Management of Cyclosporine and Nifedipine-Induced Gingival Hyperplasia

Abstract

Gingival enlargements modified by medications are becoming more common because of the increased use of inducing drugs, and may create speech, mastication, tooth eruption, periodontal, and aesthetic problems. We hereby present a case of a 54-year-old man with 12-month history of generalized gingival enlargement in the keratinized gingiva was referred to our clinic. The patient had a history of kidney transplant and was under medication of cyclosporine and nifedipine. After medical consultation, cyclosporine was changed to tacrolimus and nifedipine was changed to captopril. Gingivectomy was performed using a diode laser, and scaling and root planning were performed. At five months postoperative, the gingival enlargements relapsed and diode laser-assisted surgery was repeated. The patient was followed-up on second postoperatively at 18 months and no relapse was seen. Diode laser-assisted gingivectomy was found to be useful for coagulation during surgery and decreased postoperative bleeding. Recurrence risk of cyclosporine and nifedipine-induced gingival overgrowth is high, thus, there is a great need for prolonged care of patients following treatment and prosthetic restoration.

Keywords: Diode laser; Gingival overgrowth; Prosthetic restoration.

[Table/Fig-1]:

Generalized gingival enlargements are seen as mulberry shaped, firm, pale red, and resilient, with a lobulated surface (a) intraoperative clinical photograph after diode laser-assisted gingivectomy procedure (b)

[Table/Fig-3]:

Panoramic radiographic image of 54-year-old male patient’s baseline periodontal status. Severe alveolar bone loss is evident around the maxillary teeth

[Table/Fig-4]:

The healing process around the mandibular teeth (A), and in the maxilla (B) at postoperative days 20. Images of the healing process of the mandible (C), and the maxilla (D) are seen on postoperative days 80

[Table/Fig-5]:

The image shows the situation after renewal of the dental prosthesis

[Table/Fig-6]:

Images illustrate relapse of gingival enlargements around the mandibular tooth at postoperative five months (A), no sign of gingival enlargement was seen in the maxilla (B)

[Table/Fig-7]:

Postoperative intraoral pictures show the clinical health of periodontal tissues six months in the mandibula (A), and in the maxilla (B), and 18 months in the mandibula (C), and in the maxilla (D) after the second surgery. No clinical signs of gingival enlargement in the gingiva were noted

[Table/Fig-8]:

Proliferated parakeratinized stratified squamous epithelium, dense irregular fibroconnective tissue, and an increased number of blood vessels and fibrotic cells (A). The epithelium stratum was reduced and there was a normal rate of fibrotic cell and connective tissue, in contrast to what was seen in image A (B). Arrows indicate epithelial proliferation and regular connective tissue (H&E, x100).