Giant cell epulis (peripheral giant cell granuloma) typically appears as a reactive benign lesion in the oral cavity in areas following local irritation or chronic trauma. Here we describe the case of a 45-year-old male patient who presented with the chief complaint of a large gingival mass in the anterolateral maxilla. There had been progressive growth within the past few months, with increased painless discomfort during mastication. The patient also reported bleeding during interdental cleaning. A full physical work-up led to the suspicion of giant cell epulis alongside other differentials including mucosal hemangioma and squamous cell carcinoma, with unremarkable laboratory values. Imaging including computed tomography showed signs of previous insertion of metal implants on either side of the lesion alongside mucosal hyperplasia. A confirmatory biopsy was taken and showed multiple giant cells on a reactive bed of stroma, in line with the diagnosis of giant cell epulis. Oral inflammatory conditions such as giant cell epulis have greater chances of local recurrence and, therefore, careful investigation with timely and accurate diagnosis is imperative for appropriate early treatment. Complete surgical excision should then be employed to prevent relapses, as incomplete removal can lead to further recurrence. Identification and eradication of potential sources of irritation should also be considered when treating the patient, to avoid further recurrence.

BACKGROUND: The isolation of stem cells from pathologically damaged dental tissues has been examined only by a few studies. The purpose of this study was to evaluate the possibility of isolation of stem cells from pyogenic granuloma.
METHODS: Pyogenic granuloma tissues were enzymatically digested and the resulting single cells were cultured. Then, the cultured cells differentiated into adipocytes and osteoblasts cells. Flow cytometry analyses were performed on markers such as CD 90, CD 73, CD105, CD 45 and CD14. Other features were also analyzed including the effect of colony formation and potentials of differentiation into adipocytes and osteoblasts.
RESULTS: The cells derived from pyogenic granuloma tissue formed higher colonies similar to typical spindle-shaped fibroblasts. The cells were positive for mesenchymal markers such as CD 44, CD 271, CD 90, and CD 73, and negative for surface molecules such as CD 14, CD 34 and CD 45. Moreover, they successfully differentiated into adipocytes and osteoblasts.
CONCLUSIONS: The cells isolated from pyogenic granuloma could form CFU fibroblastic units expressing an appropriate marker panel of the cell surface antigen and adequate differentiation potential, all of which met the Cell Therapy International Association criteria for the definition of mesenchymal stromal cells. Pyogenic granuloma contains cells with stem cell properties.

Reactive lesion formation around dental implants a complication that has been given much consideration. These lesions can lead to marginal bone loss, and consequently, implant failure. In the present systematic review, all reported reactive lesions associated with dental implants in the literature were assessed. An electronic search was performed using PubMed Central, Scopus, Google Scholar, and Science Direct. The search strategy was limited to human studies (case reports and case series), full-text English language articles, published until May 2017. A total of 19 articles reporting 27 lesions in 25 cases were included. Peripheral giant cell granuloma and pyogenic granuloma were the most reactive lesions found around dental implants. The mean age of the patients was 51.28 ± 14.48 years, with a slight female predilection. Posterior mandibular gingiva was the most common location for these lesions. The recurrence rate of lesions was 33.33%, and the chance of implant removal was 29.62%. Due to the clinical significance of these lesions, early histopathologic examination is recommended to exclude the presence of such pathological lesions.