Aim The aim of this retrospective study was to evaluate the frequency and distribution of biopsy-proven gingival lesions in our patient population according to the framework of the 2017 periodontal disease classification and to assess the concordance between clinical provisional diagnoses and definitive histopathological diagnoses.Materials and Methods The records of 58 patients who underwent gingival biopsy within the specified study period were retrospectively reviewed. Demographic data, lesion location, biopsy type, clinical provisional diagnosis, and definitive histopathological diagnosis were recorded and analyzed. Diagnostic concordance between the clinical and histopathological diagnoses was evaluated.Results The most frequent definitive diagnoses were fibroma (n = 12, 20.7%) and non-specific inflammation (n = 12, 20.7%). The overall malignancy rate was 5.2% (3/58), all of which were diagnosed as squamous cell carcinoma (SCC), a rate slightly higher than that reported in the literature. Among the 12 cases with a clinical provisional diagnosis of SCC, only 25% were confirmed histopathologically. Reactive and inflammatory lesions accounted for the majority of false-positive clinical diagnoses.Conclusion Reactive lesions constituted the majority of gingival biopsies in this cohort, while the relatively elevated malignancy rate suggests a high level of biopsy selectivity in our clinic. The low diagnostic accuracy observed for the clinical provisional diagnosis of SCC highlights the challenge posed by reactive lesions that clinically mimic malignancy and underscores the indispensable role of histopathological examination as the gold standard for definitive diagnosis.