Peripheral Giant Cell Granuloma Associated With an Impacted Tooth and Prosthetic Irritation: A Multifactorial Etiological Insight and Surgical Management Challenge

Abstract

Peripheral giant cell granuloma (PGCG) is a reactive oral lesion typically associated with local irritants; however, the interactions among multiple concurrent etiological contributors remain poorly characterized in atypical presentations. We report a 55-year-old female patient presenting with a large exophytic mass in the posterior mandible. Clinical examination revealed a reddish-purple sessile lesion in contact with edentulous areas and a removable prosthesis, suggesting chronic mechanical irritation. Radiographic assessment demonstrated localized bone resorption and a vertically impacted mandibular canine adjacent to the lesion, raising suspicion of a more aggressive pathology. The initial clinical diagnosis was epulis. Surgical management included complete excision of the lesion, extraction of compromised teeth, removal of the impacted tooth, and curettage of the underlying bone. Histopathological analysis confirmed PGCG, characterized by a vascular fibrocellular stroma with numerous multinucleated giant cells. No recurrence was observed after a two-year follow-up, with satisfactory mucosal healing and functional outcome. This case suggests a possible synergistic interaction between prosthetic irritation, previous extraction, and a vertically impacted mandibular canine in promoting lesion growth and atypical features, including bone involvement. Comprehensive management that addresses both the lesion and its etiological factors appears essential for optimizing outcomes and reducing the risk of recurrence.