Peripheral ossifying fibroma is a relatively uncommon gingival growth that is considered to be reactive in nature and postulated to appear secondary to irritation or trauma. They usually occur in young adults with a female predominance and are solitary in nature. We report a case of peripheral ossifying fibroma in a 55-year old femal

Prabhat, MPV

Praveen Kumar, B

Sudhakar, S

English

Cognitive Sciences ePrint Archive

Case Report:
Peripheral Ossifying Fibroma 
Sudhakar S, Senior lecturer,
Praveen Kumar B, Senior lecturer
Prabhat MPV, Associate professor
Department of Oral Medicine & Radiology, St. Joseph Dental College & Hospital, Eluru (Andhra Pradesh) – 534003
Address For Correspondence:
Dr S. Sudhakar
Senior Lecturer, 
Department of Oral Medicine & Radiology,
St. Joseph Dental College & Hospital,
Eluru (Andhra Pradesh) – 534003
E-mail: drsudhakaroralmed@yahoo.co.in
Citation: Sudhakar S, Praveen Kumar B, Prabhat MPV. Peripheral Ossifying Fibroma. Online J Health Allied Scs. 2009;8(3):17
URL: http://www.ojhas.org/issue31/2009-3-17.htm
Open Access Archives: http://cogprints.org/view/subjects/OJHAS.html and http://openmed.nic.in/view/subjects/ojhas.html
Submitted: Sep 14, 2009; Accepted: Sep 28, 2009 Published: Nov 15, 2009
Abstract:
Peripheral ossifying fibroma is a relatively uncommon gingiv-
al growth that is considered to be reactive in nature and postu-
lated to appear secondary to irritation or trauma. They usually 
occur in young adults with a female predominance and are sol-
itary  in  nature.  We  report  a  case  of  peripheral  ossifying 
fibroma in a 55-year old female.
Key  Words: Peripheral  ossifying  fibroma;  Gingiva;  Multi-
centric; Periosteum; Recurrence
Introduction:
Peripheral  ossifying  fibroma  (POF)  is  a  solitary,  non-neo-
plastic  gingival  growth  usually  arises  from  the  interdental 
papillae. As the clinical spectrum of this entity has resemb-
lance to other common gingival masses a thorough diagnostic 
sequence is necessary to rule out other common benign gin-
gival lesions.
Case Report:
A 55-year  old  female  patient  reported  with  a  complaint  of 
painless  swelling  in  the  upper  front  gum  region  since  2 
months.  Patient’s  history  revealed  that  she  had  noticed  the 
swelling 2 months back and had gradually increased in size. 
There was no history of associated symptoms such as pain, 
paraesthesia or numbness; however, the patient had a history 
of occasional bleeding on provocation. There was no history 
of trauma or similar growth in the past. The medical, surgical 
and family histories were non-contributory. Extra-oral exam-
ination did not reveal any abnormalities.  Intra-oral examina-
tion revealed a pink, solitary, well defined oval shaped gingiv-
al growth ranging 2x1 cm in size in relation to 12, extending 
from the distal aspect of 11 to mesial aspect of 13. The growth 
had a smooth surface and appeared to arise from the underly-
ing soft tissue. It was pedunculated, mobile, non-tender, firm 
in consistency and bled to touch (Fig. 1).
Based on the history and clinical findings the following differ-
ential  diagnoses  were  considered:  fibrosed  pyogenic  granu-
loma,  peripheral  ossifying  fibroma,  peripheral  odontogenic 
fibroma, solitary fibroma, fibrosed peripheral giant cell granu-
loma.
Figure  1:  Intra  oral  photograph  showing  the  gingival 
growth
Patient was then subjected to routine hematological and radio-
graphic  investigations.  The  complete  hemogram was within 
the  normal  limits.  Intra  oral  periapical  radiograph  (IOPAR) 
and  orthopantomograph  did  not  reveal  any  pathological 
changes except for generalized horizontal bone loss (Fig. 2 & 
3).
Figure 2: IOPAR showing right maxillary anteriors
1
This work is licensed under a Creative 
Commons Attribution-No Derivative Works 
2.5 India License
Online Journal of Health and Allied Sciences
Peer Reviewed, Open Access, Free Online Journal
Published Quarterly :  Mangalore, South India : ISSN 0972-5997
Volume 8, Issue 3; Jul-Sep 2009
Figure 3: Orthopantomograph showing generalized hori-
zontal bone loss
Excisional biopsy was performed and the lesion was removed 
along with its surrounding tissue. (FIG 4). Histopathological 
examination  of  the  specimen  showed  presence  of  ulcerated 
stratified squamous epithelium. The underlying connective tis-
sue was highly cellular with plump fibroblasts intermingled in 
a delicate fibrillar stroma associated with areas of woven tra-
becullar bone and osteoids.
Based on the clinical, radiographic and histopathological find-
ings, a final diagnosis of peripheral ossifying fibroma was ar-
rived.  The  patient  is  on  regular  follow-up  for  the  past  6 
months with no signs of recurrence.
Figure 4: Post operative intra-oral photograph
Figure 5: Photomicrograph 10X
Discussion:
POF is a  relatively uncommon,  solitary,  non-neoplastic  gin-
gival  growth,  coined  by  Eversole  and  Rovin.(1)  Over  the 
years, various terminologies have been considered for its de-
scription and it includes: peripheral odontogenic fibroma, peri-
pheral  cemento-ossifying  fibroma,  peripheral  cementifying 
fibroma,  ossifying  fibro-epithelial  polyp,  peripheral  fibroma 
with  osteogenesis,  peripheral  fibroma  with  cementogenesis, 
peripheral fibroma with calcification, fibrous epulis, calcifying 
or ossifying fibrous epulis, calcifying fibroblastic granuloma.
(2,3) The term cement-ossifying fibroma is scientifically in-
valid,  as there is no histomorphic  or biochemical difference 
between bone and cementum.(4) Whereas, peripheral odonto-
genic fibroma is a true neoplasm of odontogenic origin and it 
is  the  counterpart  of  central  odontogenic  fibroma  (World 
health  organization  type).(5,6)  The  peripheral  ossifying 
fibroma however does not represent the soft tissue counterpart 
of the central ossifying fibroma, as the latter arise from the en-
dosteum and causes expansion of the medullary cavity.(5)
The pathogenesis of POF is uncertain. As they resemble clin-
ically  and histopathologically  to  pyogenic  granuloma,  some 
consider POF to develop secondary to fibrosis of granulation 
tissue.(4) Moreover, due to its female gender and second dec-
ade  predilection,  the  role  of  hormones  has  also been  ques-
tioned.(7) The most widely acceptable histiogenesis for POF is 
the inflammatory hyperplasia of the cells of the periosteum or 
periodontal ligament.(1,7-9) The inflammatory reaction is be-
lieved to occur secondary to trauma from local irritants such 
as plaque, calculus, restorations or ill fitting dental appliances.
(1,7-9) This is convincing, as they occur exclusively in gin-
giva  and  with  the  histomorphological  evidence  of  oxytalan 
fibers within the mineralized matrix.(4,10) Another interesting 
observation is the decline in number of cases as age advances.
(6,11)
POF clinically appears as a solitary nodular mass, either ped-
unculated  or  sessile  and  arise  from  the  interdental  papilla.
(8,10) The color ranges from pink to red and the surface is fre-
quently but not always ulcerated.(8) Most lesions are usually 
1-2 cm in size, however, cases ranging more than 2cm have 
also been reported.(5) POF’s are usually solitary, rarely, it can 
be multicentric.(10) Multicentric variants are reported at times 
in association with conditions such as nevoid basal cell car-
cinoma syndrome, multiple endocrine neoplasia type II, neur-
ofibromatosis and gardener’s syndrome.(10) The peak incid-
ence of POF is between second and third decades and almost 
two  thirds  of  all  cases  are  reported  in  females.(4,8,10,11) 
There is a slight  predilection for the maxillary arch and are 
frequently observed in the incisor-cuspid region.(4,8) Usually, 
the teeth are unaffected; rarely, it may cause migration, mobil-
ity and delay in eruption of permanent tooth.(8,10)
The radiographic features may range from no changes, as seen 
in  the present case to destructive  changes.(10,11) In  certain 
cases, superficial erosion of underlying bone, cupping defect 
and focal areas of radiopaque calcifications at the center of the 
lesion can be seen.(4,10,11) Considering the size of the lesion 
and details the plain radiography provides, additional imaging 
studies are rarely required. If performed, CT (computed tomo-
graphy) and MR (magnetic resonance) images can aid in eval-
uation of the epicenter of the mass.(5) On CT, they appear as a 
well  circumscribed  mass  with  evidence  of  calcification  and 
mild enhancement after contrast agent administration. At MR 
imaging, an isointense signal to muscle on non-enhanced T1 
weighted sequence and an iso-to-low signal on T2 weighted 
sequence can be seen.(5)
Microscopically,  the epithelium can be intact or ulcerated. If 
ulcerated, superficial areas of fibrinopurulent membrane with 
a  subjacent  zone  of  granulation  tissue  can  be  noticed.(4,8) 
Abundant  fibroblastic  proliferations,  variable  mineralized 
component,  sparse  endothelial  proliferation  and few inflam-
matory cells are other predominant findings of POF.(4,10) The 
mineralized components may consist of bone, cementum like 
material  or  dystrophic  calcifications.(4,8)  Less  frequently, 
ovoid  droplets  of  basophilic  cementum-like  material  are 
formed. Usually the bone is woven, lamellar or trabecular in 
type and rarely contains unmineralized osteoids and multinuc-
leated giant cells.(4,8)
The treatment of choice is local surgical excision. (8,12) POF 
has a high recurrence rate of about 8% to 16%; hence the mass 
should be excised deep into the periosteum with complete re-
moval of all irritants. In extensively destructive cases, reposi-
2
tioned flaps or connective tissue grafts may be necessary to re-
pair the gingival defects.(8,12)
References:
1. Eversole LR, Rovin S. Reactive lesions of the gin-
gival. J Oral Pathol 1972;1:30-8.
2. Zain RB, Fei YJ. Fibrous lesions of the gingiva: a 
histopathological analysis of 204 cases. Oral Surg 
Oral Med Oral Pathol 1990;70:466-70.
3. Waldron  CA.  Fibrosseous  lesions  of  the  jaws. J 
Oral Maxillofac Surg 1993;51:828-35.
4. Yadav R, Gulati A. Peripheral ossifying fibroma: a 
case report. J Oral Sci 2009;51:151-4.
5. Moon WJ, Choi SY, Chung EC, Kwon KH, Chae 
SW. Peripheral ossifying fibroma in the oral cav-
ity:  CT  and  MR findings. Dentomaxillofac  Radi-
ol 2007;36:180-2.
6. Shamim T, Varghese VI, Shameena PM, Sudha S. 
A  retrospective  analysis  of  gingival  biopsied  le-
sions in south indian population: 2001-2006. Med 
Oral Patol Oral Cir Bucal 2008 Jul 1;13(7): E414-
8.
7. Miller  CS,  Henry  RG,  Damm  DD.  Proliferative 
mass  found  in  the  gingiva. J  Am  Dent  As-
soc 1990;121:559-60.
8. Neville BW, Damm DD, Allen CM, Bouquot JE. 
Soft  tissue  tumors.  Oral  and maxillofacial  patho-
logy. 3rd ed. Missouri: Elsevier. P 521-3.
9. Delbem ACB, Cunha RF, Silva JZ. Soubhia AMP. 
Peripheral Cemento-Ossifying Fibroma in Child. A 
Follow-Up  of  4  Years.  Report  of  a  Case. Eur  J 
Dent 2008;2:134-137.
10. Kumar  SKS,  Ram S,  Jorgensen  MG, Shuler  CF, 
Sedghizadeh PP. Multicentric peripheral ossifying 
fibroma. J Oral Sci 2006;48:239-43.
11. Das UM, Azher U. Peripheral ossifying fibroma. J 
Indian Soc  Pedod Prevent  Dent 2009;  27(1):  49-
51.
12. Poon CK, Kwan PC, Chao SY. Giant peripheral os-
sifying fibroma of the maxilla: report of a case. J 
Oral Maxillofac surg 1995;53: 695-8.
3


A retrospective analysis of gingival biopsied lesions in south indian population: 2001-2006. Med Oral Patol Oral Cir Bucal

Fibrosseous lesions of the jaws.

Fibrous lesions of the gingiva: a histopathological analysis of 204 cases. Oral Surg Oral Med Oral Pathol

Multicentric peripheral ossifying fibroma.

Peripheral ossifying fibroma in the oral cavity: CT and MR findings.

Peripheral ossifying fibroma: a case report.

Peripheral ossifying fibroma. J Indian Soc Pedod Prevent Dent

Proliferative mass found in the gingiva.

Reactive lesions of the gingival.

Soft tissue tumors. Oral and maxillofacial pathology. 3rd ed.

Soubhia AMP. Peripheral Cemento-Ossifying Fibroma in Child. A Follow-Up of 4 Years. Report of a Case.

Peripheral Ossifying Fibroma

CogPrints Cognitive Sciences Eprint Archive

Peripheral Ossifying Fibroma

Abstract

Similar works

Full text

Available Versions

Cognitive Sciences ePrint Archive

CogPrints Cognitive Sciences Eprint Archive