Peripheral ossifying fibroma associated with an underlying enamel pearl on an anterior tooth

Peripheral ossifying fibroma (POF) is a reactive gingival lesion characterized by high cellularity and varying degrees of mineralization. An 18-year-old female reported a painless enlargement in the lower right anterior region that had been gradually increasing in size over five years. Clinically, the lesion appeared as a pink, smooth-surfaced, sessile mass involving the interdental papilla and attached gingiva adjacent to the mandibular right lateral incisor. There was no history of trauma. Following scaling and root planing, an excisional biopsy was performed. Intraoperatively, an enamel pearl measuring 2 mm × 3 mm was identified at the cementoenamel junction of the involved tooth and removed after flap elevation. Histopathological examination confirmed the diagnosis of POF. The postoperative healing was uneventful, with no recurrence observed over a one-year follow-up period. This case highlights the unusual association of POF with an underlying enamel pearl.