| Popis: |
Hiperplazija gingive kliničko je stanje u kojem dolazi do povećanja volumena ili broja stanice gingivnog tkiva. Etiološki hiperplazija gingive može nastati zbog upale, mehaničke traume, lijekova, genetske predispozicije ili povezanosti s nekom sistemskom bolesti ili stanjem. Najčešće se povećanje gingive javlja kod pacijenta koji su na terapiji lijekovima koji potiču povećanje tkiva gingive, a to su imunosupresivi, antiepileptici i blokatori kalcijevih kanala. Točan mehanizam nastanka hiperplazije još nije do kraja razjašnjen, ali se pretpostavlja da je glavni uzrok povećanja porast citokina i faktora rasta koji potiču fibroblaste na stvaranje kolagenih vlakana, a smanjuju aktivnost kolagenaze. Takvo će povećanje rezultirati fibroznim zadebljanjem tkiva ružičaste boje i čvrste konzistencije. Ako je razlog povećanja gingive povećana razina upalnih faktora, tkivo gingive bit će edematozno, mekše konzistencije i krvarit će pri sondiraju. Klinička slika odgovara etiološkom faktoru, a u slučaju da se klinički ne može potvrditi dijagnoza, potrebno je napraviti patohistološku analizu ili dodatne laboratorijske testove. Potrebno je ukloniti uzrok povećanja gingive jer u protivnom može doći do recidiva. Izbor terapije ovisi o težini kliničke slike, a može biti konzervativna ili kirurška. Konzervativna terapija je manje invazivna i temelji se na kontroliranju rasta tkiva gingive. Kirurška sanacija potrebna je kada konzervativna terapija nema učinka ili po završetku konzervativne terapije radi estetske korekcije, a na raspolaganju su operativni zahvati poput gingivektomije, gingivoplastke te operacije režnja. Gingival hyperplasia is a clinical condition with an increase in the volume or number of gingival tissue cells. Etiologically, gingival hyperplasia can occur due to inflammation, mechanical trauma, medications, genetic predisposition, or it can be associated with a systemic disease or condition. Gingival enlargement is most commonly present in patients on therapy with drugs that induce gingival tissue enlargements, such as immunosuppressants, antiepileptics, and calcium channel blockers. The exact mechanism of hyperplasia has not been thoroughly studied; however, it is assumed that the leading cause of the enlargement is an increase in cytokines and growth factors, which stimulate fibroblasts to produce collagen fibers and reduce collagenase activity. The result can be fibrous tissue thickening, pink gingiva, and firm consistency. If the reason for gingival hyperplasia is an increased level of inflammatory factors, then gingival tissue will be edematous, softer consistency, and it will be positive for bleeding on probing. If the diagnosis cannot be confirmed clinically, it is necessary to perform a pathohistological analysis or additional laboratory tests. With the permanent removal of the cause of gingival hyperplasia -so recurrence does not occur- the choice of therapy may either be conservative or surgical therapy. Conservative therapy is less invasive and focuses on controlling the growth of hyperplasia. Surgical therapy is required when conservative therapy has no effect or after conservative therapy if there is a need for esthetic correction of soft tissues. We can achieve this with surgical procedures like gingivectomy, gingivoplasty, and flap surgery. |
