Morphological changes of gingival tissue in hypertrophic gingivitis

Background: Hypertrophic gingivitis (HG) in the context of periodontal diseases represents a chronic proliferative pathological process, involving the epithelium and connective tissue of the gingival mucosa. This condition causes an aesthetic defect with the loss of the anatomical appearance of the gingiva but with the lack of destructive processes in the bone tissue. The frequency of HG constitutes about 3%-5% of the total volume of oral pathology, mainly affecting young people and having a harmful impact on oral health and the patient’s quality of life. The purpose of the study: Evaluation of morphological changes in hypertrophic gingivitis by macroscopic and microscopic investigations of the material obtained by biopsy. Material and methods: A total of 90 biopsies were examined taken from 63 patients, aged between 18-40 years old. HG was induced by bacterial plaque and favored by fixed partial dentures, coronary fillings, carious processes. The patients included in the study had no concomitant and associated severe pathologies. Biological material was harvested by the incisional biopsy method, immediately fixed in 10% neutral formalin and transported to the laboratory. Thus, the preparation of the study material included the following stages: material collection, fixation, dehydration, clarification, embedding in paraffin. Sections of 3-4 μm were made with microtome. After deparaffinization, the sections were stained with hematoxylin and eosin. The histological preparations were studied under the optical microscope equipped with a digital camera. The microscopic appearance of the sections was documented by color photographs. Results: The microscopic study of the material obtained by biopsy demonstrated changes both in the epithelium of the gingival mucosa and in the connective tissue of the chorion. The epithelium undergoes hypertrophy through hyperplasia with phenomena of acanthosis, parakeratosis, spongiosis, hydropic and vacuolar dystrophy, leukocyte infiltration. In some cases the epithelium was subjected to erosion, rarely to ulceration. The connective tissue of the chorion of the mucosa also undergoes severe changes – edema, hyperemia and hemorrhages, the triggering of inflam matory processes with granulocytic and then lymphocyticplasmocytic infiltration of both the papillary and the deep layer of the proper lamella of the mucosa. In cases of erosions or ulceration of the chorion, the marked vascularized granulation tissue and lymphocyte infiltrates develop. Conclusions: The used morphopathological method represents a relevant and informative complementary option that confirms the clinical diagnosis of HG. The histological support of HG highlights a process of hypertrophy, as well as one of hyperplasia, which can be associated with an increase of the extracellular matrix.