Fibrous Dysplasia Presenting as a Gingival Mass: A Rare Clinical Presentation

Background/Objectives: Fibrous dysplasia (FD) is a benign fibro-osseous disorder charac-terized by the replacement of normal bone with fibrous tissue and immature woven bone, most commonly involving the craniofacial skeleton. It typically presents as an intraosse-ous lesion in children and young adults. Gingival presentation without prominent in-traosseous expansion is exceedingly rare. This report describes an unusual case of FD presenting predominantly as an exophytic gingival mass in the anterior maxilla of a mid-dle-aged patient. Methods: A middle-aged patient presented with a slowly enlarging gingival mass extend-ing from the right canine to the left central incisor region. After being lost to follow-up for approximately 4.5 years, the patient returned with increased swelling, pain, spacing of the anterior teeth, and functional impairment affecting mastication and speech. Clinical, ra-diographic, surgical, and histopathologic findings were evaluated. Surgical management included excision of the lesion, extraction of non-restorable teeth, and bone grafting under general anesthesia. Results: Radiographic examination demonstrated minimal osseous involvement without a clearly defined intraosseous expansile lesion. Histopathologic analysis revealed irregular curvilinear trabeculae of woven bone within a fibrous stroma containing bland spin-dle-cell proliferation, consistent with FD. At the six-month follow-up, the patient remained asymptomatic without complications and was undergoing prosthetic rehabilitation with plans for future implant placement. Conclusions: FD may rarely present as a predominantly gingival lesion with minimal ra-diographic evidence of bone involvement, posing a diagnostic challenge. Recognition of this atypical presentation is important to avoid misdiagnosis and to facilitate appropriate management through comprehensive clinicoradiologic and histopathologic correlation.