gingival fibromatosis is a slowly progressive gingival enlargement caused by collagenous overgrowth of the fibrous component of the gingival connective tissue . the familial variations may occur as an isolated finding or in association with one of several hereditary syndromes , for example , zimmermann  laband , murray findings seen sometimes in conjugation with gingival fibromatosis include hypertrichosis , epilepsy , and mental retardation . this condition has also been reported in association with deficiency of growth hormone caused by lack of growth hormone release factor . hereditary gingival fibromatosis , also known as elephantiasis gingiva , hereditary gingival hyperplasia , idiopathic fibromatosis , and hypertrophied gingiva , is a rare hereditary condition characterized by slow , progressive enlargement of the gingiva . most cases of hereditary gingival fibromatosis appear to be inherited in an autosomal - dominant manner , although autosomal recessive inheritance has also been reported . autosomal - dominant forms of gingival fibromatosis , which are usually nonsyndromic , have been genetically linked to the chromosome 2p21-p22 and 5q13-q22 . in modern times , a mutation in the son of sevenless-1 ( sos-1 ) gene has been suggested as a possible cause of isolated ( nonsyndromic ) gingival fibromatosis . recent research has shown that 2 genetically separate loci are responsible for the autosomal dominant type of fibromatosis . the hyperplastic gingiva usually presents a normal color and has a firm consistency with abundant stippling . this anomaly is classified into 2 types according to its form  the nodular form and the symmetric form . the localized nodular form is characterized by the presence of multiple enlargements in the gingiva . the symmetric form , which is the most common type of the disorder , results in uniform enlargement of the gingiva . the degree of enlargement may vary from mild to severe and may be the same between individuals within the same family . it usually begins at the time of eruption of the permanent dentition but can develop with the eruption of the primary dentition . the most common effects related to gingival overgrowth are diastemas , malpositioning of teeth and prolonged retention of primary teeth . more severe lesions may cover the dental crowns , resulting in both esthetic and functional problems . histologically , hereditary gingival fibromatosis consists of dense or moderately dense , avascular , bland of collagenic connective tissue with scattered chronic inflammatory cells , beneath the surface epithelium . this report presents the clinical features and the management of a 17-year - old female patient with hereditary gingival fibromatosis who was followed - up for 2 years . a 17-year - old female reported to the department of periodontics , people 's college of dental science and research centre , complaining of gingival swelling , which hampered speech , mastication , and esthetics . the patient reported that the gingival enlargement had started at the time of eruption of permanent dentition with slow progression ; due to which there was a delayed eruption of permanent dentition . the enlargement had influenced the position of her teeth , in such as way that the dentition appeared with diastema and malpositioning . there was generalized spacing in the dentition with proclined maxillary anteriors [ figure 1 ] . preoperative photograph showing severe gingival hyperplasia panoramic radiograph was taken , which revealed normal bone height . the patient 's medical history was not indicative of drug - induced gingival enlargement or hormonal changes and exhibited no signs of hypertrihcosis or mental retardation that could be associated with gingival hyperplasia . her family history was of significance since , according to the patient , her brother ( 21 years old ) and her sister ( 15 years old ) had gingival enlargement but according to the patient there was no esthetic problem . the sections revealed moderately dense collagenous connective tissue with collagen bundles arranged in a haphazard manner . the patient was recalled at 1 , 3 , and 6 months post surgery and after that she was recalled at 6 months interval for up to 24 months after surgery . during this period , three months after surgery , the patient was suggested to undergo orthodontic treatment for diastema and malpositioning correction . although the genetic mechanism is not well understood , majority of authors have attributed the condition related with hereditary factors . in this case , the patient did not exhibit any signs or symptoms suggesting that the condition was syndromic . the diagnosis was made on the basis of clinical presentation , family history , and characteristic microscopic features of the histologic samples . bozzo and colleagues in 1994 reported autosomal dominance in a four - generation pedigree with 50 of 105 at - risk family members developing gingival fibromatosis . in the present case , the gingival enlargement was a hereditary condition , probably autosomal dominant , due to its existence in siblings ( father , brother , and sister ) , although there were other close relatives ( other sister and mother ) who were phenotypically normal . on the other hand , it was not related to endocrine problems or use of drugs . there is inconsistency in the literature as to the cellular and molecular mechanisms that lead to gingival fibromatosis . some authors report an increase in the proliferation of gingival fibroblasts , whereas others report slower - than normal growth . the gingival enlargement usually begins at the time of eruption of the permanent dentition or less frequently , with the eruption of the primary dentition . in this case , the patient reported that gingival enlargement had started at the time of eruption of permanent dentition with slow progression ; due to which there was a delayed eruption of permanent dentition . it has been suggested that gingival enlargement may be due to nutritional and hormonal factors , but these have not been completely substantiated . the constant increase in the tissue mass can result in delayed eruption and displacement of teeth , arch deformity , spacing , and migration of teeth . the condition is not painful until the tissue enlarges to partially cover the occlusal surface of the molars , and thereby getting traumatized during mastication . in the present case , enlargement was not found to cover the occlusal surface , although due to massive gingival enlargement , the patient experienced difficulty in speech and maintaining oral hygiene measures . this could have resulted in the accumulation of materia alba and plaque , which could have further complicated the existing situation . the microscopic features of the present case were classic of gingival fibromatosis , that is , hyperplastic epithelium with elongated rete ridges and dense fibrous connective tissue stroma underneath . when the enlargement is minimal , good scaling of teeth and home care may be sufficient to maintain good oral health . as the excess tissue increases , appearance and functional impairment dictate the need for surgical intervention . treatment consists of surgical excision of the hyperplastic tissue to restore the gingival contours . with the exception of carbon dioxide laser , which has been used in some studies , the most widely used method of removing large quantities of gingival tissue is the conventional external bevel gingivectomy with gingivoplasty , particularly when there are pseudopockets with no attachment loss . a periodontal flap procedure may be preferred for the treatment of gingival enlargement if there are large areas of gingival overgrowth or attachment loss and osseous defects . whenever possible , the treatment should be performed after complete eruption of the permanent dentition . one report indicated that there is less chance of recurrence if the gingivectomy is delayed until the permanent dentition is in place . there was no recurrence in a period of 2 years , 3 years or even a 14-year follow - up . for the present case , gingivectomy under local anesthesia was the favored treatment and there was no recurrence of the gingival enlargement during 2 years follow - up . hereditary gingival fibromatosis is a rare disorder characterized by various degrees of attached gingival overgrowth . unesthetic appearance and impaired function often demand surgical intervention , although recurrence can not be predicted . after treatment , regular recalls are necessary in order to evaluate oral hygiene , and the stability of the periodontal treatment .
hereditary gingival fibromatosis is a rare disorder characterized by various degrees of attached gingival overgrowth . 
 gingival fibromatosis usually develops as an isolated disorder but can be one feature of a syndrome . 
 a case of a 17-year - old female who presented with a generalized severe gingival overgrowth , involving the maxillary and mandibular arches and covering almost the whole dentition . 
 excess gingival tissue was removed by conventional gingivectomy under local anesthesia . 
 the postoperative course was uneventful and the patient 's appearance improved considerably . 
 good esthetic result was achieved without recurrence of the gingival overgrowth . 
 after treatment , regular recall visits are necessary in order to evaluate oral hygiene , and the stability of the periodontal treatment .