Recurrent idiopathic gingival fibromatosis with generalized aggressive periodontitis: A rare case report.

Dear Sir,

The report on “Recurrent idiopathic gingival fibromatosis with generalized aggressive Periodontitis: A rare case report” by Ashwini Sudhakar Jadhav et al.[1] in the online early section of your journal was interesting. However based on our experience and literature findings, we bring to your kind attention various aspects must also be explored before drawing out the final diagnosis and treatment planning.

This case highlights the unusual coexistence of nonsyndromic idiopathic gingival fibromatosis with generalized aggressive periodontitis, which is worth consideration. Before treatment planning in such lesion, clinical data like pocket probing depth, Clinical attachment loss, bleeding on probing should be taken into account. These are the lesions having a high chance of recurrence and this patient already had undergone gingivectomy 2 years ago as mentioned. While planning for the such challenging case open flap debridement, pocket elimination and correction of infrabony defects and adjunctive use of doxycycline must also be considered as the causative microbe that is, A. actinomycetemcomitans penetrates deep into the tissues.[2] Moreover problem focused surgical therapy helps in effective root debridement enhancing the success of regenerative therapy.[3] Long-term follow-up of such patients are of paramount importance, but nothing has been mentioned about postoperative clinical record and follow-up in the present case report.

Further various risk factors for aggressive periodontitis that is, microbiological factors, e.g. A. actinomycetemcomitans, immunological factors genetic factors must be taken into consideration while concluding the diagnosis of Aggressive Periodontitis.[4] Biochemical investigations like neutrophil activity also help in diagnosing the underlying pathological condition.[5] This association need further research in terms of genetic linkage to unfold the curtain of mystery.