Prosthodontics & Occlusion · patient case question
The fibrous fold in the labial sulcus is diagnosed as an epulis fissuratum. The denture flange is relieved but the lesion persists. What is the next step?
Patient case: A denture that will not stay put
demo: 71-year-old male
chief: His upper denture drops when he speaks and food collects under it. He also has a sore lump at the front.
history: He has worn the same maxillary complete denture for fourteen years and has never had it relined. Only the mandibular anterior teeth from 22 to 27 remain.
meds: None relevant.
findings: The maxillary anterior ridge is displaceable and mobile on palpation while the posterior ridge is firm. A folded, fibrous ridge of tissue lies in the labial sulcus adjacent to the denture flange. The mandibular anterior teeth show generalised wear.
Show answer and explanation
Correct answer: A. Surgical excision followed by prosthetic replacement
- A. Correct. Epulis fissuratum starts as reactive hyperplasia from a chronically overextended flange. Once dense fibrous tissue has matured it will not resolve on its own. Remove the irritant first, then excise the residual tissue with histological examination, and replace or reline the denture so the cause does not recur.
- B. There is no fungal component to a fibrous hyperplasia. Antifungals treat denture stomatitis, which is a different diagnosis.
- C. Further relief alone will not reverse mature fibrous hyperplasia, and continuing to observe simply delays definitive care.
- D. Steroids treat inflammatory and immune-mediated mucosal disease. This lesion is a fibrous overgrowth and will not respond.
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