Background: Localized juvenile spongiotic gingival hyperplasia (LJSGH) is a rare gingival lesion characterized by exuberant epithelial proliferation. Its etiology remains unclear, with few studies exploring its clinical and histopathological features. This retrospective study aimed to analyze the demographic, clinical, and etiological characteristics of LJSGH across 13 diagnostic centers in Latin America. Methods: Data were extracted from clinical records, including variables such as age, sex, clinical phenotype, anatomical site, comorbidities, potential triggering factors, and therapeutic approaches. Results: Seventy cases were included. The mean patient age was 15.9 years, with a female-to-male ratio of 1.41:1. Most lesions were unifocal (72.9%), and the anterior maxillary gingiva was the predominant location (60%). The exophytic protruding pattern was the most common (45.7%). Systemic comorbidities were rare (4.3%), and 58.5% of cases showed no identifiable factors. Regarding potential local etiological factors, 27.14% of patients had teeth malposition in the affected region, and 14.28% were undergoing orthodontic appliances. The presence of biofilm was detected in 47.14% of the cases. Surgical excision was the most frequent treatment (57.1%). Conclusion: This study supports SGH as a reactive, odontogenic lesion influenced by local and/or multifactorial triggers. Future studies should investigate its multifactorial etiology, focusing on periodontal, microbiological, and histopathological factors.