Integrated Therapy For Stage ⅱ Grade B Periodontitis With Epulis

This case highlights the efficacy of integrated periodontal management in resolving chronic periodontitis with epulis, emphasizing long-term stability through structured maintenance. A 31-year-old female presented with persistent gingival bleeding and localized swelling of the maxillary anterior teeth. Clinical examination revealed Stage Ⅱ Grade B periodontitis (2018 classification) with fibrous hyperplasia affecting teeth 12 and 13. Treatment comprised: 1) oral hygiene instruction (modified Bass technique, flossing); 2) nonsurgical therapy (full-mouth scaling and root planing); 3) surgical excision of the hyperplastic tissue; and 4) periodic supportive care. Composite restorations were placed on teeth 45 and 46. The histopathological examination confirmed a fibrous epulis. Post-treatment evaluations at 1 month and 1 year demonstrated significant improvements: mean probing depth (PD) decreased from 3.0 mm to 2.1 mm, clinical attachment level (CAL) stabilized, and bleeding on probing (BOP) incidence decreased by 34%. No recurrence of epulis was observed. The combination of surgical intervention and meticulous plaque control enhanced tissue stability, while supportive therapy maintained outcomes. This case underscores the importance of combining mechanical debridement, surgical correction, and patient compliance in managing complex periodontitis. Regular supportive care and tailored oral hygiene protocols are critical for sustained success, particularly in cases with epulis.