Gingival Hyperplasia and PAI-1: a case report

Objectives: Gingival hyperplasia is a volumetric augmentation, related to a local or systemic pathology, or drug assumption. Gingival hyperplasia with plasminogen deficit is a rare condition caused by fibrin depositing on connective tissue. This paper de- scribes a case of gingival hyperplasia, related at hyper expression of PAI-1, with normal plasminogen level. Clinical case: S.N., female, aged 18, was admitted presenting diffuse gingival hyperplasia with absence of major risk factors. Anamnesis revealed a total relapse after a previous complete gingivectomy performed 2 years before. Clinical and radiolog- ical evaluation confirmed the absence of periodontal disease. Hematochemical-serological-genetic set-up revealed the follow- ing: PLT 132 E+09/L, RDW 12.9%, P-PT 1.25 INR, P-APTT 1.33, vWF 43%, RISTOCETINIC CO-FACTOR 34%, desmo- pressin test: positive, homozygosis 4G for PAI-1 gene, heterozy- gosis for VLF and for XIIIF (Val34Leu) and for MTHFR (C677T and A1298C), absence of polymorphism in GpIIIa (Leu33Pro). Histological evaluation showed evidence of gingival tissue with a severe fibrin depositing and chronic inflammation. Therapy protocol included: a full mouth gingivectomy and gin- givoplasty in local anaesthesia, professional dental care every 3 months, a soft diet. After a five years follow up no evidence of relapse is observed. Conclusions: Recurrent gingival hyperplasia, related to altered blood PAI-1 level, is a rare condition, still to be properly de- fined. The action mechanism is referred to a genetic set up (homozygosis 4G for PAI-1 gene) that, arising PAI-I blood levels, inhibits plasminogen activation and so fibrin degradation. Fibrin is produced where tissue is affected by inflammation and regeneration, like in gingival mucosa while chewing