Ossifying Fibroma of Maxilla

Special Article - Periodontal Diseases

Austin J Dent.2017; 4(6): 1088.

Ossifying Fibroma of Maxilla

Saravanan Rethinam¹, Deepshika Saravanan¹, Kavitha Muthu¹* and Preethi Sambandam²

¹Department of Oral Surgery, RVS Dental College and Hospital, India

²Department of Periodontics, RVS Dental College and Hospital, India

*Corresponding author: Kavitha Muthu, Department of Oral Pathology, RVS Dental College and Hospital, Coimbatore 641402, Tamil Nadu, India

Received: June 23, 2017; Accepted: July 11, 2017; Published: August 30, 2017


Peripheral Ossifying Fibroma is a solitary growth over the gingiva that arises from the periodontal ligament. The common site of occurrence is the interdental papilla of the maxillary anterior teeth. This paper documents a case of peripheral ossifying fibroma in the right maxillary posterior region and alveolar ridge in forty-year old female patient. This contradicts the common predilection of lesion with regard to site, as the common occurrence is the anterior maxillary region.

Keywords: Peripheral ossifying fibroma, Epulis, Fibro-osseous lesion, Fibroma


Peripheral Ossifying Fibroma (POF) is a non-neoplastic growth which is relatively common. It occurs only on the soft tissue over the alveolar bone and is a reactive lesion [1]. This reactive lesion occurs in response to low–grade irritations such as trauma, plaque, calculus, micro-organisms, masticatory forces, ill-fitting dentures and poor quality restorations. The lesion occurs in any age group predominantly in the second decade of life [2]. Females are commonly affected and anterior maxilla is the most prevalent location of involvement [3]. Almost 60% of the lesions occurred in the maxilla, and in both jaws more than 50% occurred in the incisor-cuspid region [4].

A recent study revealed that the prevalence of peripheral ossifying fibroma is 4% among all reactive gingival lesions with female predilection of third decade. With regard to the anatomic location posterior maxilla contributes only for 7% distribution of all reactive gingival lesions [5].

It occurs exclusively on gingiva, appears as a nodular mass, pedunculated or sessile that usually emanates from interdental papilla. The colour ranges from red to pink with the lesion frequently but not always ulcerated. The teeth are usually unaffected and rarely migration or loosening of adjacent teeth has been noticed. In vast majority of cases, there is no apparent underlying bone involvement, on rare occasions superficial erosion of bone has been noticed. It accounts for 3% of all oral tumors and for 9.6% of all gingival lesions [6].

In the early stages the lesion totally radiolucent. Intermediate stages of lesion exhibit mixed radiolucent and radio opaque densities depending on the amount of the calcified material. Histopathologically, a large number of fibroblast and cementoblast with flat elongated nuclei are present within a network of interlacing collagen fibres. At the later stages the cementoblasts coalesce to present as common islands of bone & calcification.

The definitive diagnosis is based on histological examination with the identification of cellular connective tissue and the focal presence of bone or calcifications [3,7].

Prognosis is good, but some instances of recurrence have been reported regularly in various studies. After elimination of the local etiological factors surgical excision is the treatment of choice. The surgical treatment includes aggressive curettage, localized surgical resection and segmental resection.

The mass should be excised down to the periosteum because recurrence is more likely, if the base of the lesion is allowed to remain. The teeth associated with Peripheral Ossifying fibroma are generally not mobile. Though there have been reports of dental migration secondary to bone loss. Extraction of the neighboring teeth is usually not considered necessary [8].

Case Presentation

A forty year old female patient named Mrs. Chithra presented to Department of Periodontology with the complaint of swelling in the upper right premolar-molar region present for the past three months. The swelling was insidious in onset, was initially small in size and gradually grew to the present size. The swelling was associated with bleeding on brushing and was asymptomatic.

On intraoral examination a pinkish red pedunculated growth extending mesiodistally from fifteen to seventeen was noticed, it was measuring about 2.8x2.5x2.7 cm in the upper right alveolar region (Figure 1). On palpation the growth was fibrous and non tender in consistency and had a papillated surface. The oral hygiene was fair with considerable amount of supra and subgingival calculus, there was a grade- III mobility in 15, 16.