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focal gingival enlargements are quite frequent lesions in the oral cavity amounting to almost 3.1% of all oral tumors and for 9.6% of gingival lesions . in 1992 ,
the world health organization classification about this kind of focal overgrowth had tapered toward one universal term  peripheral cemento - ossifying fibroma .
we , in our case report prefer to call it as peripheral ossifying fibroma ( pof ) .
pofs are more frequent in younger ages , peak being in the second decade , although there are cases occurring in older age groups also
there is uncertainty for diagnosing focal reactive overgrowths of the gingiva because of their nearly same clinical presentation .
the typical appearance of pof is small gingival growth ( epulis ) initially which can attain large sizes so as to cause facial disfigurement .
if the lesions grow to larger sizes , there can be a mild erosion of bone .
the treatment of pof is straight forward with surgical excision with blade and scalpel commonly followed .
a newer approach is the use of diode lasers for its removal , probably having an advantage of lesser bleeding and predicted results .
whatever may be the method of removal , it should be sent for histopathological diagnosis . here
a 60 year old female presented to us with a chief complaint of swelling on the right maxillary posterior region of jaw since 3 - 4 years .
she also gave a history of the slow growth of the mass since last 3-years to reach the present size .
the oral examination showed the presence of a solitary pedunculated mass of size 4 cm  2 cm  3 cm which was red in color with lobulated surface on the right maxillary posterior alveolar ridge .
on palpation , the mass was firm , nontender , and not fixed to underlying structure .
orthopantomogram ( opg ) evaluation showed the presence of a unilocular radiolucent area extending superiorly into the corresponding maxillary sinus , posteriorly to maxillary tuberosity , and anteriorly until the distal end of canine .
dento - alveolar scan did not show the extension of mass into maxillary sinus , rather showed the inflamed lining of the sinus .
a three dimensional construction image done after dento - alveolar scan confirmed the calcifications [ figure 2c ] within the mass which was seen as radio - opaque areas in opg . after clinical and radiographic investigations pof , peripheral giant cell granuloma ( pgcg ) and pyogenic granuloma ( pg ) ( longstanding ) were considered in differential diagnosis .
the clinical presentation of intraoral mass ( a ) orthopantomogram showing the extension of mass .
( b ) dento - alveolar scan showing the extension of lesion and inflamed maxillary sinus lining .
( c ) three - dimensional construction showing calcifications within the mass a comprehensive explanation was given to the patient and sign was taken on the consent form .
excisional biopsy was carried out , and the tissue was sent for histopathological examination for confirmatory diagnosis .
macroscopically , the gross specimen was measuring 3.5 cm  2 cm  1 cm , creamish brown in color , firm to hard in consistency with lobulated , and pebbly surface .
the specimen was cut into two halves , and most representative areas were taken for processing [ figure 3 ] . the complete gross specimen
the specimen was fixed in phosphate - buffered neutral formalin for 1 day , subsequently , five - micron paraffin sections were obtained and stained with hematoxylin and eosin ( h and e ) .
microscopic analysis of the h and e section showed parakeratinized stratified squamous epithelium covering loosely arranged highly cellular connective tissue stroma [ figure 4a ] .
few vascular spaces of varied sizes and inflammatory infiltrate were also seen in underlying connective tissue . based on these histologic features ,
( a ) photomicrography showing parakeratinized stratified squamous epithelium covering loosely arranged highly cellular connective tissue stroma .
pof is clinically present as a soft nodular mass which may be either pedunculated or sessile present near the interdental papilla .
pof histopathologically is described as a lesion which has a fibrous stroma in which there is presence of mineralized tissues such as bone and/or cementum - like .
 however , this term is discarded as clinical and histopathological presentation is the same in those cases where there is no cementum .
some authors have reported the presence of odontogenic epithelium and also that the proliferating cells may be of myofibroblastic origin .
some researchers feel that it represents that some kind of chronic irritation is responsible for stimulation of cells in the periodontal ligament .
the purpose of reporting this case was to give a brief review to the surgeon that there can be a number of lesions presenting with the same picture but have varying histopathological presentation .
it is always better to be aware of the fact and plan the surgery accordingly .
pofs are common in the mandibular region and in the second decade of life usually .
irrespective of the type of mineralized component , the treatment of choice is surgical excision and there are very few cases of recurrence reported .
focal gingival enlargements are a diverse group of lesions with almost similar clinical presentation but varied etiology and histopathology . 
 the actual cause of peripheral ossifying fibroma ( pof ) has been debated over many years . 
 pofs are usually seen in childhood and younger ages . 
 there is a slight female predilection . 
 it is usually localized , rarely generalized . 
 usually , the treatment option is only surgical excision with minimal chances of recurrence . here 
 , we report a case of pof of the right maxillary posterior region with a review of literature .