Management of a Complex Case of Gingival Enlargement Associated With Underlying Arteriovenous Malformation: A Five-Year Follow-Up Case Report

Arteriovenous malformations (AVMs) are high-flow congenital vascular anomalies characterized by abnormal direct communication between arteries and veins, bypassing the capillary bed. Gingival enlargement or gingival overgrowth is a common gingival disease characterized by an increase in the size of the gingival tissues. The main factors of gingival enlargement are inflammation, drugs, systemic conditions or diseases, neoplastic or false enlargements, and local factors, such as plaque, calculus, and/or overhanging restorations. The purpose of this article is to present an interesting case of the management of a patient with mandibular gingival enlargement occurring in association with an underlying AVM. A 24-year-old non-smoker female patient presented to the periodontal clinic for the evaluation of a gingival overgrowth on the right side of the mandible that had developed over a four-week period, following a referral from her vascular specialist. Patient was previously diagnosed with an intraosseous AVMs in jaws (j-AVMs). Her medical history consisted of undergone embolization therapy for the j-AVM one year before. Clinical evaluation revealed an asymptomatic, soft-consistency, red/purple tumor-like mass with a broad base, measuring 0.5 x 0.5 cm. The surrounding gingival tissues in the right mandibular region appeared hyperplastic and edematous. A diagnosis of generalized gingivitis was established. The region of AVM was topographically associated with the vascular lesion of the mandibular gingiva. The gingival hyperplasia was distinguished from the underlying AVM, clarifying that the two represented coexisting independent lesions. The coexistence of gingival overgrowth with an underlying intraosseous AVM is exceptionally uncommon and presents notable challenges in clinical management and treatment. This case highlights the importance of adopting a conservative and multidisciplinary management approach, particularly in patients with high-flow vascular anomalies, where invasive procedures may pose substantial risks. Effective management relies on close collaboration among dental clinicians, radiologists, and vascular specialists.