Treatment

Under general anesthesia, a full-thickness incision was made around the facial surface of teeth #s 6-9. The lesion was fully excised and the area sutured using 4-0 Vicryl. The surgery left a small denuded area of anterior palate which was packed with iodoform gauze and impregnated with antibiotic ointment. A pre-surgical stent was placed onto the maxillary dentition for pain control and to act as a bandage. The area healed well with no complication or evidence of recurrence.

Incisional and excisional biopsy

The first specimen showed evidence of a moderately cellular fibrous connective tissue mass with an ulcerated surface, clusters of calcified material and areas of osteoid material.  The ulcerated surface was covered by fibrin and neutrophils.  The mass and the surrounding connective tissue were infiltrated by neutrophils, plasma cells and lymphocytes.  The second specimen was more of a loose and vascular granulation tissue mass with small clusters of calcified material and many inflammatory cells.

 

Figure 3 Low power (100X) the H & E stained specimen shows an ulcerated and moderately cellular fibrous connective tissue nodule with clusters of calcified material.

Figure 4 Higher power (200X) the H & E stained specimen shows cellular fibrous connective tissue containing osteoid material, young osteoblasts and clusters of calcified material.