
Combined periodontic-endodontic lesions may sometimes be abscesses, but these are considered in a separate category. A gingival abscess involves only the gingiva near the marginal gingiva or the interdental papilla. A periodontal abscess involves a greater dimension of the gum tissue, extending apically and adjacent to a periodontal pocket.
The efficacy of allogeneic cultured keratinocytes and fibroblasts in bovine collagen (Gintuit) was evaluated in two clinical studies in adults with insufficient gingival tissue. [2] In each of the two studies, Gintuit was associated with an increase of at least 2 mm of gingival tissue in at least 50% of the study subjects.
To be more specific, stippling occurs at sites of fusion of the epithelial ridges (also known as rete pegs – depression of epithelium) and correspond to the fusion of the valleys created by the connective tissue papillae (elevation of connective tissue papilla). An example of stippling could be dots found on a basketball or an orange. [2]
Perforating vessels originate from lamina dura and the vessels perforate the socket wall (cribriform plate). Gingival vessels are derived from the gingival tissue. Outer layers of blood supply in PDL may help in mechanical suspension and support of the tooth while inner layers of blood vessels supply surrounding PDL tissues. [11]