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  • The patient was kept under observation for 10 months [Table/Fig-7] to check for signs of recurrence prior to orthodontic intervention. The patient is currently under follow up, and undergoing orthodontic therapy. Efforts are on to motivate the patient��s sister to seek treatment for herself and her daughter. [Table/Fig-6]: Histology

    [Table/Fig-7]: 10 months post-surgical view Discussion One of the rare causes of gingival overgrowth is hereditary gingival fibromatosis (HGF), also known as familial or idiopathic gingival fibromatosis. HGF is a characterized clinically by gradual and progressive enlargement of keratinized gingiva, which is of normal colour, firm in consistency, non-haemorrhagic, and asymptomatic [1]. The first case was described by Gross in 1856 and the prevalence has been estimated at 1:750000 [2]. Oral Adenylate cyclase manifestations of HGF are highly heterogeneous and can vary from isolated areas of gingival enlargement typically seen around the maxillary tuberosities and the labial gingiva around the lower molars to generalized involvement [3]. The degree

    of enlargement may vary from mild to severe. The onset of gingival enlargement is usually at the time of eruption of the permanent dentition but can develop with the eruption of the deciduous dentition and rarely can be seen at birth [4,5]. HGF occurs only in dentulous areas and has been known to reduce in size or regress completely with the loss of the teeth, suggesting an influence of dental plaque on its pathogenesis [2,6]. The gingival enlargement results in significant aesthetic and functional impairment in affected

    individuals. The most common effects are diastemas, malpositioning of teeth, prolonged retention of primary dentition, delayed eruption, cross and open bites, prominent lips, and open lip posture [7,8]. The gingiva in HGF displays normal colour, exaggerated stippling, and firm consistency. The tissue is densely fibrotic (bony hard on palpation) and displays a nodular or pebbled surface. Both attached and free gingiva is involved but does not extend beyond mucogingival junction [9,10]. The histologic appearance of HGF is non-specific and is characterized by a well-structured epithelium with elongated and thin papillae inserted in fibrous connective tissue that is rich in collagen fibers [11]. Due to this, the definitive diagnosis of HGF should be based on family history and clinical findings. HGF can develop as an isolated disorder or more rarely it is associated with other manifestations as part of a syndrome or some chromosomal abnormality [Table/Fig-8]. Accordingly, HGF has been divided into two forms: non-syndromic and syndromic.

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