Removal of an oral squamous cell carcinoma including parts of osseointegrated implants in the marginal mandibulectomy. A case report

Peri-implantitis and peri-implant oral malignancies: a systematic review and meta-analysis of diagnostic challenges and potential associations

OBJECTIVE

This systematic review and meta-analysis aimed to investigate the potential association between peri-implantitis (PI) and peri-implant oral malignancies (PIOM).

DATA AND SOURCES

Systematic searches were conducted in Medline (PubMed), Embase, CENTRAL, and Web of Science up to December 10, 2024. Gray literature and reference lists were also searched. The protocol was registered in PROSPERO (CRD42024622566). Data synthesis involved descriptive analyses, Kaplan-Meier survival estimates, and a meta-analysis of proportion.

STUDY SELECTION

Studies were eligible if they reported PIOM cases. Animal studies, in vitro studies, reviews, and conference proceedings were excluded. A meta-analysis included retrospective studies reporting more than five PIOM cases. Inter-investigator reliability was assessed using Cohen's kappa statistic.

CONCLUSIONS

Fifty-seven studies (51 case reports/case series, 6 retrospective studies) involving 161 patients were included. Although the current evidence, limited to retrospective analyses and case reports, was insufficient to establish a definitive link, this review synthesized available data to provide preliminary insights and highlight directions for future research. The meta-analysis revealed that 50% of PIOM cases were initially misdiagnosed as PI, with squamous cell carcinoma being the most common final diagnosis (81% in case reports and 97% in retrospective studies). The median time from implant placement to PIOM diagnosis was 5 years, irrespective of traditional risk factors such as smoking, alcohol consumption, or previous cancer history. Although the evidence suggests a potential link between chronic peri-implant inflammation and malignant transformation, the limited nature of the available data highlights the need for prospective studies to establish causality and improve diagnostic protocols.

CLINICAL SIGNIFICANCE

PIOM can mimic peri-implantitis, leading to misdiagnosis and delayed treatment. Clinicians should maintain a high index of suspicion for malignancy in persistent peri-implant lesions unresponsive to conventional therapy, emphasizing the need for timely biopsy and histopathological evaluation, even in patients without traditional risk factors.

An Update on Implant-Associated Malignancies and Their Biocompatibility

Implanted medical devices are widely used across various medical specialties for numerous applications, ranging from cardiovascular supports to orthopedic prostheses and cosmetic enhancements. However, recent observations have raised concerns about the potential of these implants to induce malignancies in the tissues surrounding them. There have been several case reports documenting the occurrence of cancers adjacent to these devices, prompting a closer examination of their safety. This review delves into the epidemiology, clinical presentations, pathological findings, and hypothesized mechanisms of carcinogenesis related to implanted devices. It also explores how the surgical domain and the intrinsic properties and biocompatibility of the implants might influence the development of these rare but serious malignancies. Understanding these associations is crucial for assessing the risks associated with the use of medical implants, and for developing strategies to mitigate potential adverse outcomes.

Do dental implants facilitate bone invasion in patients with oral squamous cell carcinoma? A case series

Osseointegrated dental implants in the vicinity of oral squamous cell carcinoma (OSCC) will become more common given the increasing popularity of dental implants. Reports and studies of OSCC around dental implants are rare, as is the topic of how to handle OSCC surgically when implants are in contact with the tumour. In view of this uncertainty, a histological study was performed to assess tumour behaviour around implants. The aim was to determine whether an implant facilitates inward growth of the tumour and how this should be taken into account during staging and treatment planning. A total of 20 specimens were collected. The implants were macroscopically in contact with OSCC in 13 of the 20 specimens. Histologically, tumour tissue near the implant was indeed confirmed in nine of these cases. In seven cases, tumour invasion had led to resorption of the underlying jaw bone; tumour between the bone-implant interface was identified in only two of these cases, but without downward growth along the implant. In conclusion, no proof was found to confirm that the bone-implant interface is a preferred route for invasion. Therefore, dental implants in the vicinity of OSCC should not influence staging and treatment planning in this regard.

Oral squamous cell carcinoma around dental implants: a systematic review

OBJECTIVE

This systematic review aimed to evaluate the epidemiologic profile, screen for possible risk factors, and evaluate the spectrum of clinical characteristics of oral squamous cell carcinoma (OSCC) around dental implants (DIs).

METHODS

The systematic review was performed according to the Preferred Reporting Items for Systematic Reviews and Meta- Analyses statement.

RESULTS

Thirty-three articles met the eligibility criteria. In total, the sample consisted of 63 patients, and women comprised the majority (55.5%). The mean age of patients was 66.7 years. Oral potentially malignant disorders were reported in 46% of patients, of which 65.5% occurred in women. The most common lesion found in women was oral lichen planus (52.6%). In 88.8% of patients OSCC around DIs occurred in the mandible, and the most common clinical appearance of the lesions was an exophytic mass (46%). Most of these lesions were initially treated as peri-implantitis.

CONCLUSIONS

Most patients with OSCC around DIs were women without known risk factors. It is important to emphasize that these lesions may present clinical and radiographic features that could resemble peri-implantitis, which can lead to delay in the diagnosis and subsequent treatment.

Epidemiological profile and clinical implications of oral squamous cell carcinoma adjacent to dental implants

OBJECTIVES

Describe the epidemiological profile of patients with oral squamous cell carcinoma (OSCC) around dental implants (DI), investigate the spectrum of clinical and pathological characteristics, and discuss the implications of diagnosis delay of these lesions.

METHODS

Retrospective analysis of patients treated of OSCC adjacent to DI at A.C. Camargo Cancer Center between 2009 and 2020.

RESULTS

Thirty one patients were identified, being women the majority (58.1%). The mean age of the patients was 68.8 years. Never smoker corresponds to 46.9% and never alcohol consumer to 54.9% of the sample. OPMD was reported in 45.2% of patients, affecting mainly women (78.5%). Leukoplakia (63.7%) followed by oral lichen planus (36.3%) was the most common OPMD found in women. OSCC adjacent to DI occurred in the inferior gingiva/alveolar mucosa in 48.3% of cases, and ulceration was the most common clinical appearance (87%). Peri-implantitis (PI) was initial clinical diagnosis in 16.1% of cases.

CONCLUSIONS

Oral squamous cell carcinoma adjacent to DI was more common in women over 70 years old, non-smokers and non-drinker, and the majority had oral leukoplakia before the diagnosis of OSCC. OSCC may present clinical and radiographic features that resemble PI which can delay the diagnosis and impair the prognosis.

Cancerous lesions in the vicinity of dental implants: a systematic review

Introduction: The massive diffusion of dental implant treatments in the last decades leads to the appearance of complications, most of them inflammatory, although important complications have been described as malignant lesions in the vicinity of dental implants. The objective of this article is to describe the cases described in the literature of oral squamous cell carcinoma (OSCC) or clinical variants and metastases, in the vicinity of dental implants and to analyze the possible etiological agents involved. Material and methods: The criteria used were those described in the PRISMA® Declaration for performing systematic reviews. An electronic search was performed on MEDLINE (via PubMed) using the terms MeSH: “dental implants” AND “squamous cell carcinoma” OR “dental implant complications” AND “squamous cell carcinoma”. Results: Thirty-eight articles describing a total of 76 cases of OSCC or clinical variants, as well as metastasis in the vicinity of dental implants, were included. Conclusions: It is not possible to establish a cause-effect relationship between dental implants and the development of OSCC. Its clinical appearance can be confused with periimplantitis, so that, in cases of sudden onset, which do not respond to conventional treatment and/or have associated alterations in sensitivity, a biopsy should be performed.

Evaluation of the Effects of Dental Implants on Oral Lesions

OBJECTIVE

To determine whether dental implants impress oral lesions, and to evaluate the nature of their effect on the lesions.

MATERIALS AND METHODS

A comprehensive search was done via Google and PubMed for articles (including case reports and literature reviews) containing the keywords 'oral squamous cell carcinoma' (OSCC), 'oral lichen planus' (OLP), 'lichenoid contact reaction' (LCR), 'osseointegrated implants', and 'dental implants' , in the last 10 years (2002-2012).

RESULTS

The study included 24 articles involving patients with dental implants, and some oral lesions (e.g. oral lichen planus and oral squamous cell carcinoma) or with a history of lesions. In these publications, there is evidence suggesting the possibility of emergence, exacerbation, recurrence, or even malignant transformation of the oral lesions after implant placement in some cases.

CONCLUSION

Based on our review of the literature, implant treatment does not seem to be completely safe under any circumstances, but may have some complications in subjects with certain diseases (e.g. oral lesions, autoimmune diseases, malignancies, allergic reactions, etc.). Therefore prior to treatment, patients should be fully informed of the risks.

CLINICAL SIGNIFICANCE

Implant treatment is best done with caution in patients with cancer or mucocutaneous disorders.

Prosthodontic rehabilitation of patient with marginal mandibular resection using attachment supported prostheses: A clinical report

Marginal mandibular resection to treat neoplasms leads to loss of alveolar bone and teeth at the affected side. Consequently patient suffers with poor masticatory performance and esthetic disfigurement, which we need to restore with the help of prosthodontic rehabilitation. The success of rehabilitation of these patients depends on strategic treatment planning and choice of most suitable treatment modality. In this article, case of a patient has been presented who underwent marginal mandibular resection and reported with many limiting factors like obliterated buccal and lingual sulci, attachment of lingual frenum and lower lip at the level of alveolar ridge and Macroglossia. Impression making and fabrication of a retentive prosthesis were the main challenges. Therefore, a modified impression technique was used to fabricate mandibular cast partial denture with extracoronal semi precision attachments to enhance the retention of the prosthesis.

Rehabilitation of a patient with mandibular resection using osteointegrated implants: a case report

This case report details a 65-year-old male patient who underwent mandibular resection and radiotherapy as treatment for squamous cell carcinoma of the right mandible. The patient was rehabilitated with an implant-supported fixed partial denture and a maxillary occlusal ramp. The patient has been wearing his prosthesis for 2 years with no complaints.

Oral squamous cell carcinoma arising around osseointegrated dental implants

PURPOSE

This literature review investigates the occurrence of oral squamous cell carcinoma (OSCC) around osseointegrated dental implants (DI).

METHODS

Databases were searched from 1989 up to and including November 2011. The eligibility criteria were as follows: (1) original studies, (2) clinical studies and case reports, (3) reference lists of the relevant original and review articles, (4) intervention: occurrence of OSSC around osseointegrated DI, and (5) articles published only in English language.

RESULTS

Fourteen studies were included. In nine studies, the dental implant patients with diagnosed OSCC had previously been exposed to cancer. In five studies, the patients presented with a history of habitual tobacco smoking and alcohol consumption.

CONCLUSION

OSCC is more likely to arise around osseointegrated DI in patients with a previous history of cancer. However, the role of other factors including tobacco and alcohol usage cannot be disregarded.

Osteointegration in oncologic patients: a case report

OBJECTIVE

the present case report aims at illustrating how implant-prosthetic rehabilitation in patients with oral cancer resection aids to improve their quality of life.

MATERIAL AND METHODS

a patient with verrucous squamous cell carcinoma of the mandible was treated with surgery and rehabilitation with three interforaminal dental implants and Toronto bridge. Three years after treatment, because of cancer recurrence, a segment of jaw and one of the three mandibular implants were removed. The histological examination showed healthy bone contact to implant surface, despite proximity to the neoplastic area.

RESULTS

the case shows the maintainance of the osseointegration implants despite the cancer recurrence in the same area.

CONCLUSIONS

endosseous implants represent a useful and valid tool for the prosthetic rehabilitation of cancer patients. Long-term effects of implant-prosthetic rehabilitation in patients with cancer still need to be verified. It would be interesting to confirm the data obtained by numerical studies of representative samples.