title: [Surgical correction of excessive gingival enlargements. Case studies].
abstract: BACKGROUND
  Gingival enlargement is a common form of periodontal tissue reaction to several irritating factors. The most common form is the drug related gingival hyperplasia--nevertheless the heredity gingival fibromatosis and hematological cases can also occur and might impose a challenge to periodontists. After a short literature summary three Case reports are presented. The first case is a drug related gingival overgrowth in a young kidney transplant women who took Cyclosporin-A. The excessive mass of fibrotic tissue was removed by a series of internal beveled incision and the oral and buccal gingival flaps were united with sutures. The healing was uneventful and during the follow up patient's compliance and oral hygiene was superb. The second case is a very severe antihypertensive drug related gingival overgrowth in a 62 years old man interfering with the closure of his lip and corrected with a combination of conventional gingivectomy and internal reverse beveled incision both and Ca-channel blockers. The third case is a 42 years old woman with chronic idiopathic hemolytic anemia who presented a sudden onset acute excessive generalized gingival enlargement accompanied with severe pain and fever. At admission she was suspect for leukemia. After obtaining biopsy samples and having negative histology the soft tissue mass was removed under general anesthesia with conventional gingivectomy technique, but after a couple of days the severe pain and gingival swelling recurred. With administering systemic corticosteroid therapy (32 mg Medrol), the gingiva healed in five days and the one year follow-up showed a stable hematological and periodontal status. Today the more conservative internal beveled incision is preferred over the conventional gingivectomy in the most cases because it provides a more predictable healing and better esthetics. The recurrence of the drug related gingival hyperplasia can be anticipated by meticulous postoperative individual oral hygiene and regular supportive therapy.
  
  
  CONCLUSIONS
  The combined conservative and surgical therapy leads to predictable postoperative result even in very severe systematically motivated gingival enlargements, nevertheless the successful patients management needs good cooperation with medical doctors and with the patients themselves.
authors.affiliation: Semmelweis Egyetem, Parodontológiai Klinika, Budapest.
authors.forename: Boróka
authors.initials: B
authors.lastname: Csifó-Nagy
authors.affiliation: Semmelweis Egyetem, Parodontológiai Klinika, Budapest.
authors.forename: Emese
authors.initials: E
authors.lastname: Hulik
authors.affiliation: Semmelweis Egyetem, Parodontológiai Klinika, Budapest.
authors.forename: Géza Márton
authors.initials: GM
authors.lastname: Zsoldos
authors.affiliation: Semmelweis Egyetem, Parodontológiai Klinika, Budapest.
authors.forename: István
authors.initials: I
authors.lastname: Gera
mesh_terms: D000328:Adult; D000368:Aged; D000743:Anemia, Hemolytic / Q000150:complications; D000959:Antihypertensive Agents / Q000008:administration & dosage / Q000009:adverse effects; D002121:Calcium Channel Blockers / Q000008:administration & dosage / Q000009:adverse effects; D016572:Cyclosporine / Q000008:administration & dosage / Q000009:adverse effects; D005260:Female; D005334:Fever / Q000209:etiology; D005885:Gingival Hyperplasia / Q000139:chemically induced / Q000150:complications / Q000209:etiology* / Q000601:surgery*; D005886:Gingival Hypertrophy / Q000139:chemically induced / Q000150:complications / Q000209:etiology* / Q000601:surgery*; D005890:Gingivectomy / Q000379:methods; D006099:Granuloma / Q000150:complications; D006801:Humans; D007166:Immunosuppressive Agents / Q000008:administration & dosage / Q000009:adverse effects; D016030:Kidney Transplantation; D008297:Male; D008875:Middle Aged; D009910:Oral Hygiene; D010146:Pain / Q000209:etiology; D013492:Suppuration; D016896:Treatment Outcome
chemical_list: D000959:Antihypertensive Agents; D002121:Calcium Channel Blockers; D007166:Immunosuppressive Agents; D016572:Cyclosporine