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case_images: The intraoral view (A-D) of a patient with Hyperplastic Gingival Fibromatosis (HGF) shows a generalized overgrowth of the gingival tissues that covers a significant portion of the teeth, affecting both attached and free gingiva. The gingiva appears swollen and puffy, with a pale pink coloration and a granular texture, especially in the anterior mandible. The interdental papillae are notably pronounced, which has led to difficulties with mastication and oral hygiene. This symmetrical presentation significantly impacts both oral function and aesthetics.
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case_images: Intraoral examination revealed generalized enlargement of keratinized gingiva, with interdental papilla in the buccal, lingual, and palatal sides covering half of some teeth's anatomical crowns with gingiva (Figure 1).
case_images: In the extraoral view of a patient with Hyperplastic Gingival Fibromatosis (HGF), the upper lip shows a slight bulge, while other facial features appear normal.
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case_images: The orthopantomogram (OPG) of the mandible and maxilla shows mispositioning of some teeth, which may be related to gingival overgrowth. Additionally, missing teeth are noted in quadrants 1, 3, and 4, with a remaining root in quadrant 4.
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case_images: Microscopic examination revealed a dense collection of soft tissue neoplastic cells arranged in cellular fascicles and a storiform pattern. The cells are monomorphic, spindle-shaped, and have scant cytoplasm. The nucleoli are enlarged and hyperchromatic, with no cytological atypia observed. There is no evidence of mitosis in the examined lesion. The overlying squamous mucosa is unremarkable. There is no evidence of atypia or malignancy in the material examined.
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case_images: Based on the clinical findings and family history, the case was diagnosed as hereditary gingival fibromatosis, a diagnosis that was confirmed by pathological examination of a gingival biopsy (Figure 4).
case_images: Step-by-step surgical procedure on the buccal side of the upper left quadrant: (A) Submarginal incisions, (B) Sulcular incisions, (C) Removal of excessive tissue, (D) Split-thickness flap elevation, (E) Removal of excessive connective tissue, (F) Exposure of several exostoses, (G) After osteotomy and osteoplasty, (H) Flap fixation, (I) One month after surgery.
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case_images: Surgery on the palatal side of the upper left quadrant: (A) Before surgery, showing gingival overgrowth on the palatal side, (B) Gingivectomy followed by split-thickness flap elevation, (C) Removal of excessive connective tissue, (D) Bone recontouring and flap adaptation, (E) Flap fixation, (F) One month after surgery.
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case_images: One year after surgery (A-E), the patient's gingiva has notably reduced in size, making the teeth more visible. The gingiva now has a more normal contour and texture, with decreased swelling and a healthier, pale pink color. The surface is smoother, and there are no signs of recurrent overgrowth. Oral function, including mastication and speech, has improved, and the aesthetic outcomes are enhanced with more natural-looking gingival tissues. Periodontal health is also better.
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case_images: Frontal view: (A) Before surgery, (B) One year after surgery, (C) During orthodontic treatment.
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case_images: Intraoral views (A-E) reveal severe gingival enlargement, excessive stippling, crowding in the lower front teeth, teeth malposition, and retained primary teeth in front of the permanent mandibular teeth. These issues have significantly compromised function and aesthetics.
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case_images: The gingiva appeared pink in color, had a leathery consistency, and exhibited abundant stippling features (Figure 9). 
case_images: Intraoral views (A-E) of the patient six months after surgery show a significant decrease in gingival overgrowth. The gingival texture, contour, and color have markedly improved. While function and aesthetics related to the gingiva have improved, the misalignment of the teeth still requires orthodontic treatment.
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case_images: The surgical procedure technique used for the patient was similar to the patient described in the above case with the addition of deciduous teeth extraction and removal of subgingival calculus which was exposed after flap elevation during surgery (Figure 10). 
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case_images: Intraoral views (A-D) show generalized bead-like features of the interdental papillae on the buccal side of both the maxilla and mandible, which have drastically compromised aesthetics, function, and oral hygiene.
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case_images: The gingiva appeared pink in color, firm and dense in consistency, and exhibited a bead-like feature in all interdental papillae in the buccal side of the maxilla and mandible (Figure 11).