Fibroma osificante periférico / Peripheral ossifying fibroma

RESUMEN Con relativa frecuencia, en la mucosa bucal se observan agrandamientos gingivales como el fibroma osificante periférico, que es una lesión reactiva inflamatoria del tejido blando. Clínicamente se trata de una tumefacción deformante, de crecimiento lento, sin una causa clara, aunque su formación está asociada a traumatismos o irritaciones crónicas a nivel gingival. Usualmente su aparición es a nivel de la papila interdental en la zona anterior del maxilar, aunque se puede observar en otras regiones de la cavidad bucal. El tratamiento es quirúrgico y consiste en la enucleación total de la lesión, retirando además los factores irritativos. En las radiografías, la imagen frecuentemente observada, aparece como un área radiolúcida, unilocular, bien definida y delimitada por un halo radiopaco (esclerótico); ocasionalmente puede presentarse como una imagen radiopaca.

ABSTRACT In the buccal mucosa are observed, with relative frequency, gingival enlargements such as the peripheral ossifying fibroma, which is considered a reactive inflammatory soft tissue lesion. It is clinically characterized by a slow-growing, disfiguring swelling with no clear cause, although its formation is associated with trauma or chronic irritation at the gingival level. Its appearance is usually at the level of the interdental papilla in the anterior region of the maxilla, although it can be seen in other regions of the oral cavity. The treatment is surgical consisting of the total enucleation of the lesion and removing the irritating factors. On radiographs, the frequently observed image appears as a well-defined, unilocular, radiolucent area delimited by a radiopaque halo (sclerotic); it can be occasionally presented as a radiopaque image.

Tumores fibroóseos de cavidades paranasales: experiencia en el Hospital Clínico de la Universidad de Chile y revisión de la literatura / Fibro-osseous tumors of paranasal cavities: experience in the Hospital Clínico de la Universidad de Chile and review of the literature

Los tumores de cavidades paranasales presentan una baja frecuencia. Dentro de éstos, entre los benignos destacan las lesiones fibroóseas que se caracterizan por el reemplazo de hueso normal por estroma celular fibroso. Dentro de estas lesiones se describen osteoma, displasia fibrosa y fibroma osificante. Se revisan 3 casos de pacientes del Hospital Clínico de la Universidad de Chile y se presenta una revisión bibliográfica en cuanto a las lesiones fibroóseas, su clínica, diagnóstico, imagenología y tratamiento.

The tumors of paranasal cavities present a low frequency. Among the benign tumors are fibro-osseous lesions characterized by the replacement of normal bone by fibrous cell stroma. Osteoma, fibrous dysplasia, and ossifying fibroma are described within these lesions. Three cases of patients from the Hospital Clínico de la Universidad de Chile are reviewed and a bibliographic review is presented regarding the fibro-osseous lesions, their clinical features, diagnosis, imaging and treatment.

Fibroma osificante periférico de establecimiento precoz: reporte de un caso / Early onset peripheral ossifying fibroma: Presentation of a case

RESUMEN: El fibroma osificante periférico (FOP) es una hipertrofia benigna de los tejidos. Se localiza en la región de la papila interdental, proveniente de células que derivan del ligamento periodontal. Generalmente mide menos de 1,5cm de diámetro, siendo muy raro en recién nacidos. El objetivo de la presentación de este caso clínico es describir un caso de FOP en un bebé de 6 meses de edad. La niña presentaba una lesión nodular localizada en la mucosa gingival, en el área de incisivos inferiores, de aproximadamente 1,5cm diámetro, de consistencia firme, lisa, y coloración igual a la de la mucosa subyacente. Un diente neonatal había sido removido a los 2 meses de nacida. El FOP es una lesión poco común y que raramente puede encontrarse en bebés menores de un año de edad; por este motivo es importante realizar el diagnóstico adecuado, para evitar cualquier complicación debido a su establecimiento precoz y rápido crecimiento.

ABSTRACT: The peripheral ossifying fibroma (POF) is a rare, reactive and inflammatory gingival overgrowth, arising on the interdental papilla, from cells derived of the periodontal ligament. Usually its diameter is less than 1.5 cm. It's uncommon in newborns, frequently occurring in teenagers and young adult. The purpose of this report is to describe a case of FOP in a six months old baby. She had a nodular lesion, located on the gingival mucosa of the lower incisor area, of approximately 1.5 cm; it was firm, smooth, pedunculated, with an equal color of the underlying mucosa. A neonatal tooth had been removed four months back. Although FOP is a rare injury, it can be found in infants with less than one year of age, which is why it is important to make the right diagnosis, and an opportune treatment, to avoid further complications due to its early establishment and rapid growth.

Manejo quirúrgico de tumor mandibular asistido con la tecnología de impresión tridimensional: nota técnica y reporte de caso / Surgical management of mandible tumor assisted with three-dimensional printing technology: a technical note and case report

Objetivo: Introducir la tecnología de impresión tridimensional para la creación de modelos anatómicos para asistir la planificación quirúrgica de tumores mandibulares. Caso clínico: Presentamos el caso de una paciente de 30 años con historial de tumoración en la mandíbula, sector anterior, con 2 años de evolución. La biopsia incisional confirmó que se trataba de un fibroma osificante. Con la asistencia de la tecnología de impresión tridimensional se realizó la planificación quirúrgica para establecer los márgenes de osteotomías y el predoblado de la placa de reconstrucción. Adicionalmente se describe en detalle el proceso de construcción del modelo de prototipado rápido con la tecnología de impresión tridimensional.

Aim: Introduction of three-dimensional printing technology for the generation of medical rapid prototyping models, an assistant tool in surgical planning of mandibular tumors. Clinical case: We report the case of a 30-years-old female patient who presented an anterior mandible mass with 2 years of evolution. Incisional biopsy confirmed ossifying fibroma. With the assistance of three-dimensional printing technology, 3D model was created and surgical planning was performed with the design of osteotomy sites for mandibular resection. Furthermore, prebending of reconstruction plate based on 3D model was accomplished. The protocol for rapid prototyping models creation in details is described in this article.

Central Ossifying Fibroma of the Maxilla (Matured Type): Report of a Rare Case.

Central ossifying fi broma is a bony tumor, which is believed to be derived from the cells of the periodontal ligament. Central ossifying fi broma behaves like, a benign bone neoplasm. Th is bone tumor consists of highly cellular, fi brous tissue that contains varying amounts of calcifi ed tissue resembling bone, cementum, or both. Central ossifying fi bromas of the mandible are common; however, they are rare in the maxillary region however they are common in the mandible, have got a female predeliction and is usually seen in the age between 35 and 40 years of age. In this report, we have described a 35-year-old female with minimal clinical symptoms diagnosed as central ossifying fi broma in the anterior maxillary region.

Peripheral Ossifying Fibroma: A Case Report & Review of Literature.

Gingival enlargements are commonly seen especially localized. Most of these enlargements are non-neoplastic and rather reactive by nature. On clinical examination, it is not always possible to differentiate one specific gingival enlargement from other. Clinically, differentiating one from the other as a specific entity is often not possible. To identify these lesions, histopathological examination is required. One of such seen entities is peripheral ossifying fibroma (POF) that is diagnosed by histopathological examination. Peripheral ossifying is a reactive benign lesion. A clinical report of 23 years old male with POF maxillary left canine and premolar region is reported with treatment and 1-year follow-up.

Psammomatoid Type Juvenile Ossifying Fibroma of Mandible: A Rare Entity.

Juvenile ossifying fibroma (JOF) is a rare fibro-osseous neoplasm that arises within the craniofacial bones. Two distinct histopathological variants have been described; trabecular JOF and psammomatoid JOF (PsJOF). The later occurs predominantly in craniofacial skeleton and rarely in jaws and more so in mandible (50% of the times than that in maxilla). Here we report a rare case of PsJOF in mandible body ramus region with its unique radiographic characteristics to help the diagnostician approach the diagnosis very closely for this rare entity. The tumor has been present since 1 year with unilocular radiographic appearance; having homogeneous ground-glass appearance with higher imaging, without any focal radio-opacity and inferior alveolar canal was displaced but still intact. Thus these lesions can expand to large sizes even without maturing to its radiopaque stages and without destruction of adjacent vital structures although displacing them.

Fibroma osificante: presentación de un caso clínico en mandíbula y revisión de la literatura / Ossifying fibroma: presentation of a clinical case in the jaw and review of the literature

El fibroma osificante es un tumor benigno casi idéntico al fibroma cementificante. Se inscribe dentro de las llamadas lesiones fibroóseas, como la displasia fibrosa y la displasia cemento-osificante, que se caracterizan por el reemplazo de la arquitectura ósea normal por fibroblastos, tejido fibroso y cantidades variables de tejido mineralizado. Debido a sus características clínicas, radiológicas e histológicas, la clasificación de estas lesiones ha sido muy controversial. Presentamos un caso clínico en mandíbula, detalladno su diagnóstico y tratamiento y una revisión de la literatura...

Peripheral ossifying fibroma: A case report / Fibroma osificante periférico: Reporte de un caso

Peripheral ossifying fibroma (POF) is a relatively uncommon gingival growth that is considered to be reactive in nature and appear secondary to irritation or trauma. It presents as an exophytic growth with smooth surface. POF in older age group, observance of calcification in radiograph of excised specimen, pathologic migration, mobility and size greater than 2 cm is an occasional entity. The article presents such a rare case of POF in a 60-year-old female patient which was treated by surgical excision. This case contradicts the logic that this lesion occurs in teenagers and in second and third decades of life

El fibroma osificante periférico (FOP) es un crecimiento gingival poco común, considerado reactivo por su naturaleza y en general se manifiesta secundario a una irritación o trauma y se presenta como un crecimiento exofítico de superficie lisa. En grupos de mayor edad, el FOP muestra calcificación radiográfica, migración patológica, movilidad y un tamaño mayor de 2 cm, es de carácter ocasional. Se presenta un caso raro de FOP en una paciente de 60 años que fue tratado mediante excisión quirúrgica. Este caso, contradice su lógica de aparición en adolescentes o adultos entre la segunda y tercera década de la vida

Ossifying Fibroma of the Jaws: A Clinicopathological Case Series Study

The aim of this study was to assess the clinical, radiographic and microscopic features of a case series of ossifying fibroma (OF) of the jaws. For the study, all cases with OF diagnosis from the files of the Oral Pathology Laboratory, University of Ribeirão Preto, Ribeirão Preto, SP, Brazil, were reviewed. Clinical data were obtained from the patient files and the radiographic features were evaluated in each case. All cases were reviewed microscopically to confirm the diagnosis. Eight cases were identified, 5 in females and 3 in males. The mean age of the patients was 33.7 years and most lesions (7 cases) occurred in the mandible. Radiographically, all lesions appeared as unilocular images and most of them (5 cases) were of mixed type. The mean size of the tumor was 3.1 cm and 3 cases caused displacement of the involved teeth. Microscopically, all cases showed several bone-like mineralized areas, immersed in the cellular connective tissue. From the 8 cases, 5 underwent surgical excision and 1 patient refused treatment. In the remaining 2 cases, this information was not available. In conclusion, OF occurs more commonly in women in the fourth decade of life, frequently as a mixed radiographic image in the mandible. Coherent differential diagnoses are important to guide the most adequate clinical approach. A correlation between clinical, imaginological and histopathological features is the key to establish the correct diagnosis.

O objetivo deste estudo foi analisar as características clínico-radiográficas e microscópicas de uma série de casos de fibroma ossificante (FO). Para o estudo, todos os casos com diagnóstico de FO do arquivo do Laboratório de Patologia Bucal da Universidade de Ribeirão Preto, Ribeirão Preto, São Paulo, Brasil, foram estudados. Os dados clínicos foram coletados das fichas de encaminhamento das lesões ao Laboratório. As características radiográficas foram avaliadas em cada caso. Todos os casos foram revisados microscopicamente para confirmação do diagnóstico. Oito casos foram identificados, 5 em mulheres e 3 em homens. A idade média dos pacientes foi de 33,7 anos e a maioria das lesões (7 casos) ocorreu na mandíbula. Radiograficamente todas as lesões se apresentavam como imagens uniloculares e a maioria (5 casos) se mostravam como imagem mista. O tamanho médio do tumor foi de 3,1 cm e 3 casos causavam deslocamento dos dentes envolvidos. Microscopicamente, todos os casos apresentavam várias áreas mineralizadas semelhantes a osso, imersas em um tecido conjuntivo celularizado. Dos 8 casos, 5 foram submetidos a excisão cirúrgica da lesão e 1 paciente recusou tratamento. Nos outros 2 casos, essa informação não estava disponível. Conclui-se que o FOs ocorrem mais comumente na mandíbula de pacientes do gênero feminino durante a quarta década de vida e se apresentam frequentemente como uma imagem radiográfica mista. Diagnósticos diferenciais coerentes são importantes para guiar a conduta clínica mais adequada. A correlação entre as características clínicas, imaginológicas e histopatológicas é a chave para estabelecer o diagnóstico correto.

Fibroma osificante periférico asociado a resorción ósea: revisión de la literatura y presentación de un caso / Peripheral ossifying fibroma associated with bone resorption: literature review and presentation of a case

El Fibroma Osificante Periférico (FOP) es una hiperplasia reactiva del tejido conjuntivo que contiene áreas de hueso. Se origina a partir del ligamento periodontal. Se presenta con frecuencia en la segunda y tercera década de vida, con mayor frecuencia en el género femenino. Se observa como una lesión sésil o pediculada, circunscrita, lisa o ulcerada, firme y del mismo color de la mucosa, asintomático. Se localiza en la encía, por lo general en papilas interdentales. En gran parte de los casos no se lesiona el hueso subyacente. Se reporta un caso de un paciente masculino de 47 años de edad, quien es referido por su odontólogo tratado por una lesión en el maxilar. El paciente refiere inicio de la enfermedad hace aproximadamente un año, que comienza con un aumento de volumen de la encía, asintomático, sangrante y asociada a dientes con movilidad dentaria. Al examen extrabucal se observa un aumento de volumen de la mejilla izquierda que produce asimetría facial. Intrabucalmente se observa una lesión de naturaleza tumoral que se desprende de la encía vestibular distal al 25 al diente 28, de aproximadamente 3cm de diámetro, circunscrita, roja, sangrante y de superficie ulcerada. El examen radiográfico revela una gran resorción ósea del hueso alveolar que produjo movilidad de los dientes 25, 27 y 28. Se planteó como diagnóstico provisional: Lesión Periférica de Células Gigantes y como diagnósticos diferenciales: Fibroma Osificante Periférico, Granuloma Piogénico. La conducta a seguir fue extirpación quirúrgica de la lesión para posterior estudio histopatológico con exodoncias de los dientes 25, 27 y 28. Se destaca la importancia de este caso por su presentación clínica de gran tamaño y la destrucción ósea que produjo, condición que determinó las exodoncias de los dientes involucrados, hecho que es inusual para este tipo de patologías

Peripheral ossifying fibroma (POF) is a reactive hyperplasia of connective tissue containing areas of bone. It originates from the periodontal ligament. It occurs frequently in the second and third decades, predominantly in females. It appears as a sessile or pedunculated lesion, circumscribed, smooth or ulcerated, firm, and the color of the mucosa, asymptomatic. Located in the gum, usually in interdental papillae. In most cases no underlying bone is injured. We report a case of a male patient aged 47 who are referred by your dentist treated for an injury to the jaw. The patient reported onset of illness for about a year, which begins with an enlargement of the gums, asymptomatic, bleeding and teeth associated with tooth mobility. Extra-oral examination showed an increase in volume of the left cheek that produces facial asymmetry. The oral examination shows tumoral lesion of nature that emerges from the buccal gingiva distal to the tooth 28 to 25, approximately 3 cm in diameter, circumscribed, red, bleeding and ulcerated surface. Radiographic examination reveals a large alveolar bone resorption resulting in tooth mobility 25, 27 and 28. Was raised as a provisional diagnosis: Peripheral giant cell lesion as a differential diagnosis: peripheral ossifying fibroma, pyogenic granuloma. The action to take was surgical removal of the lesion for subsequent histopathological study extractions of teeth 25, 27 and 28. The importance of this case the clinical presentation and the large bone destruction that occurred, a condition that determined the extractions of the teeth involved, a fact which is unusual for this type of pathology

Fibroma cemento-osificante mandibular: presentación de un caso y revisión de la literatura / Mandibular cemento-ossifying fibroma: case report and review of the literature

Objetivo: presentar una patología tumoral odontogénica de baja frecuencia y complejo diagnóstico diferencial. Caso clínico: el fibroma cemento-osificante es considerado un raro e infrecuente proceso neoplásico benigno, cuyos elementos originarios se encuentran en el ligamento periodontal. Se conoce generalmente también como fibroma osificante (World Health Organization Classification of Tumors - WHO Classification, 2005), con dos variantes histológicas: el fibroma cemento-osificante trabecular juvenil (JTOF) y el fibroma cemento-osificante juvenil psamomatoide (JPOF). La clínica y los estudios radiológicos pueden ayudar a su diferenciación, demarcación y/o encapsulación del fibroma. Conclusiones: es el estudio anatomo-patológico el determinante de la conducta a seguir. El fibroma cemento-osificante radiográficamente podría conofundirse con otros tipos de lesiones, pero éste en particular posee un comportamiento benigno.

Fibroma cemento osificante: análisis clínico, radiológico e histológico de 2 casos en una misma familia / Cemento-ossifying fibroma: clinical, radiological and histological analysis of 2 cases in one family

El Fibroma Cemento Osificante (FCO) es una lesión pseudo tumoral benigna de origen odontogénico, que se ubica preferentemente a nivel de molares y premolares mandibulares. Nuestro objetivo es presentar casos de FCO dentro de una misma familia, describiendo las características clínicas, radiográficas, histológicas, tratamiento y seguimiento de cada uno de ellos. Dos pacientes hermanos con FCO mandibulares atendidos en el Hospital de Carabineros fueron incluidos en este estudio. La evolución completa de cada caso es expuesta, resaltando el componente familiar de esta patología poco prevalente. Todos los pacientes fueron tratados con remoción completa de la lesión y relleno del defecto óseo con injerto autólogo de cresta iliaca o con injerto óseo particulado sintético (ChronOS®). Un paciente presento recidiva de la lesión y posteriormente un nuevo FCO en el lado contra lateral. En este tipo de lesiones, es muy importante valerse de todas las herramientas diagnosticas que estén a nuestro alcance, ya que la baja ocurrencia de estas lesiones, junto con la gran similitud tanto clínica, radiográfica e histológica que presenta con otras entidades patológicas de los maxilares, hacen que un estudio superficial, puedan llevar a un diagnostico y tratamiento erróneo, afectando la calidad de vida del paciente. El tratamiento de estas lesiones es conservador, y las recidivas son raras.

The Cemento-ossifying fibroma (COF) is a benign fibro-osseous neoplasm of odontogenic origin, that is preferentially localized in the molar and premolar mandibular area. Our goal is to present cases of COF that occurred within the same family, describing clinical, radiological and histological characteristics, in addition to treatment and monitoring of each case. Two patients who are brothers, treated at the Hospital de Carabineros, who had mandibular COF, were included in this study. The complete evolution of each case is presented, highlighting the family component of this uncommon disease. All patients were treated with complete removal of the lesion and filling the bone defect with autologous iliac crest graft or synthetic particulated bone graft (ChronOS®). One patient had recurrence of the injury and then presented a new COF on the contralateral side. In this type of injury it is very important to use all the diagnostic tools within our reach. The rarity of these lesions, and the great similarity of both clinical, radiological and histological features with other pathological conditions of the jaws, and a poorly conducted study can lead to wrong diagnosis and treatment affecting the quality of life of patients. The treatment of these lesions is conservative, and relapses are rare.

Peripheral ossifying fibroma: a clinical report / Fibroma osificante periférico: un reporte clínico

Localized growths are commonly seen on the gingiva. Many of these enlargements are considered to be reactive rather than neoplastic in nature. Clinically differentiating one from the other as a specific entity is often not possible. Histopathologic examination is needed in order to positively identify the lesion. The peripheral ossifying fibroma is one such lesion. We report in this study, the clinical report of a 20-yr-old male patient with a peripheral ossifying fibroma in the maxilla exhibiting significant size with the disease duration of 1 year. The signs of recurrence in spite of thorough excision and debridement exposed the need for further study of the causes of recurrence and possible modes to avoid the situation. Clinical, radiographical and histological characteristics are discussed and recommendations regarding treatment and follow-up are provided.

Aumentos de volumen localizados se observan con frecuencia en la encía. Muchos de estos crecimientos se consideran de tipo reaccional más que de naturaleza neoplásica. Clínicamente diferenciar uno del otro como una entidad específica no siempre es posible. El examen histopatológico es necesario con el fin de identificar positivamente a la lesión. El fibroma osificante periférico es una de estas lesiones. Se presenta en este estudio, el informe clínico de un paciente de sexo masculino de 20 años de edad con un fibroma osificante periférico en el maxilar de un tamaño significativo con 1 año de duración de la lesión. Los signos de recurrencia a pesar de la escisión completa y desbridamiento expusieron la necesidad de estudiar más a fondo las causas de la recurrencia y los posibles modos de evitar la situación. Las características clínicas, radiográficas e histológicas son discutidas junto a recomendaciones sobre el tratamiento y seguimiento.

Tumor fibromixoide osificante simulando un cáncer anaplásico de tiroides: reporte de un caso / Ossifying fibromyxoid tumor of the neck: case report

El tumor fibromixoide osificante corresponde a una neoplasia infrecuente, de comportamiento benigno pero que presenta recurrencia en un tercio de los casos, comportándose como un sarcoma de bajo grado. Se reporta el caso de una paciente operada de tiroides en dos oportunidades en 9 años, cuyo diagnóstico final fue tumor fibromixoide osificante.

Ossifying fibromyxoid tumor of soft parts in an uncommon tumor with a benign behavior but with a tendency to relapse. We report a 76 years old female presenting with a growing mass located in the anterior portion of the neck that was excised. The pathological study disclosed an anaplastic thyroid cancer. The patient received chemotherapy and was lost from follow up. Nine years later, she presented with progressive dysphagia. A neck CT scan showed a mass in the left thyroid base that completely included the cervical esophagus. The patient was operated and the mass was excised. The pathological diagnosis disclosed an ossifying fibromyxoid tumor.

La punción no aspirativa como método de elección en lesiones óseas de los maxilares / Non-aspirative punction as the method of choice in jaw bone lesions

Las lesiones de los huesos maxilares requieren con frecuencia la realización de una toma de tejido que permita arribar a un diagnóstico de certeza. Se presentan detalles operativos de la punción ósea no aspirativa (PONA) que a criterio de los autores es el método de elección para las lesiones localizadas en los huesos maxilares, sean estas osteolíticas o condensantes. La punción no aspirativa es una técnica poco traumática y de fácil realización que requiere de entrenamiento por parte del operador quirúrgico y del laboratorio de patología

Fibroma ossificante juvenil trabecular (tipo OMS): relato de um caso e discussão de parâmetros de diagnóstico diferencial / Trabecular (who-type) juvenile ossifying fibroma: report of a case and

O fibroma ossificante juvenil (FOJ) é uma neoplasia benigna que tem sido distinguida dos fibromas ossificantes pela idade dos pacientes afetados (geralmente abaixo dos 15 anos), sítio anatômico preferencial de ocorrência (maxila), e comportamento biológico agressivo. Nós relatamos um caso atípico de um FOJ de grandes dimensões envolvendo a maxila direita de uma paciente de 28 anos que provocou perfuração das corticais ósseas vestibular e palatina em seis meses deevolução. Uma ampla discussão de critérios histológicos para estabelecimento do diagnóstico deste tumor também foi realizada

Fibroma ossificante periférico: relato de caso e histórias de recidivas / Peripheral ossifying fibroma: case report and recurrence histoy

O fibroma ossificante periférico apresenta-se como uma das lesões hiperplásicas inflamatórias reacionais mais comuns da cavidade bucal. Sua localização mais frequente é na papila interdentária anterior da maxila. Aparece clinicamente como um crescimento focal de tecido bem delimitado e seu aspecto histopatológico mais marcante consiste na presença de calcificações em um estroma de tecido conjuntivo com inúmeros fibroblastos. O tratamento recomendado é a excisão cirúrgica total da lesão, que apresenta alto índice de recidiva, em média de 15 por cento. O presente trabalho tem como objetivo relatar um caso clínico de fibroma ossificante periférico com história de três recidivas

Fibroma ossificante periférico e hiperplasia inflamatória: relato de caso clínico / Ossifying fibroma peripheral and inflamatory fibrous hyperplasia: relates a clinical case

No periodonto os crescimentos teciduais são relativamente comuns nas diversas faixas etárias, gêneros e etnias, sendo que a grande maioria apresenta componente inflamatório, decorrente de irritação local (BIRMAN; GONÇALVES, 01). Em algumas situações a resposta pode ser modificada pelas condições sistêmicas do paciente (ZAGARELLI et al, 14). Esses crescimentos guardam uma estreita relação clínica, apresentando-se sob a forma de massa gengival ou tecidual em área de rebordo firme, podendo ser séssil ou pedunculada, recobertas por mucosa aparentemente normal ou com pequenas ulcerações superficiais e sangramento, necessitando de um exame clínico (anamnese ou exame físico) bem conduzido, além da utilização racional de recursos auxiliares de diagnóstico como o exame radiográfico e a biópsia para diferenciá-los entre: Granuloma Piogênico, Lesão Periférica de Células Gigantes, Fibroma Calcificante Periférico, Hiperplasia Fibrosa Inflamatória e Odontoma Periférico, bem como para planejamento e condução do tratamento (COLEMAN; NELSON, 07)