PMC7527614_01
A] Mirror image of gingival swelling seen in lingual aspect of mandibular canine (#33) and first premolar (#34) area. B] IOPA X ray showing ovoid radiolucency in mesial aspect of #34. C] CBCT image showing the soft tissue shadow of the gingival enlargement in lingual aspect of #34 as well as the extensive bone loss in the lingual cortical bone.
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Upon clinical examination, a well-circumscribed and fluctuant swelling, measuring about 10 mm in diameter, was observed at the junction of the buccal attached and free gingival margins in between the teeth #33 and #34 (Fig. 1A). An Intra-oral periapical (IOPA) radiograph of the site revealed a radiolucency of oval shape between the roots of teeth 33 and 34 (Fig. 1B). There was extensive loss of lingual cortical plate approximately 7.5 mm measured from the cemento-enamel junction (Fig. 1C).
[A-D]: Histopathological examination of the excised lesion showing showed cystic lumen lined by 2-3 layers of non-keratinizing cuboidal cells resembling REE which were hyperplastic at places. The lining epithelium also showed clear cells, localized thickenings/plaques and mural bulges. The underlying connective stroma is dense collagenous made up of bundles of collagen fibers, fibroblasts, blood vessels and dense infiltration of chronic inflammatory cell infiltrate. The overlying epithelium is parakeratinized stratified squamous in nature and is separated from the lesional tissue by a zone of normal connective tissue stroma.
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The overlying epithelium is parakeratinized stratified squamous in nature and is separated from the lesional tissue by a zone of normal connective tissue stroma (Fig. 2A-D).
A] On excision of lesion, extensive destruction of bone and expansion of cortical bone seen. B] 4 weeks post-operative IOPA xray showing filling of bony lesion. C] 4 weeks post operative clinical photograph showing healing lesion (mirror image) D] 8 weeks post operative clinical photograph showing satisfactory healing (mirror image).
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The bone defect showed expansion of the lingual cortical plate with a smoothened appearance of the bone (Fig. 3A). The post-operative clinical healing was uneventful (Fig. 3C & D). Regeneration of bone in the defect area laterally was observed in periapical radiography at 8 weeks (Fig. 3B).