Management of Fibrous Hyperplasia

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					CASE REPORT: FIBROUS EPULIS
SURGICAL MANAGEMENT
DR WAYNE FITZGERALD, BVSc MACVSc (VET.DENTISTRY)
Reservoir Veterinary Clinic
226 Spring Street, Reservoir, Vic. 3073


Most oral masses seen are benign (Epuli and gingival hyperplasia).

Fibrous epulis arises from the periodontal ligament and is the most common of
this group seen. This means that treatment not only involves extraction of the
tooth, but of the periodontium as well.

Epuli: have been categorized as fibrous, ossifying and acanthomatous. The last
is locally aggressive, requiring a more aggressive surgical approach.
The tissue of origin is the periodontal ligament and this defines the type of
treatment required.

Several cases diagnosed as fibrous epulis are presented to demonstrate a
reasonable surgical treatment modality of this not uncommon tumour.
To date, I have seen no reoccurrences following this treatment method.

Under general anaesthesia, a full examination can be performed and
radiographs taken to exclude bony involvement which may point towards a
diagnosis of acanthomatous epulis; this finding would require a revised
modification of the treatment planned.

Don’t expect any significant alveolar bone changes with fibrous epuli. The
mass is fairly radiolucent and if it lies between two teeth, it is generally
impossible to be certain of its exact origin. In this situation, I recommend
extraction of both the mesially and distally involved teeth.

A surgical flap procedure is performed to expose the buccal bone prior to
surgical extraction of the tooth/teeth involved. Remembering that the mass has
originated from the periodontal ligament it is then necessary to carefully remove
this structure and its attached alveolar bone. I usually use a surgical length
round carbide bur on a high-speed handpiece equipped with fibreoptics. This
procedure is akin to a more severe form of alveoplasty post-extraction.

In a number of cases where there has been significant bone debridement, I
have added Consil to the clean bone deficits prior to flap closure.

After trimming the epulis mass from the flap with reasonable but affordable
margins, close the flap with 4/0 Maxon in a simple interrupted suture with buried
knots.
Post surgical radiographs are taken as routine. The mass is sent for
histopathology.

The patient is monitored for healing and reoccurrence.

				
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