Peripheral giant cell granuloma poor dental restorations, unstable dental pros- fected site for all patients in this report was the thesis, dental extractions, plaque and calculus anterior mandible. In the literature, PGCG is more accumulation, and food retention seem to play a common in the lower jaw than in the upper jaw.4,5 significant role in the development of a PGCG.2,3,5,9- Clinically, PGCG is a smooth brown, red, or blu- 11 Histopathologic characteristics of PGCG may ish nodule, sessile or pedunculated. Radiographic be consistent with periodontal ligament or peri- examinations generally have no findings, because osteum origin.4 Histologically, PGCG is identified the lesion is a soft tissue mass. Although the etiol- as a non-encapsulated mass of tissue compiled of ogy of PGCG is unclear, in the present report the a reticular and fibrillar connective tissue stroma etiologic factor is thought to be chronic trauma, containing profuse young connective tissue cells because of unstable prosthesis. Our three patients of ovoid or fusiform shape, and multinucleated gi- have used complete dentures for numerous years. ant cells.8 The fibrocellular reaction is akin to that PGCGs generally develop either in the gingival tis- of other reactive lesions such as fibrous hyperpla- sue or in the alveolar processes of the incisor and sia and peripheral ossifying fibroma.10-12 The calci- canine region.3 Of our three cases, all were located fied material or newly formed bone may also be in the edentulous alveolar margins of the anterior seen all over the cellular connective tissue, and mandibular region. Lesion size differs from 0.5 to some of the lesions may be either woven bone or 1.5 cm in diameter, although there have been 5 cm lamellar bone produced by the mononuclear stro- size cases in the literature, in which factors such mal cells, which might be similar to latent prolif- as poor oral hygiene or xerostomia seem to play erative osteoblasts or osteoprogenitor cells.5,6,13 an important role in lesion growth.4 None of our The microscopic appearance of PGCG is distinctive cases exceeded 2 cm in size. mainly due to the large number of multinucleated In the present report, all three cases have had giant cells that are disseminated in the connective long-term use of complete dentures that might tissue stroma.4 The exact basis of the giant cells be thought of as having the possible effect of un- is still uncertain. Many opinions have been offered stable dental prostheses on PGCGs etiology. The in the literature, as osteoblasts, phagocytes, en- most preferred occlusion type for complete den- dothelial cells, and spindle cells are thought to tures is bilateral balanced occlusion (BBO). In be responsible for giant cell proliferation.6,14 The BBO, the anterior teeth do not make contact dur- widely reported discrepancy in the gender ratio ing functional movements (Figure 10).16 Over time, may mirror the small number of cases consid- as a result of posterior denture erosion, anterior ered in some series, but the majority of studies teeth may contact.17 These contacts may cause re- agree that there is a female predominance.15 In sorption on residual ridges and so soft tissues can this report, two of our three patients were female. lose bone support and, after all these changes, in- PGCG is seen in almost every decade group, but creased forces may create irritation on these ar- most patients were aged between four and seven eas.16,18,19 This may be an irritant factor for PGCG decades, as reported in previous studies.4,5,7 Two development. Edentulous patients wearing com- of our patients were in the five-decade age cohort plete dentures should be followed up at one-year and one patient was in the eighth decade. The af- intervals and should be considered for implant- 332 Figure 10. Clinical view of the post prothetic treatment of first patient. European Journal of Dentistry