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Available online at ajdhs.com 

Asian Journal of Dental and Health Sciences 
Open Access to Dental and Medical Research 

Copyright  © 2023 The  Author(s): This is an open-access article distributed under the terms of the CC BY-NC 4.0 
which permits unrestricted use, distribution, and reproduction in any medium for non-commercial use provided 

the original author and source are credited  

 

 

Granuloma Pyogenicum in an Extraction Site: An Unusual Case Report 

Nethra Devi* , Naveena Srinivasam , Saravanan Thalaimalai  

Karpaga Vinayaga Institute of Dental Sciences, Padalam, Tamil Nadu 603308, India 

Article Info: 
_____________________________________________ 
Article History: 

Received 04 September 2023     
Reviewed  18 October 2023 
Accepted 13 November 2023 
Published 15 December 2023 

_____________________________________________ 
Cite this article as:  

Devi N, Srinivasam N, Thalaimalai S, Granuloma 
Pyogenicum in an Extraction Site: An Unusual Case 
Report, Asian Journal of Dental and Health Sciences. 
2023; 3(4):4-7 

DOI: http://dx.doi.org/10.22270/ajdhs.v3i4.60          

Abstract 
_________________________________________________________________________________________________________________ 

Pyogenic granuloma also known as Granuloma pyogenicum is a typical, acquired, benign vascular 
lesion of the skin and mucous membranes. It can occasionally present intravascularly or 
subcutaneously. This report discusses the case of pyogenic granuloma in a 25-year-old male in 
extraction site in lower left back tooth region. 

Keywords: Pyogenic granuloma, lobular capillary hemangioma, benign neoplasm, hyperplastic 
lesion. 

 

*Address for Correspondence:   

Nethra Devi L, Karpaga Vinayaga Institute of Dental Sciences, Padalam, Tamil Nadu 603308, India. 

 

Introduction:  

One of the most frequently occurring benign mucocutaneous 
lesions is pyogenic granuloma which is also known as lobular 
capillary hemangioma 1. It is believed that this soft tissue tumor 
of the oral cavity, is reactive rather than malignant in nature 2,3. 

From clinical point of view, Pyogenic granuloma is present as a 
solitary nodule or sessile collagenous papule with a smooth or 
lobulated surface. Lesions become less vascular as they become 
mature, and clinically it is more pink and 4,5. The marginal 
gingiva is the most frequently observed site, but lesions have 
also been reported on the palate, buccal mucosa, tongue, and 
lips6. 

The preferred method of treatment for these lesions has always 
been complete surgical excision with sub-periosteal curettage. 
Plaque, swollen restorations, etc. are examples of potential 
irritating elements that must be similarly eliminated to prevent 
recurrence 7. 

This article includes a case of pyogenic granuloma present in 
extraction site in the lower left back tooth region. 

Case Report: 

A 25-year-old male patient reported to the Department of Oral 
Medicine and Radiology, Karpaga Vinayaga Institute Of Dental 
Sciences, Chengalpattu district, Tamil Nadu, India. 

The patient’s chief complaint was pain in his left lower back 
tooth region for past 1 month. History revealed tooth extraction 
in left lower back tooth region before 2 years. Growth which is 
initially small in size and gradually increased to the present size 
for past 1 month. Pain is present which is dull throbbing, 
intermittent and non-radiating in nature. Aggravated by 

mastication and relieved by medications. Spontaneous bleeding 
was present.  

 

Figure1: Front view 

On extra-oral examination, there was no evidence of external 
swelling, no palpable lymph node in submental and 
submandibular region and no evident of pus discharge or 
bleeding. 

On intra-oral examination, presence of single well-defined 
growth of size 2x2 cm is seen in relation to 37 region. It is 
roughly oval in shape and sessile in nature extending anteriorly 
distal aspect of 36, posteriorly mesial aspect of 38, superiorly 
along the alveolar mucosa and inferiorly along the lower left 
buccal vestibule ( fig.2 ). No secondary changes were seen. On 
palpation, all inspectory findings are confirmed with respect to 
number, site, size, shape and extent. It is non-tender, fibrous in 
consistency with bleeding discharge.

                     Open Access                                                                                                                                                                                                       Research Article                                                                           

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Nethra Devi et al                                                                                                                             Asian Journal of Dental and Health Sciences. 2023; 3(4):4-7 

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Figure 2: Intra oral Photograph 

Histopathological examination  

 Section studied show a polypoidal lesion lined by ulcerated stratified squamous epithelium with underlying stroma showing lobules 
of proliferating capillary sized blood vessels lined by plump endothelial cells with interstitial lymphoplasmacytic infiltrate. (Fig.3) 

 

Figure 3:  Histopathology 

Radiographic examination  

 Intra oral periapical examination reveals radiolucency in relation to 37. It also reveals vertical bone loss and widening of periodontal 
in relation to 36. ( Fig.4 ) 

 

Figure 4: Radiographic image 

Treatment: 

Patient positioned 2% lignocaine with adrenaline administered as left Inferior alveolar nerve block. Extraction of 36 done under local 
anaesthesia and a tissue of size 1x2 cm excised and placed in formalin container for histopathological study (Fig.5). Bone filing done. 
Granulomatous tissue removed. Saline irrigation done. Suturing done with 3-0 silk. Hemostasis achieved. 

     

(a)                                                                  (b) 

Figure 5(a) Surgical excision of the lesion (b) Extracted 36 



Nethra Devi et al                                                                                                                             Asian Journal of Dental and Health Sciences. 2023; 3(4):4-7 

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(a)                                                                  (b) 

Figure 6: Post Op image (a) Day 1 (b) Day 7 

 

Discussion: 

A pyogenic granuloma is an inflammatory hyperplasia that 
develops when connective tissue reacts excessively to a 
localized small injury or any underlying irritation8. Dental 
calculi, poor oral hygiene, an unidentified illness, and over-
contoured restorations are all potential sources of irritation 7,8. 

Pyogenic granulomas can develop anywhere on the body's 
surface. They are most common around the fingers and toes. 
Pyogenic granulomas in the oral cavity have a strong 
predilection for the gingiva, with interdental papillae being the 
most frequent site in 70% of cases9. Vilmann et al. claim that 
only 15% of pyogenic granulomas are found on the alveolar 
portion, with the majority of them being found on the marginal 
gingiva 10. The second decade of life is when pyogenic 
granuloma most frequently occurs, according to studies by Zain 
RB et al. among Singaporean communities 11. 

A smooth or lobulated exophytic lesion with a pedunculated or 
sessile base is the most common clinical manifestation of 
pyogenic granuloma. The size of a pyrogenic granuloma can 
range from a few millimeters to several centimeters, but it 
rarely exceeds 2.5 cm12,13. It bleeds readily, grows quickly, and 
is typically asymptomatic and painless. Due to the masticatory 
trauma, the surface is frequently covered in fibrin, ulcerated, 
and friable. The surface color varies from pink to red or purple 
depending on how old the lesion is. While older PGs contain 
more collagen, younger PGs have more vascularity and 
hyperplastic granulation tissue13. 

Since they infect minor trauma sites during the healing process, 
bacteria like streptococci and staphylococci may be involved in 
the etio-pathogenesis of this lesion. As a result, there may be an 
increase in vascular growth and tumor-like hyperplasia.12,15 

The histopathological examination consists of numerous thin-
walled arterial channels visible inside an edematous connective 
tissue matrix9,16. Sometimes, these vessels are grouped into 
lobular aggregates, and some pathologists need this lobular 
arrangement to make a diagnosis. Moreover, there is a mixed 
cellular infiltration that is rather dense. The underlying 
stratified squamous epithelium is typically deteriorated or 
ulcerated in large sections, and the ulcer edge may have a 
primitive dysplastic look. It can also be atrophic or 
hyperplastic9,16. 

The majority of vascular tumors, such as haemangiomas, oral 
fibromas, peripheral giant cell granulomas, and peripheral 
ossifying fibromas, as well as neoplastic lesions, such as Kaposi 
sarcoma, metastatic carcinoma, and other malignant tumors, 
are included in differential diagnosis17. There have been some 
reports of drug-induced gingival hypertrophy among 
Nifedipine users. Drug-induced gingival enlargement is a 
generalized fibrotic event that affects a significant section of 

upper and lower gingiva and has a pebbly surface. It is pale-pink 
in color13. 

With respect to treatment, Powell mentioned using a Nd YAG 
laser to remove this lesion because there were fewer chances of 
bleeding than with previous surgical methods.18 In a case study 
by Kocaman et al., bleeding time and operating time were 
decreased during surgery when Nd:YAG laser was utilized to 
treat PG. Additionally, postoperative hemostasis was 
accomplished quickly, and no scars or discomfort were seen19. 
According to a report by Fekrazad et al., who used an Er:YAG 
laser for the excision of PG, CO2 and Er:YAG lasers aids in better 
cutting  than Nd:YAG and diode lasers because of their high 
water absorption, less penetration, and reduced coagulation20. 

But as of right now, the majority of reports recommend using 
surgical excision as the preferred treatment. It is advised to do 
curettage of the underlying tissue following lesion excision, 
performing an excision with 2 mm margins in the periphery and 
at a depth that will include periosteum. Additionally, it is 
necessary to remove any foreign objects, calculi, or restorations 
that may be connected to the development of pyogenic 
granulomas.21 

Pyogenic granuloma recurrence following excision is a known 
hazard. Re-excision of such lesions may be required due to the 
pyogenic granuloma recurrence rate, which is reported to be 16% 
of treated lesions15. Pyogenic granuloma can be effectively 
treated if the right diagnosis and course of action are taken. A 
meticulous approach to the lesion's therapy also aids in 
preventing its recurrence. 

Conclusion 

Literature on oral pyogenic granulomas is extensive. However, 
the occurrence on the extraction site is very rare. Since tooth 
extraction is a common dental procedure, professionals should 
be aware that pyogenic granuloma can also develop from an 
extraction socket.  A practitioner may misinterpret this reactive 
lesion for a more serious one due to lack of awareness about its 
atypical location. Histopathology validates its innocuous nature, 
making it easy to overcome. 

Conflicts of interest: None. 

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Nethra Devi et al                                                                                                                             Asian Journal of Dental and Health Sciences. 2023; 3(4):4-7 

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