The reasons for considering periodontal ligament origin is the exclusive occurrence of these fibromas in the gingiva (interdental papilla
), the proximity of gingiva to the periodontal ligament and the presence of oxytalan fibers within the mineralized matrix of some lesions and the fibrocellular response, which is similar to other reactive gingival lesions of periodontal ligament origin.
The second option consisted of the esthetic reconstruction of the anterior teeth without orthodontic movement by increasing the mesial emergence profile and the additional mesiodistal width of the lateral incisors (0.75 mm each) with HA injections to treat the interdental papilla loss.
Injection of HA fillers was planned to fill the deficient interdental papilla, because there was an excessive distance from the alveolar bone crest to the approximal contact in this case.
(8) Interdental papilla augmentation along with reconstruction of interdental bone to create appropriate support for gingival papilla has also been reported.
CONCLUSION: This novel surgical procedure combined the use of semilunar incision and platelet rich fibrin for augmenting the lost interdental papilla in the anterior esthetic zone.
(6) Drug-induced gingival overgrowth usually occurs within the first 3 months of starting drug therapy at a dose of 10mg/day and begins as an enlargement of the interdental papilla
. Although few cases of amlodipine induced hyperplasia have been reported, the present case is interesting as it occurred with a low dose of amlodipine (5mg) and appeared on administration for 6 months.
The third incision is then placed interproximally to release the interdental papilla
. Additional minor gingival recontouring was performed to establish symmetrical gingival margins.
Establisment of contact point too gingivally will induce inflammatory response in interdental papilla
region leading to bone loss.
Bokenkamp in 19944 has given score for gingival enlargement as Grade O--No sign of gingival enlargement, Grade I--Enlargement confined to interdental papilla
, Grade II--Involves papillae and marginal gingiva, Grade III--Enlargement covers % or more of the crown.Of the several drugs currently, more than 20 drugs are associated with gingival enlargements (5) and can be broadly divided into three categories--
When the lesion is found on the attached gingiva, in the areas of gingival sulcus or interdental papilla
, it is known as peripheral fibroma.
The attached gingiva and interdental papilla
were anesthetized using xylonor spray (lignocaine 15.0 g) and if required infiltration was done using 2% lignocaine HCl with 1:80,000 adrenaline injection.
Since this procedure includes the complete removal of the frenum, a common complication encountered with this technique is the undesireable loss of interdental papilla
. Hence, the frenotomy which is a more superficial procedure, with only partial removal of the frenum and just a relocation of the attachment, is an esthetically preferable procedure lately (14).