Soft Tissue Lesions
Epulis Fissuratum
aka Denture-Induced Fibrous Hyperplasia · Denture Granuloma · Inflammatory Fibrous Hyperplasia
Hyperplastic fibrous tissue folds in the vestibule caused by ill-fitting denture flanges.
§ figuresFigures (1)
Fig. 1Epulis Fissuratum around dental implant
“Epulis in transition” · DentalSchoolProf · CC BY-SA 3.0 · Wikimedia Commons
Verified open-access images only, reproduced for education under their stated licences · no AI-generated or illustrative artwork · Epulis Fissuratum figures pending faculty review.
§ overviewOverview
Reactive tissue overgrowth secondary to chronic irritation from a denture flange.
§ icdICD Classification
K06.1
§ etiologyEtiology
- 01Ill-fitting denture flange
- 02Chronic mechanical irritation
§ epidemiologyEpidemiology
Common in denture wearers, especially elderly.
§ pathogenesisPathogenesis
Chronic low-grade trauma → fibrous tissue proliferation → redundant folds.
§ clinicalClinical Features
- 01Single or multiple soft tissue folds in vestibule
- 02Firm, fibrous consistency
- 03Denture flange sits within groove between folds
- 04Usually painless
§ differentialDifferential Diagnosis
- 01Inflammatory papillary hyperplasia
- 02Fibroma
- 03Peripheral giant cell granuloma
- 04SCC (if ulcerated)
§ histopathHistopathology
- 01Hyperplastic stratified squamous epithelium
- 02Dense fibrous connective tissue with chronic inflammation
§ investigationsInvestigations
- 01Clinical exam + biopsy if atypical
§ treatmentTreatment
- 01Relieve denture flange
- 02Surgical excision of redundant tissue
- 03Reline or new denture
§ complicationsComplications
- 01Recurrence if denture not corrected
§ prognosisPrognosis
Excellent after excision and denture correction.
§ examKey Examination Points
- 01Always assess denture fit
- 02Excise + address cause
- 03No malignant potential but biopsy to exclude SCC
§ revisionQuick Revision Summary
- 01Denture flange irritation
- 02Firm folds in vestibule
- 03Excision + new denture
§ vivaBDS Viva Questions
- 01What causes epulis fissuratum?
- 02How do you manage it?
- 03What would you expect on histology?
§ mcqsMCQs — Assessment (3)
Question 1
Epulis fissuratum is caused by:
Question 2
Treatment includes:
Question 3
Histology shows:
§ evidenceReferences & Evidence
Current Classification
WHO Classification of Tumours Online — Head and Neck
IARC / WHO · 2022
Continuously updated online edition of the WHO head and neck tumour classification.
Evidence summary
Highest level of evidence linked to this page: WHO / Official Classification.
- L1 · Classification — 1
- L6 · Textbook — 3
1 linked source was published from 2024 onwards. Where guidance is limited or contested, rely on the higher-level sources above rather than this summary. Educational use only — not a substitute for clinical judgement.
Content last reviewed
September 2026
Evidence last reviewed
September 2026
Next scheduled review
September 2027
Review status
EVIDENCE REVIEWED
Search latest PubMed evidence
Last literature search: 7 September 2026
Current Classification
IARC / WHO. IARC · 2022
Continuously updated online edition of the WHO head and neck tumour classification.
Histopathology References
Barnes L. CRC Press · 2008
Detailed histopathological reference for head and neck diagnostic criteria.
Textbook References
Neville BW, Damm DD, Allen CM et al.. Elsevier · 2024
Standard reference textbook of oral and maxillofacial pathology used throughout this atlas.
Rajendran R, Sivapathasundharam B. Elsevier · 2020
Undergraduate and postgraduate oral pathology textbook widely used in BDS and FCPS curricula.
Additional sources cited on this page
- Neville BW. Oral & Maxillofacial Pathology, 4e
Draft — pending faculty review. Educational use only; verify against current guidelines and primary sources before clinical application.