An Atypical Peripheral Ossifying Fibroma of the Mandible in a Male Patient: A Clinico-pathologic and Surgical Case Report

Abstract

Peripheral Ossifying Fibroma (POF) is an uncommon reactive, inflammatory gingival lesion believed to originate from the periodontal ligament in response to chronic irritation such as plaque, calculus, trauma, or defective restorations. It belongs to the spectrum of reactive gingival overgrowths, including pyogenic granuloma and Peripheral Giant Cell Granuloma (PGCG). Pathologically, POF displays a fibrocellular connective tissue matrix with characteristic areas of mineralisation. These may appear as immature woven bone, cementum-like deposits, or dystrophic calcifications. The presence of these mineralised foci is a key histopathological hallmark and reflects the osteogenic potential of periodontal ligament fibroblasts, which are capable of differentiating into cementoblasts or osteoblast-like cells under persistent inflammatory stimulation. POF typically occurs in young females and most frequently involves the maxillary anterior region. This case report describes an atypical presentation of POF in a 54-year-old male who reported a slowly enlarging, asymptomatic gingival mass in the mandibular canine–premolar area. Clinical examination revealed a firm, sessile, well-circumscribed nodular overgrowth in the attached gingiva of the mandibular left canine-premolar region, with normal surface appearance and no bleeding. Adjacent teeth showed pathologic migration, and periodontal support appeared compromised clinically. As part of the diagnostic work-up, an intraoral periapical radiograph was obtained, which demonstrated bone loss, widening of the periodontal ligament space, and migration of adjacent teeth, but no radiopaque material. Complete surgical excision was performed, and the specimen was submitted for histopathological evaluation. The gingival origin, clinical behaviour, radiographic and histopathological evaluation supported the diagnosis of POF. The patient was followed up regularly for three years and demonstrated no recurrence. This case underscores the importance of detailed clinical, radiographic and histopathologic evaluation when assessing atypical gingival enlargements occurring outside their usual demographic and anatomical patterns.