PMC9807311_01
PMC9807311_02
(a) Extra-oral frontal view at presentation. (b)-(f) Intra-oral views at presentation. (g) Orthopantomogram at presentation. (h) and (i) Hematoxylin & eosin stained images of first excisional biopsy of gingival lesion palatal to teeth #8 and #9. (h) Photomicrograph depicting surface squamous mucosa exhibiting focal ulceration, and underlying submucosal proliferation of capillary sized blood vessels with lobular arrangement (x40). (i) High power view showing proliferation of capillaries admixed with numerous mononuclear and polymorphonuclear inflammatory cells (x200).
CRID2022-1379769.001.jpg
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fig1
The histopathological assessment showed proliferation of capillaries admixed with numerous mononuclear and polymorphonuclear inflammatory cells consistent with pyogenic granuloma (Figure 1).
PMC9807311_03
(a) Extra-oral frontal view at presentation. (b)-(f) Intra-oral views at presentation. (g) Orthopantomogram at presentation. (h) and (i) Hematoxylin & eosin stained images of first excisional biopsy of gingival lesion palatal to teeth #8 and #9. (h) Photomicrograph depicting surface squamous mucosa exhibiting focal ulceration, and underlying submucosal proliferation of capillary sized blood vessels with lobular arrangement (x40). (i) High power view showing proliferation of capillaries admixed with numerous mononuclear and polymorphonuclear inflammatory cells (x200).
CRID2022-1379769.001.jpg
PMC9807311_04_CRID2022-1379769.001.jpg
fig1
The histopathological assessment showed proliferation of capillaries admixed with numerous mononuclear and polymorphonuclear inflammatory cells consistent with pyogenic granuloma (Figure 1).
PMC9807311_04
(a) Extra-oral frontal view at presentation. (b)-(f) Intra-oral views at presentation. (g) Orthopantomogram at presentation. (h) and (i) Hematoxylin & eosin stained images of first excisional biopsy of gingival lesion palatal to teeth #8 and #9. (h) Photomicrograph depicting surface squamous mucosa exhibiting focal ulceration, and underlying submucosal proliferation of capillary sized blood vessels with lobular arrangement (x40). (i) High power view showing proliferation of capillaries admixed with numerous mononuclear and polymorphonuclear inflammatory cells (x200).
CRID2022-1379769.001.jpg
PMC9807311_04_CRID2022-1379769.001.jpg
fig1
The histopathological assessment showed proliferation of capillaries admixed with numerous mononuclear and polymorphonuclear inflammatory cells consistent with pyogenic granuloma (Figure 1).
(a)-(c) Follow-up radiographs at 6 months. (d)-(h) Intra-oral views at 6 months follow-up. (h) and (i) Hematoxylin & eosin stained images of second excisional biopsy of interdental gingival lesion to teeth #8 and #9 showing. (i) Hyperplastic squamous mucosa with underlying nodular sheet-like plasma cells in a background of collagenized stroma composed of fibroblasts and myofibroblasts. (j) High power view showing morphologically monotonous and diffused cells with no mitotic figures or nuclear atypia indicative of plasma cell infiltrate. (k) Immunostains for kappa and lambda showing a strong diffused positivity with no light chain restriction. Findings were indicative of polyclonality of the lesion.
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fig2
An interdisciplinary treatment plan was developed and performed (Figure 2), whereby the patient underwent an intensive home preventive care, regular scaling with selective root planning of deep periodontal pockets, restoration of the carious teeth #14 and #19, and extraction of the unrestorable tooth #30. Up to 6 months recall, the initial treatment plan was found to be partially successful in improving the patient's oral health with initial resolution of gingival edema and erythema, and the periodontal and gingival lesions associated with tooth #3 (Figure 2). The second histopathological assessment showed evidence of hyperplastic squamous mucosa with underlying nodular sheet-like plasma cells in a background of collagenized stroma composed of fibroblasts and myofibroblasts, and morphologically monotonous and diffused cells with no mitotic figures or nuclear atypia indicative of plasma cell infiltrate (Figure 2). In addition, immunostains for kappa and lambda showed a strong diffused positivity with no light chain restriction (Figure 2).
PMC9807311_05
Periapical radiographs and intra-oral images taken at 6 months recall from second excisional biopsy (no recurrence was observed up to 12 months).
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fig3
This approach led to total resolution of inflammation signs and prevented the recurrence of the lesion between teeth #8 and #9 up to 12 months post-operatively (Figure 3).