Fibrous Dysplasia Presenting as an Exophytic Gingival Mass: A Rare Clinical Presentation

Background/Objectives: Fibrous dysplasia (FD) is a benign fibro-osseous disorder characterized by the replacement of normal bone with fibrous tissue and immature woven bone, most commonly involving the craniofacial skeleton. It typically presents as an intraosseous lesion in children and young adults. Fibrous dysplasia may rarely present with predominant gingival involvement and minimal radiographic evidence of intraosseous disease. We report an unusual case of craniofacial fibrous dysplasia that clinically mimicked an exophytic gingival mass in the anterior maxilla of a middle-aged patient. Methods: A middle-aged patient presented with a slowly enlarging gingival mass extending 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, radiographic, 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 spindle 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 radiographic 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.