Aim: Gingival enlargement (GE) is a very frequent condition to be witnessed in routine clinical practice. With a wide array of factors responsible for this clinical situation, it is imperative to identify the precise nature of the causative factor and underlying disease process. Background: Continuous lifestyle alterations and clinical dental practice over a period of time have seen many new behaviors, disease conditions, and dental treatment options associated with GEs. The existing classification system for the assessment and treatment planning of GEs essentially has been proposed almost half a century ago and thus does not accommodate the newer variants reported by the authors in the form of case reports. Largely all such conditions, which do not fall under the major categories, are grouped under the broad heading of “idiopathic GEs.” This grossly affects the clinicians’ acumen to comprehend the subtle differences in etiology and pathogenesis of GEs and to provide precise personalized patient care to these patients. Review results: This article showcases the newer variants of GEs as published in the literature over the last 60 years. Conclusion: This review provides a contemporary comprehensive update to include the variants as novel categories or subcategories for better identification, diagnosis, and management of these cases. Clinical significance: With the continuous surge of advances in knowledge of periodontal disease pathogenesis and novel diagnostic/therapeutic methods, a multitude of variants of GE conditions have been witnessed in recent clinical practice. There is a significant need for periodic expansion and update of the variants for GE conditions for precise identification and management of these conditions.