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Kandaswamy E, Harsha M, Joshi VM. Titanium corrosion products from dental implants and their effect on cells and cytokine release: A review. J Trace Elem Med Biol 2024; 84:127464. [PMID: 38703537 DOI: 10.1016/j.jtemb.2024.127464] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2024] [Revised: 04/17/2024] [Accepted: 04/22/2024] [Indexed: 05/06/2024]
Abstract
INTRODUCTION Titanium is considered to be an inert material owing to the ability of the material to form a passive titanium oxide layer. However, once the titanium oxide layer is lost, it can lead to exposure of the underlying titanium substructure and can undergo corrosion. SUMMARY The article explores the role of titanium ions and particles from dental implants on cells, cytokine release, and on the systemic redistribution of these particles as well as theories proposed to elucidate the effects of these particles on peri-implant inflammation based on evidence from in-vitro, human, and animal studies. Titanium particles and ions have a pro-inflammatory and cytotoxic effect on cells and promote the release of pro-inflammatory mediators like cytokines. Three theories to explain etiopathogenesis have been proposed, one based on microbial dysbiosis, the second based on titanium particles and ions and the third based on a synergistic effect between microbiome and titanium particles on the host. CONCLUSION There is clear evidence from in-vitro and limited human and animal studies that titanium particles released from dental implants have a detrimental effect on cells directly and through the release of pro-inflammatory cytokines. Future clinical and translational studies are required to clarify the role of titanium particles and ions in peri-implant inflammation and the etiopathogenesis of peri-implantitis.
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Affiliation(s)
- Eswar Kandaswamy
- Department of Periodontics, LSUHSC, School of Dentistry, 100 Florida Avenue, New Orleans, LA 70119, USA
| | - M Harsha
- Department of Oral Pathology & Microbiology, Yogita Dental College & Hospital, Naringi Riverside, At Post Tal Dist. SH104, Khed, Maharashtra 415709, India
| | - Vinayak M Joshi
- Department of Periodontics, LSUHSC, School of Dentistry, 100 Florida Avenue, New Orleans, LA 70119, USA.
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Menchini-Fabris GB, Cosola S, Toti P, Hwan Hwang M, Crespi R, Covani U. Immediate Implant and Customized Healing Abutment for a Periodontally Compromised Socket: 1-Year Follow-Up Retrospective Evaluation. J Clin Med 2023; 12:jcm12082783. [PMID: 37109120 PMCID: PMC10144425 DOI: 10.3390/jcm12082783] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Revised: 04/02/2023] [Accepted: 04/07/2023] [Indexed: 04/29/2023] Open
Abstract
Immediate dental implant placement with or without immediate loading is reported in daily dentistry and implantology, but these procedures are not common in the case of periradicular and periapical lesions around the tooth needed to be replaced. In the following retrospective evaluation, 10 cases with a 1-year follow-up were selected to propose the technique of an immediate provisional non-loading prosthesis being delivered on the same day of the post-extraction implant placement in multiradicular teeth affected by chronic periradicular and periapical lesions. Post-extractive sockets underwent immediate dental implant placement by filling the empty space with sterile, re-absorbable gelatin sponges. The widths of the alveolar ridge were measured on three-dimensional radiographs before and after the operation, 4 and 12 months later. Non-parametric statistics were performed to compare the outcomes over time with a level of significance of 0.05. Comparing the preoperative cross-sectional images of cone beam computerized tomography (CBCT) scans to the postoperative ones, it was noted that changes in the crestal ridge width, ΔCW, (compared to baseline) were negligible and not clinically appreciable. However, while ΔCW at 4 months appeared to be negative (-0.17 ± 045 mm), crestal width at 12 months was at the same level as the baseline (ΔCW = 0.02 ± 0.48 mm), with a significant difference between 4 and 12 months (p-value = 0.0494). Immediate implant placement with an immediate non-loading provisional customized healing abutment of polyether-ether-ketone placed into the post-extractive sockets with asymptomatic and large chronic periapical and periradicular lesions could represent a further treatment strategy for patients' rehabilitation and soft tissue preservation to replace a hopeless tooth.
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Affiliation(s)
- Giovanni-Battista Menchini-Fabris
- Department of Stomatology, Tuscan Stomatologic Institute, Foundation for Dental Clinic, Research and Continuing Education, 55041 Camaiore, Italy
- San Rossore Dental Unit, San Rossore Private Hospital, 56122 Pisa, Italy
- Department of Dentistry, Unicamillus International Medical University, 00100 Rome, Italy
| | - Saverio Cosola
- Department of Stomatology, Tuscan Stomatologic Institute, Foundation for Dental Clinic, Research and Continuing Education, 55041 Camaiore, Italy
| | - Paolo Toti
- Department of Stomatology, Tuscan Stomatologic Institute, Foundation for Dental Clinic, Research and Continuing Education, 55041 Camaiore, Italy
- Department of Dentistry, Unicamillus International Medical University, 00100 Rome, Italy
| | - Myoung Hwan Hwang
- Department of Stomatology, Tuscan Stomatologic Institute, Foundation for Dental Clinic, Research and Continuing Education, 55041 Camaiore, Italy
- New Smiles Dental Implant Center Galleria, 2930 Chimney Rock Rd, Houston, TX 77057, USA
| | - Roberto Crespi
- Department of Stomatology, Tuscan Stomatologic Institute, Foundation for Dental Clinic, Research and Continuing Education, 55041 Camaiore, Italy
- Department of Dentistry, Unicamillus International Medical University, 00100 Rome, Italy
| | - Ugo Covani
- Department of Stomatology, Tuscan Stomatologic Institute, Foundation for Dental Clinic, Research and Continuing Education, 55041 Camaiore, Italy
- Department of Dentistry, Unicamillus International Medical University, 00100 Rome, Italy
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3
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Abofoul S, Hurvitz AZ, Grienstein OK, Shuster A, Vered M, Edel J, Kaplan I. Peripheral giant cell granuloma associated with dental implants: Case-series. Clin Implant Dent Relat Res 2022; 24:133-137. [PMID: 34981625 DOI: 10.1111/cid.13063] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2021] [Revised: 12/17/2021] [Accepted: 12/22/2021] [Indexed: 11/28/2022]
Abstract
PURPOSE The objectives were to characterize clinico-pathologically a large series of peri-implant peripheral giant cell granuloma (PGCG), and investigate the role of foreign material as a possible etiological factor. MATERIAL AND METHODS The study was retrospective, conducted on peri-implant specimens submitted for histology between 2005 and 2021. RESULTS Three hundred and thirty-five peri-implant biopsies were retrieved, of which 52 (15.5%) were PGCG. The study population included 28 females and 24 males, age 35-92 years, mean 61. 51.2% reported bone involvement. The lesion involved the margins of the specimen in 65.3%, recurrence was reported in 46.1%. In 58.8% the implant was removed at the same time the specimen was submitted for histopathological analysis. Small foci of black granular foreign material were observed in 53.8% of cases of which 67.8% were birefringent under polarized light. The foreign material granules were not ingested inside multinucleated giant cells, but were scattered in the stromal compartment. CONCLUSIONS Peri-implant PGCG is locally aggressive, with frequent bone involvement and high recurrence rate, resulting in implant loss in the majority of cases. The high recurrence rate may be related to conservative or inadequate surgery. Foreign material although common does not seem to have a role in its development.
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Affiliation(s)
- Samar Abofoul
- Department of Oral Pathology, Oral Medicine and Maxillofacial Imaging, Goldschleger School of Dental Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Ayelet Zlotogorski Hurvitz
- Department of Oral Pathology, Oral Medicine and Maxillofacial Imaging, Goldschleger School of Dental Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Osnat Koren- Grienstein
- Department of Oral Pathology, Oral Medicine and Maxillofacial Imaging, Goldschleger School of Dental Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Amir Shuster
- Department of Otolaryngology, Head and Neck Surgery and Maxillofacial Surgery, Tel-Aviv Sourasky Medical Center, Tel-Aviv, Israel.,Department of Oral and Maxillofacial Surgery, Goldschleger School of Dental Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Marilena Vered
- Department of Oral Pathology, Oral Medicine and Maxillofacial Imaging, Goldschleger School of Dental Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Jeremy Edel
- Department of Oral Pathology, Oral Medicine and Maxillofacial Imaging, Goldschleger School of Dental Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Ilana Kaplan
- Department of Oral Pathology, Oral Medicine and Maxillofacial Imaging, Goldschleger School of Dental Medicine, Tel-Aviv University, Tel-Aviv, Israel
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Sánchez-Torres A, Pérez-Amate B, Javier AN, Cercadillo-Ibarguren I, Figueiredo R, Valmaseda-Castellón E. Peripheral giant cell granuloma associated with a dental implant: A case report. J Clin Exp Dent 2021; 13:e1049-e1052. [PMID: 34667501 PMCID: PMC8501856 DOI: 10.4317/jced.57189] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2020] [Accepted: 05/15/2020] [Indexed: 11/12/2022] Open
Abstract
Peripheral giant cell granuloma (PGCG) is a reactive exophytic lesion classified as a benign tumor of the oral mucosa. Although its etiology is not clear, it may be a consequence of local chronic irritation or persistent trauma. The objective of this case report was to document the main clinical and histopathological characteristics of a patient with a PGCG associated with a dental implant. A 36 years-old man presented a partly-ulcerated violet-colored sessile-based tumor in the buccal aspect of an implant placed in the fourth quadrant. Radiographically, the implant had one third of marginal bone loss. Differential diagnosis included PGCG and pyogenic granuloma. The implant and the lesion were removed and the histopathological diagnosis was PGCG. After 6 months, there was no evidence of relapse. Peripheral giant cell granulomas may appear in implants that have suffered bone loss. When facing with peri-implant soft tissue lesions, it is advisable to perform an anatomopathological study to obtain a correct diagnosis, to establish an adequate treatment plan, and to rule out malignant lesions. Key words:Peri-implant bone loss, peripheral giant cell granuloma, benign tumor.
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Affiliation(s)
- Alba Sánchez-Torres
- DDS, MS, Master of Oral Surgery and Implantology. Associate Professor of Oral Surgery, School of Medicine and Health Sciences, University of Barcelona. Researcher at the IDIBELL Institute. Barcelona, Spain
| | - Berta Pérez-Amate
- DDS, Fellow of Master of Oral Surgery and Implantology. School of Medicine and Health Sciences, University of Barcelona, Spain
| | - Alberdi-Navarro Javier
- DDS, MS, PhD, Oral Medicine and Oral and Maxillofacial Pathology Units, Dental Clinic Service. Department of Stomatology II. University of the Basque Country (UPV/EHU). Leioa, Spain
| | - Iñaki Cercadillo-Ibarguren
- DDS, MS, PhD, Master of Oral Surgery and Implantology. Associate Professor of Oral Surgery, School of Medicine and Health Sciences, University of Barcelona, Barcelona. Researcher at the IDIBELL Institute. Barcelona, Spain
| | - Rui Figueiredo
- DDS, MS, PhD, Master of Oral Surgery and Implantology. Professor of Oral Surgery, School of Medicine and Health Sciences, University of Barcelona, Barcelona. Researcher at the IDIBELL Institute. Barcelona, Spain
| | - Eduard Valmaseda-Castellón
- DDS, MS, PhD, EBOS. Professor of Oral Surgery, Professor of the Master of Oral Surgery and Implantology. School of Medicine and Health Sciences, University of Barcelona. Researcher at the IDIBELL Institute. Barcelona, Spain
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5
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Friedrich RE, WÜsthoff F, Luebke AM, Kohlrusch FK, Wieland I, Zenker M, Gosau M. KRAS Mutation in an Implant-associated Peripheral Giant Cell Granuloma of the Jaw: Implications of Genetic Analysis of the Lesion for Treatment Concept and Surveillance. In Vivo 2021; 35:947-953. [PMID: 33622887 DOI: 10.21873/invivo.12335] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2020] [Revised: 01/21/2021] [Accepted: 01/22/2021] [Indexed: 12/16/2022]
Abstract
The aim of this case report was to detail diagnosis and therapy in a case of implant-associated peripheral giant cell granuloma (IA-PGCG) of the jaw. Case Report: The 41-year-old female attended the outpatient clinic for treatment of recurrent mandibular IA-PGCG. The lesion was excised and the defect was closed with a connective tissue graft of the palate. Healing of oral defects was uneventful, and no local recurrence has occurred during a follow-up of 7 months. Genetic examination of the lesion identified a somatic mutation in KRAS. Conclusion: The lesions are assessed as reactive-inflammatory changes in the mucous membrane of the oral cavity. The cause of the lesion is unknown. KRAS mutations are commonly found in various cancer tissues, but also in germline and mosaic RASopathies. Recently, KRAS mutations have been identified in several IA-PGCG. The clinical course of a frequently locally recurring lesion gives rise to the assumption that lesions of this type show characteristics known in benign neoplasms.
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Affiliation(s)
- Reinhard E Friedrich
- Department of Oral and Maxillofacial Surgery, Eppendorf University Hospital, University of Hamburg, Hamburg, Germany;
| | - Falk WÜsthoff
- Department of Oral and Maxillofacial Surgery, Eppendorf University Hospital, University of Hamburg, Hamburg, Germany
| | - Andreas M Luebke
- Institute of Pathology, Eppendorf University Hospital, University of Hamburg, Hamburg, Germany
| | - Felix K Kohlrusch
- Department of Oral and Maxillofacial Surgery, Eppendorf University Hospital, University of Hamburg, Hamburg, Germany
| | - Ilse Wieland
- Institute of Human Genetics, Otto-von-Guericke University Magdeburg, Magdeburg, Germany
| | - Martin Zenker
- Institute of Human Genetics, Otto-von-Guericke University Magdeburg, Magdeburg, Germany
| | - Martin Gosau
- Department of Oral and Maxillofacial Surgery, Eppendorf University Hospital, University of Hamburg, Hamburg, Germany
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6
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Román-Quesada N, González-Navarro B, Izquierdo-Gómez K, Jané-Salas E, Marí-Roig A, Estrugo-Devesa A, López-López J. An analysis of the prevalence of peripheral giant cell granuloma and pyogenic granuloma in relation to a dental implant. BMC Oral Health 2021; 21:204. [PMID: 33892689 PMCID: PMC8067650 DOI: 10.1186/s12903-021-01566-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2020] [Accepted: 04/14/2021] [Indexed: 11/26/2022] Open
Abstract
Background The aim of the present investigation was to evaluate the literature recurrence of peripheral giant cell granuloma and pyogenic granuloma associated with dental implants. It’s important to know the characteristics present in these lesions and possible effects on the prognosis of dental implants. Methods An electronic search without time restrictions was done in the databases: PubMed/Medline. With the keywords "Granuloma" OR "Granuloma, Giant Cell" OR "peripheral giant cell" OR "Granuloma, Pyogenic” AND "Dental implants" OR "Oral implants”.
Results After applying the inclusion and exclusion criteria, a total of 20 articles were included, which reported 32 lesions (10 pyogenic granulomas, 21 peripheral giant cell granulomas and one peripheral giant cell granuloma combined with peripheral ossifying fibroma, all associated with implants). According to our review, these lesions are more frequent in males and in the posterior region of the mandible. Both excision and curettage of the lesion, compared to only excision, presented similar recurrences (40%). Explantation of the implant was performed in 41% of cases without additional recurrences. The results are not statistically significant when comparing one lesion to the other in terms of explantation (p = 0.97), recurrence (p = 0.57) or bone loss (p = 0.67). Conclusions The main therapeutic approach is tissue excision. The lesions show a high recurrence rate (34.4%), which often requires explantation of the associated implant. This recurrence rate is not affected by curettage after excision.
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Affiliation(s)
- Nieves Román-Quesada
- Faculty of Medicine and Health Sciences (Dentistry), University of Barcelona, Barcelona, Spain
| | - Beatriz González-Navarro
- Department of Odontoestomatology, Faculty of Medicine and Health Sciences (Dentistry), Bellvitge Campus, University of Barcelona, Barcelona, Spain.,Oral Health and Masticatory System Group, Institut D'Investigació Biomédica de Bellvitge (IDIBELL, Bellvitge Institute of Biomedical Research), L'Hospitalet de Llobregrat, Barcelona, Spain
| | - Keila Izquierdo-Gómez
- Department of Odontoestomatology, Faculty of Medicine and Health Sciences (Dentistry), Bellvitge Campus, University of Barcelona, Barcelona, Spain.,Oral Health and Masticatory System Group, Institut D'Investigació Biomédica de Bellvitge (IDIBELL, Bellvitge Institute of Biomedical Research), L'Hospitalet de Llobregrat, Barcelona, Spain
| | - Enric Jané-Salas
- Department of Odontoestomatology, Faculty of Medicine and Health Sciences (Dentistry), Bellvitge Campus, University of Barcelona, Barcelona, Spain.,Oral Health and Masticatory System Group, Institut D'Investigació Biomédica de Bellvitge (IDIBELL, Bellvitge Institute of Biomedical Research), L'Hospitalet de Llobregrat, Barcelona, Spain
| | - Antonio Marí-Roig
- Oral Health and Masticatory System Group, Institut D'Investigació Biomédica de Bellvitge (IDIBELL, Bellvitge Institute of Biomedical Research), L'Hospitalet de Llobregrat, Barcelona, Spain.,Department of Maxillofacial Surgery, Bellvitge University Hospital, L'Hospitalet de Llobregrat, Barcelona, Spain
| | - Albert Estrugo-Devesa
- Department of Odontoestomatology, Faculty of Medicine and Health Sciences (Dentistry), Bellvitge Campus, University of Barcelona, Barcelona, Spain. .,Oral Health and Masticatory System Group, Institut D'Investigació Biomédica de Bellvitge (IDIBELL, Bellvitge Institute of Biomedical Research), L'Hospitalet de Llobregrat, Barcelona, Spain.
| | - José López-López
- Department of Odontoestomatology, Faculty of Medicine and Health Sciences (Dentistry), Bellvitge Campus, University of Barcelona, Barcelona, Spain. .,Oral Health and Masticatory System Group, Institut D'Investigació Biomédica de Bellvitge (IDIBELL, Bellvitge Institute of Biomedical Research), L'Hospitalet de Llobregrat, Barcelona, Spain. .,Odontology Hospital University of Barcelona (HOUB), Barcelona, Spain.
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7
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Sotorra-Figuerola D, Lafuente-Ibáñez de Mendoza I, Parra-Pérez C, Aguirre-Urizar JM. Histopathological analysis of biopsies of "peri-implant inflammatory lesions." Everything is not what it seems. Clin Implant Dent Relat Res 2020; 22:366-372. [PMID: 32378812 DOI: 10.1111/cid.12905] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2019] [Revised: 03/12/2020] [Accepted: 03/17/2020] [Indexed: 11/30/2022]
Abstract
BACKGROUND Peri-implantitis is the inflammatory process, which most commonly affects the therapy with dental implants. However, there are other reactive and neoplastic entities, mainly benign but also malignant, which also take place in the peri-implant mucosa. There is little information about the histopathological analysis of these peri-implant inflammatory diseases. PURPOSE To analyze the histopathological diagnosis of biopsies located in the peri-implant mucosa that showed an inflammatory clinical appearance. MATERIALS AND METHODS We have made a retrospective study of 111 peri-implant biopsies analyzed in the Oral and Maxillofacial Pathology Unit of the Dental Clinic Service at the University of the Basque Country, from January 2001 to December 2018. These samples corresponded to 84 women and 27 men, whose mean age was 59 years. We performed a standard histological processing with paraffin embedding, and sections were stained with H&E and PAS. All cases were analyzed following a specific diagnostic histopathological protocol. A descriptive statistical analysis was carried out with the obtained data. RESULTS Lesions located in the mandible (64.8%) were more frequent and 34.2% of the biopsies arrived without a presumptive clinical diagnosis. "Inflammatory peri-implant lesion" or peri-implantitis was the most common clinical diagnosis. Histopathologically, the majority of the lesions were peri-implant nonspecific inflammatory hyperplasia (60.3%), followed by peripheral giant cell granuloma (18.1%), pyogenic granuloma (lobular capillary hemangioma) (14.4%), actinomicotic infection (3.6%), and squamous cell carcinoma (3.6%). Individually, peri-implant lesions were more common among women and in the mandible, except for actinomicotic infection and squamous cell carcinoma. CONCLUSIONS An important percentage of cases whose initial presumptive clinical diagnosis was "peri-implant inflammatory lesion" truly corresponded to other reactive and neoplastic processes. Thus, it is key to always submit all the tissue removed during the implant surgery, in order to perform a good histopathological study and achieve the correct final diagnosis.
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Affiliation(s)
- Didac Sotorra-Figuerola
- Oral Pathology Master Programme, Oral and Maxillofacial Pathology Unit, Dental Clinic Service, Department of Stomatology II, University of the Basque Country (UPV/EHU), Leioa, Spain
| | - Irene Lafuente-Ibáñez de Mendoza
- Oral Pathology Master Programme, Oral and Maxillofacial Pathology Unit, Dental Clinic Service, Department of Stomatology II, University of the Basque Country (UPV/EHU), Leioa, Spain
| | - Carmen Parra-Pérez
- Oral Pathology Master Programme, Oral and Maxillofacial Pathology Unit, Dental Clinic Service, Department of Stomatology II, University of the Basque Country (UPV/EHU), Leioa, Spain
| | - José Manuel Aguirre-Urizar
- Oral Pathology Master Programme, Oral and Maxillofacial Pathology Unit, Dental Clinic Service, Department of Stomatology II, University of the Basque Country (UPV/EHU), Leioa, Spain
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8
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Mixed density mandibular mass in a patient with pain and paresthesia. J Am Dent Assoc 2020; 151:204-209. [DOI: 10.1016/j.adaj.2019.02.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2018] [Revised: 01/03/2019] [Accepted: 02/06/2019] [Indexed: 11/23/2022]
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9
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Baesso RCP, de Lima Jacy Monteiro Barki MC, de Souza Azevedo R, da Costa Fontes KBF, Pereira DL, Tucci R, Pires FR, Picciani BLS. Peripheral giant cell granuloma associated with a dental implant. BMC Oral Health 2019; 19:283. [PMID: 31842866 PMCID: PMC6916108 DOI: 10.1186/s12903-019-0983-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2019] [Accepted: 12/08/2019] [Indexed: 11/24/2022] Open
Abstract
Background Peripheral giant cell granuloma (PGCG) is an uncommon pathology that affects gingival or alveolar mucosa. Although PGCG can be associated with dental implants, little is known about this lesion and implant osseointegration as well as its etiopathogenesis and the treatments available. This study sought to report a rare case of PGCG associated with dental implant, emphasizing its clinical and histopathological aspects. Case presentation A 53-year-old man had an exophytic, reddish lesion, around a crown attached to a dental implant located in the left mandible. Radiographically, there was bone loss around the implant. After excisional biopsy, histological examination revealed a submucosal proliferation of multinucleated giant cells rendering the diagnosis of peripheral giant cell granuloma. Patient has been under follow-up for 6 months with no recurrence. Conclusions Peri-implant lesions must be completely removed to prevent recurrence of PGCG and implant failure, even in cases suspected to be reactive. Besides, histological examination must be performed on all peri-implant reactions to achieve the appropriate diagnosis and, consequently, the best treatment and follow up.
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Affiliation(s)
- Rafaela Carriço Porto Baesso
- Graduate Program in Dentistry, Health Institute of Nova Friburgo, Universidade Federal Fluminense, Nova Friburgo, Rio de Janeiro, Brazil.
| | | | - Rebeca de Souza Azevedo
- Department of Specific Formation, School of Dentistry, Universidade Federal Fluminense, Nova Friburgo, Rio de Janeiro, Brazil
| | | | - Débora Lima Pereira
- Department of Specific Formation, School of Dentistry, Universidade Federal Fluminense, Nova Friburgo, Rio de Janeiro, Brazil
| | - Renata Tucci
- Department of Specific Formation, School of Dentistry, Universidade Federal Fluminense, Nova Friburgo, Rio de Janeiro, Brazil
| | - Fábio Ramôa Pires
- Department of Oral Pathology, School of Dentistry, Universidade Estadual do Rio de Janeiro, Rio de Janeiro, Brazil
| | - Bruna Lavinas Sayed Picciani
- Graduate Program in Dentistry, Health Institute of Nova Friburgo, Universidade Federal Fluminense, Nova Friburgo, Rio de Janeiro, Brazil. .,Department of Specific Formation, School of Dentistry, Universidade Federal Fluminense, Nova Friburgo, Rio de Janeiro, Brazil. .,Graduate Program in Pathology, Medical School, Universidade Federal Fluminense, Niterói, Rio de Janeiro, Brazil.
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10
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Schwarz F, Derks J, Monje A, Wang HL. Peri-implantitis. J Periodontol 2019; 89 Suppl 1:S267-S290. [PMID: 29926957 DOI: 10.1002/jper.16-0350] [Citation(s) in RCA: 390] [Impact Index Per Article: 78.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2016] [Revised: 09/14/2017] [Accepted: 09/24/2017] [Indexed: 12/28/2022]
Abstract
OBJECTIVES This narrative review provides an evidence-based overview on peri-implantitis for the 2017 World Workshop on the Classification of Periodontal and Peri-Implant Diseases and Conditions. METHODS A literature review was conducted addressing the following topics: 1) definition of peri-implantitis; 2) conversion from peri-implant mucositis to peri-implantitis, 3) onset and pattern of disease progression, 4) characteristics of peri-implantitis, 5) risk factors/indicators for peri-implantitis, and 6) progressive crestal bone loss in the absence of soft tissue inflammation. CONCLUSIONS 1)Peri-implantitis is a pathological condition occurring in tissues around dental implants, characterized by inflammation in the peri-implant connective tissue and progressive loss of supporting bone. 2)The histopathologic and clinical conditions leading to the conversion from peri-implant mucositis to peri-implantitis are not completely understood. 3)The onset of peri-implantitis may occur early during follow-up and the disease progresses in a non-linear and accelerating pattern. 4a)Peri-implantitis sites exhibit clinical signs of inflammation and increased probing depths compared to baseline measurements. 4b)At the histologic level, compared to periodontitis sites, peri-implantitis sites often have larger inflammatory lesions. 4c)Surgical entry at peri-implantitis sites often reveals a circumferential pattern of bone loss. 5a)There is strong evidence that there is an increased risk of developing peri-implantitis in patients who have a history of chronic periodontitis, poor plaque control skills, and no regular maintenance care after implant therapy. Data identifying "smoking" and "diabetes" as potential risk factors/indicators for peri-implantitis are inconclusive. 5b)There is some limited evidence linking peri-implantitis to other factors such as: post-restorative presence of submucosal cement, lack of peri-implant keratinized mucosa and positioning of implants that make it difficult to perform oral hygiene and maintenance. 6)Evidence suggests that progressive crestal bone loss around implants in the absence of clinical signs of soft tissue inflammation is a rare event.
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Affiliation(s)
- Frank Schwarz
- Department of Oral Surgery and Implantology, Carolinum, Johann Wolfgang Goethe-University Frankfurt, Frankfurt, Germany
| | - Jan Derks
- Department of Periodontology, Institute of Odontology, The Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden
| | - Alberto Monje
- Department of Oral Surgery and Stomatology, ZMK School of Dentistry, University of Bern, Bern, Switzerland.,Department of Periodontics and Oral Medicine, University of Michigan School of Dentistry, Ann Arbor, MI, USA
| | - Hom-Lay Wang
- Department of Periodontics and Oral Medicine, University of Michigan School of Dentistry, Ann Arbor, MI, USA
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11
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Morais TM, Soares CD, Aguirre Urizar JM, Alberdi-Navarro J, Almeida OP, Pires FR. Peri-implant peripheral giant cell lesions: report of 13 new cases and comparative histological and immunohistochemical analysis with peripheral and central giant cell lesions. Med Oral Patol Oral Cir Bucal 2019; 24:e739-e745. [PMID: 31655833 PMCID: PMC6901135 DOI: 10.4317/medoral.23088] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2019] [Accepted: 05/06/2019] [Indexed: 01/21/2023] Open
Abstract
BACKGROUND Few cases or peri-implant peripheral giant cell lesions (PGCL) have been reported in the literature. The aim of this study was to report 13 new cases of peri-implant PGCL and compare the expression of smooth muscle actin, Bcl-2 protein, GLUT-1, CD68, osteoprotegerin, receptor activator of nuclear factor kappa-B, Ki-67 and CD34 in these cases with PGCL and central giant cell lesions (CGCL). MATERIAL AND METHODS Clinical data were retrieved from the laboratory records and histological analysis was performed using HE-stained slides. Immunohistochemical reactions for the above mentioned antibodies were performed and digitally scored. RESULTS Peri-implant PGCL mostly affected the posterior mandible of adult females. CD68 and Bcl-2 expressions were higher in conventional PGCL and CGCL than in peri-implant PGCL ( p=0.033 for CD68 and p<0.0001 for Bcl-2). Microvessel density was higher in conventional peripheral than in central and peri-implant PGCL ( p=0.002). Proliferative index of the mononuclear cells showed no statistically significant differences comparing the three groups but it was higher in peri-implant PGCL. CONCLUSIONS The current study demonstrated that peri-implant PGCL is more common in the posterior mandible of adult females. There were some differences in microvessel density, proliferative activity and expression of CD68 and Bcl-2 among conventional PGCL, peri-implant and CGCL. Further studies are encouraged to better understand these early findings.
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Affiliation(s)
- T-M Morais
- Oral Pathology, School of Dentistry, State University of Rio de Janeiro Av. 28 de Setembro, 157, Vila Isabel, Rio de Janeiro/RJ Postal code: 20551-030, Brazil
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12
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Schwarz F, Derks J, Monje A, Wang HL. Peri-implantitis. J Clin Periodontol 2019; 45 Suppl 20:S246-S266. [PMID: 29926484 DOI: 10.1111/jcpe.12954] [Citation(s) in RCA: 371] [Impact Index Per Article: 74.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2016] [Revised: 09/14/2017] [Accepted: 09/24/2017] [Indexed: 01/14/2023]
Abstract
OBJECTIVES This narrative review provides an evidence-based overview on peri-implantitis for the 2017 World Workshop on the Classification of Periodontal and Peri-Implant Diseases and Conditions. METHODS A literature review was conducted addressing the following topics: 1) definition of peri-implantitis; 2) conversion from peri-implant mucositis to peri-implantitis, 3) onset and pattern of disease progression, 4) characteristics of peri-implantitis, 5) risk factors/indicators for peri-implantitis, and 6) progressive crestal bone loss in the absence of soft tissue inflammation. CONCLUSIONS 1)Peri-implantitis is a pathological condition occurring in tissues around dental implants, characterized by inflammation in the peri-implant connective tissue and progressive loss of supporting bone. 2)The histopathologic and clinical conditions leading to the conversion from peri-implant mucositis to peri-implantitis are not completely understood. 3)The onset of peri-implantitis may occur early during follow-up and the disease progresses in a non-linear and accelerating pattern. 4a)Peri-implantitis sites exhibit clinical signs of inflammation and increased probing depths compared to baseline measurements. 4b)At the histologic level, compared to periodontitis sites, peri-implantitis sites often have larger inflammatory lesions. 4c)Surgical entry at peri-implantitis sites often reveals a circumferential pattern of bone loss. 5a)There is strong evidence that there is an increased risk of developing peri-implantitis in patients who have a history of chronic periodontitis, poor plaque control skills, and no regular maintenance care after implant therapy. Data identifying "smoking" and "diabetes" as potential risk factors/indicators for peri-implantitis are inconclusive. 5b)There is some limited evidence linking peri-implantitis to other factors such as: post-restorative presence of submucosal cement, lack of peri-implant keratinized mucosa and positioning of implants that make it difficult to perform oral hygiene and maintenance. 6)Evidence suggests that progressive crestal bone loss around implants in the absence of clinical signs of soft tissue inflammation is a rare event.
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Affiliation(s)
- Frank Schwarz
- Department of Oral Surgery and Implantology, Carolinum, Johann Wolfgang Goethe-University Frankfurt, Frankfurt, Germany
| | - Jan Derks
- Department of Periodontology, Institute of Odontology, The Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden
| | - Alberto Monje
- Department of Oral Surgery and Stomatology, ZMK School of Dentistry, University of Bern, Bern, Switzerland.,Department of Periodontics and Oral Medicine, University of Michigan School of Dentistry, Ann Arbor, MI, USA
| | - Hom-Lay Wang
- Department of Periodontics and Oral Medicine, University of Michigan School of Dentistry, Ann Arbor, MI, USA
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13
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Bidra AS, Persenaire MJ, Natarajan E. Management of peripheral giant cell granuloma around complete-arch fixed implant-supported prosthesis: A case series. J Prosthet Dent 2019; 122:181-188. [PMID: 31027952 DOI: 10.1016/j.prosdent.2019.02.014] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2019] [Revised: 02/20/2019] [Accepted: 02/20/2019] [Indexed: 11/15/2022]
Abstract
Abnormal peri-implant tissue response in the form of benign reactive lesions, such as peripheral giant cell granuloma and pyogenic granuloma, is a less frequent biologic complication associated with dental implant therapy. However, these lesions can cause gingival pain, swelling, and discomfort, as well as peri-implant bone loss and possible implant failure. Few reports in the dental literature have described these lesions around complete-arch fixed implant-supported prostheses. The purpose of this clinical report was to describe 3 distinct scenarios in patients with complete-arch fixed implant-supported prostheses presenting with benign reactive lesions that were histologically diagnosed as peripheral giant cell granulomas. Each of these 3 patients had acrylic resin as one of the materials in their prosthesis. The distinctive management of each of these 3 patients encompassed surgical, prosthodontic, and pharmacologic means.
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Affiliation(s)
- Avinash S Bidra
- Program Director and Maxillofacial Prosthodontist, Post-Graduate Prosthodontics, University of Connecticut Health Center, Farmington, Conn; Private practice, Meriden, Conn.
| | | | - Easwar Natarajan
- Associate Professor, Section of Oral Pathology, University of Connecticut Health Center, Farmington, Conn
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14
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Chrcanovic BR, Gomes CC, Gomez RS. Peripheral giant cell granuloma associated with dental implants: a systematic review. JOURNAL OF STOMATOLOGY, ORAL AND MAXILLOFACIAL SURGERY 2019; 120:456-461. [PMID: 30677564 DOI: 10.1016/j.jormas.2019.01.010] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/18/2018] [Accepted: 01/14/2019] [Indexed: 10/27/2022]
Abstract
The purpose of the present review was to integrate the available published data on peripheral giant cell granuloma (PGCG) associated with dental implants into a comprehensive analysis of its clinical/radiologic features. An electronic search was undertaken in February/2018 in three databases, looking for publications reporting cases of PGCGs associated with dental implants. Nineteen publications were included, reporting 37 implant-associated PGCG. These lesions are more prevalent in women, in mandible, and in posterior regions of the jaws. Both 'excision alone' and 'excision + curettage' presented high recurrence rates (40% and 31.3%, respectively). The etiology of implant-associated PGCG has not yet been determined. Despite the small number of cases reported, implant-associated PGCG shows a high recurrence rate (1/3) for a benign non-neoplastic lesion and sometimes it requires the removal of the associated implant in order to prevent further recurrences. This recurrence rate is not affected by curettage after excision.
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Affiliation(s)
- B R Chrcanovic
- Department of Prosthodontics, Faculty of Odontology, Malmö University, Malmö, Sweden.
| | - Carolina C Gomes
- Department of Pathology, Biological Sciences Institute, Universidade Federal de Minas-Gerais, Belo Horizonte, Brazil.
| | - R S Gomez
- Department of Oral Surgery and Pathology, School of Dentistry, Universidade Federal de Minas-Gerais, Belo Horizonte, Brazil.
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15
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Atarbashi-Moghadam F, Atarbashi-Moghadam S, Namdari M, Shahrabi-Farahani S. Reactive oral lesions associated with dental implants. A systematic review. ACTA ACUST UNITED AC 2018; 9:e12342. [PMID: 29752778 DOI: 10.1111/jicd.12342] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2017] [Accepted: 03/03/2018] [Indexed: 11/26/2022]
Abstract
Reactive lesion formation around dental implants a complication that has been given much consideration. These lesions can lead to marginal bone loss, and consequently, implant failure. In the present systematic review, all reported reactive lesions associated with dental implants in the literature were assessed. An electronic search was performed using PubMed Central, Scopus, Google Scholar, and Science Direct. The search strategy was limited to human studies (case reports and case series), full-text English language articles, published until May 2017. A total of 19 articles reporting 27 lesions in 25 cases were included. Peripheral giant cell granuloma and pyogenic granuloma were the most reactive lesions found around dental implants. The mean age of the patients was 51.28 ± 14.48 years, with a slight female predilection. Posterior mandibular gingiva was the most common location for these lesions. The recurrence rate of lesions was 33.33%, and the chance of implant removal was 29.62%. Due to the clinical significance of these lesions, early histopathologic examination is recommended to exclude the presence of such pathological lesions.
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Affiliation(s)
| | - Saede Atarbashi-Moghadam
- Department of Oral and Maxillofacial Pathology, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Mahshid Namdari
- Department of Oral Health Community, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Shokoufeh Shahrabi-Farahani
- Department of Diagnostic Sciences and Oral Medicine, University of Tennessee Health Science Center, College of Dentistry, Memphis, TN, USA
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16
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Bountaniotis F, Tzerbos F, Tosios K, Melakopoulos I. Reactive Fibrous Hyperplasia of Peri-implant Mucosa. J ORAL IMPLANTOL 2017; 43:378-379. [PMID: 28873017 DOI: 10.1563/aaid-joi-d-17-00021] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Affiliation(s)
- Fotios Bountaniotis
- 1 Department of Oral & Maxillofacial Surgery, Dental School of Athens, National and Kapodistrian University of Athens, Goudi, Athens, Greece
| | - Fotios Tzerbos
- 1 Department of Oral & Maxillofacial Surgery, Dental School of Athens, National and Kapodistrian University of Athens, Goudi, Athens, Greece
| | - Konstantinos Tosios
- 2 Department of Oral Pathology, Dental School of Athens, National and Kapodistrian University of Athens, Goudi, Athens, Greece
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17
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Halperin-Sternfeld M, Sabo E, Akrish S. The Pathogenesis of Implant-Related Reactive Lesions: A Clinical, Histologic and Polarized Light Microscopy Study. J Periodontol 2016; 87:502-10. [PMID: 26832832 DOI: 10.1902/jop.2016.150482] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
BACKGROUND Peri-implant soft tissue reactive lesions (I-RLs) may jeopardize implant success and survival. To the best of the authors' knowledge, its pathogenesis is unknown. The objective of this study is to conduct a clinicopathologic and polarized light microscopy (PLM) analysis of 14 new I-RLs and compare them with comparable tooth-associated cases (T-RLs) to better understand I-RL pathogenesis. METHODS Fifty-eight new cases of I-RL and T-RL were retrieved from the pathology department archives of Rambam Health Care Campus, Haifa, Israel. Retrospective analysis of histopathologic and clinical features was conducted, documented, and then compared for: 1) I-RL (n = 14), 2) peri-implant pyogenic granuloma (I-PG) (n = 5), 3) peri-implant peripheral giant cell granuloma (I-PGCG) (n = 9), 4) T-RL (n = 44), 5) tooth-associated pyogenic granuloma (T-PG) (n = 21), and 6) tooth-associated peripheral giant cell granuloma (T-PGCG) (n = 23). Presence of foreign bodies was assessed using PLM. RESULTS Foreign bodies were found more commonly in I-RLs (n = 13/14; 93%) when compared with T-RLs (n = 18/44; 41%), which was a statistically significant difference (P = 0.01) with an odds ratio of 7.9. Microscopically, I-PGCG was associated with: 1) lower multinucleated giant cell count (P = 0.04); 2) lower density of mesenchymal cells (P = 0.05); and 3) more diffuse, non-lobulated stromal morphology (P = 0.001). Clinically, I-RLs were found in patients who were older, and all cases were located in the posterior region: mandible (n = 12/14; 86%) and maxilla (n = 2/14; 14%). CONCLUSIONS In cases of implant failure, implantation of foreign bodies may play a role with subsequent development of I-PG and I-PGCG-like lesions. Clinicians should be aware of this risk so they can implement measures to minimize adverse implant outcomes.
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Affiliation(s)
- Michal Halperin-Sternfeld
- Department of Periodontology, School of Graduate Dentistry, Rambam Health Care Campus, Haifa, Israel
| | - Edmond Sabo
- Department of Pathology, Rambam Health Care Campus.,Bruce Rappaport Faculty of Medicine, Technion, Israel Institute of Technology, Haifa, Israel
| | - Sharon Akrish
- Department of Pathology, Rambam Health Care Campus.,Bruce Rappaport Faculty of Medicine, Technion, Israel Institute of Technology, Haifa, Israel.,Department of Oral and Maxillofacial Surgery, Rambam Health Care Campus
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18
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Clinical Management of a Peri-Implant Giant Cell Granuloma. Case Rep Dent 2015; 2015:976756. [PMID: 26788379 PMCID: PMC4691601 DOI: 10.1155/2015/976756] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2015] [Revised: 11/29/2015] [Accepted: 11/30/2015] [Indexed: 11/17/2022] Open
Abstract
Purpose. Implant therapy plays an important role in contemporary dentistry with high rates of long-term success. However, in recent years, the incidence of peri-implantitis and implant failures has significantly increased. The peripheral giant cell granuloma (PGCG) rarely occurs in peri-implant tissues and it is clinically comparable to the lesions associated with natural teeth. Therefore, the study of possible diseases associated with dental implants plays an important role in order to be able to diagnose and treat these conditions. Materials and Methods. This report described a 60-year-old Caucasian male who presented a reddish-purple pedunculated mass, of about 2 cm in diameter, associated with a dental implant and the adjacent natural tooth. Results. An excisional biopsy was performed and the dental implant was not removed. Histological examination provided the diagnosis of PGCG. After 19-month follow-up, there were no signs of recurrence of peri-implantitis around the implant. Conclusion. The correct diagnosis and appropriate surgical treatment of peri-implant giant cell granuloma are very important for a proper management of the lesion in order to preserve the implant prosthetic rehabilitation and prevent recurrences.
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19
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Pyogenic Granuloma/Peripheral Giant-Cell Granuloma Associated with Implants. Int J Dent 2015; 2015:839032. [PMID: 26697068 PMCID: PMC4678085 DOI: 10.1155/2015/839032] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2015] [Revised: 11/12/2015] [Accepted: 11/16/2015] [Indexed: 11/29/2022] Open
Abstract
Introduction. Pyogenic granuloma (PG) and peripheral giant-cell granuloma (PGCG) are two of the most common inflammatory lesions associated with implants; however, there is no established pathway for treatment of these conditions. This paper aims to illustrate the successful treatment of PG and PGCG and also report a systematic review of the literature regarding the various treatments proposed. Methods. To collect relevant information about previous treatments for PG and PGCG involving implants we carried out electronic searches of publications with the key words “granuloma”, “oral”, and “implants” from the last 15 years on the databases Pubmed, National Library of Medicine's Medline, Scielo, Scopus, and Cochrane Library. Results. From the electronic search 16 case reports were found showing excision and curettage as the main successful treatment. As no clinical trials or observational studies were identified the authors agreed to present results from a review perspective. Conclusion. This is the largest analysis of PG and PGCG associated with implants published to date. Our review would suggest that PGCG associated with implants appears to have a more aggressive nature; however the level of evidence is very limited. Further cohort studies with representative sample sizes and standard outcome measures are necessary for better understanding of these conditions.
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20
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Peripheral giant cell granuloma associated with a dental implant: a case report and review of the literature. Case Rep Dent 2015; 2015:697673. [PMID: 25861485 PMCID: PMC4378320 DOI: 10.1155/2015/697673] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2014] [Accepted: 03/04/2015] [Indexed: 02/06/2023] Open
Abstract
The peripheral giant cell granuloma (PGCG) is a nonneoplastic lesion commonly caused by local irritation. This report describes a 46-year-old Caucasian male who presented with a PGCG associated with a dental implant. The dental implant was originally placed in August 2012. Ten months later, the patient presented with a well-circumscribed lesion associated with and covering the implant, at which time the lesion was excised. Four months later, due to recurrence of the lesion, a deeper and wider excisional biopsy with curettage of the adjacent bone was performed. No evidence of recurrence has been reported after 12 months of follow-up. Immunohistochemistry, using the antibody CD68, was performed to investigate the origin of the multinucleated giant cells, with their immunophenotype being similar to those of other giant cell lesions, including central giant cell granuloma, foreign-body reactions, and granulomatous reactions to infectious agents.
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21
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Ogbureke EI, Vigneswaran N, Seals M, Frey G, Johnson CD, Ogbureke KUE. A peripheral giant cell granuloma with extensive osseous metaplasia or a hybrid peripheral giant cell granuloma-peripheral ossifying fibroma: a case report. J Med Case Rep 2015; 9:14. [PMID: 25649957 PMCID: PMC4417193 DOI: 10.1186/1752-1947-9-14] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2014] [Accepted: 12/08/2014] [Indexed: 11/10/2022] Open
Abstract
INTRODUCTION Peripheral giant cell granuloma and peripheral ossifying fibroma are clinicopathologically distinct gingival lesions. Both are included in clinical differential diagnoses of common benign and reactive gingival epulides in humans. It is often impossible to make a clinical distinction between the two entities, thereby making definitive diagnosis dependent on histopathologic features. While our search of the English literature revealed several reports of peripheral giant cell granuloma with 'bone formation', we were unable to identify any reports of hybrid peripheral ossifying fibroma-peripheral giant cell granulomas. CASE PRESENTATION We report a case of a 44-year-old Caucasian man presenting with a three-month history of swelling of his right posterior mandible, related to an area of previous dental implant restoration. A clinical examination revealed modest extraoral facial swelling of his right posterior mandible, while an intraoral examination showed a 45 × 25 × 15 mm sessile, lobular soft tissue mass of the right posterior mandibular gingiva. The mucosal covering of the lesion exhibited focal surface ulceration. A panoramic radiograph showed two implants at the vicinity of the lesion with no other significant findings. An excisional biopsy of the lesion followed by histopathologic examination of the biopsy specimen revealed salient and distinctive features of peripheral giant cell granuloma and of peripheral ossifying fibroma, estimated at near equal proportions. This raises the possibility of a hybrid odontogenic lesion. CONCLUSION The presentation of this lesion, with areas of peripheral giant cell granuloma along with a distinct area of extensive osseous formation and stroma reminiscent of a peripheral ossifying fibroma, justifies consideration of this as a possible hybrid lesion. Although the biologic behavior of a combined lesion is not anticipated to deviate significantly from that of either of the single entities, this case resurrects an enduring debate as to whether peripheral giant cell granuloma and peripheral ossifying fibroma are simply parts of a disease spectrum, or whether some of these lesions represent true hybrid lesions. It is therefore recommended that more cases with histopathologic features similar to the lesion in our case be reported in the literature to further elucidate the histogenesis of these lesions.
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Affiliation(s)
- Ezinne I Ogbureke
- Department of General Practice and Dental Public Health, The University of Texas School of Dentistry, Houston, TX, USA.
| | - Nadarajah Vigneswaran
- Department of Diagnostics and Biomedical Sciences, The University of Texas School of Dentistry, Houston, TX, USA.
| | - Matthew Seals
- Department of General Practice and Dental Public Health, The University of Texas School of Dentistry, Houston, TX, USA.
| | - Gary Frey
- Department of General Practice and Dental Public Health, The University of Texas School of Dentistry, Houston, TX, USA.
| | - Cleverick D Johnson
- Department of General Practice and Dental Public Health, The University of Texas School of Dentistry, Houston, TX, USA.
| | - Kalu U E Ogbureke
- Department of Diagnostics and Biomedical Sciences, The University of Texas School of Dentistry, Houston, TX, USA.
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22
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Kang YH, Byun JH, Choi MJ, Lee JS, Jang JH, Kim YI, Park BW. Co-development of pyogenic granuloma and capillary hemangioma on the alveolar ridge associated with a dental implant: a case report. J Med Case Rep 2014; 8:192. [PMID: 24934284 PMCID: PMC4082161 DOI: 10.1186/1752-1947-8-192] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2014] [Accepted: 04/01/2014] [Indexed: 11/10/2022] Open
Abstract
Introduction The development of various benign oral mucosal lesions associated with dental implants, such as pyogenic granuloma or peripheral giant cell granuloma, has been rarely reported. However, the occurrence of vascular diseases, such as hemangioma, related to dental implants has not been explored in the literature. In this study, we report a case of co-development of pyogenic granuloma and capillary hemangioma on the alveolar ridge associated with a dental implant in a patient undergoing antithrombotic therapy. To the best of our knowledge, this is first case of hemangioma formation associated with a dental implant. Case presentation A 68-year-old Korean man was referred for intermittent bleeding and a dome-shaped overgrowing mass on his upper alveolar ridge. He underwent dental implantation 5 years ago, and was started on warfarin for cerebral infarction a year ago. He had experienced gum bleeding and gingival mass formation 6 months after warfarinization; then, his implant fixture was removed. However, his gingival mass has been gradually increasing. The gingival mass was surgically excised, and revealed the coexistence of pyogenic granuloma and capillary hemangioma in histological analysis of the specimen. The lesion has showed no recurrence for more than a year. Conclusions Regarding immunostaining features, the endothelial cell markers, CD34 and CD31, and the mesenchymal cell marker, vimentin, were strongly detected, but cell proliferation marker, Ki-67, was negatively expressed in the endothelial cells of the hemangioma portion. However, in the pyogenic granuloma portion, CD34 was almost negatively detected, whereas vimentin and Ki-67 were highly detected in the fibroblast-like tumor cells. According to these heterogeneous characteristics of the lesion, the patient was diagnosed with coexistence of pyogenic granuloma and capillary hemangioma associated with the dental implant on the attached gingiva. We recommend that patients with dental implants who have chronic peri-implantitis under antithrombotic therapy should be closely followed to ensure early detection of oral mucosal abnormalities.
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Affiliation(s)
| | | | | | | | | | | | - Bong-Wook Park
- Department of Oral and Maxillofacial Surgery, Institute of Health Science, School of Medicine, Gyeongsang National University, Jinju, Korea.
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Shnaiderman-Shapiro A, Dayan D, Buchner A, Schwartz I, Yahalom R, Vered M. Histopathological spectrum of bone lesions associated with dental implant failure: osteomyelitis and beyond. Head Neck Pathol 2014; 9:140-6. [PMID: 24687889 PMCID: PMC4382485 DOI: 10.1007/s12105-014-0538-4] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2014] [Accepted: 03/23/2014] [Indexed: 10/25/2022]
Abstract
Early or late post-implant placement complications are usually localized infectious/inflammatory processes and treated accordingly. If the healing process does not take place within a reasonable timeframe, the possibility of a pathologic process beyond localized infection/inflammation should be suspected. We describe a radiological/histopathological spectrum of bony lesions ranging from inflammatory to malignant lesions surrounding failed dental implants. Five cases of mandibular dental implant failure that clinically, radiologically and histopathologically appeared to be inflammatory processes are presented. The failure of the dental implants was immediate in two cases and late in the remaining three. The radiological features were essentially similar for all five, and they included radiolucent or mixed radiolucent-radiopaque lesions with poorly defined borders. Three lesions were limited to the area of the failed implant, while the other two extended to a large part of the mandible. The histopathological findings ranged from acute osteomyelitis and chronic osteomyelitis with features of a fibro-osseous-like lesion and occasional rimming of atypical osteoblasts to osteogenic sarcoma that was admixed with a component of osteomyelitis (diagnosis of the latter was achieved only after a series of biopsies). In-depth investigative procedures are imperative in order to establish an accurate diagnosis whenever the histopathological diagnosis is inconsistent with persisting clinical signs and symptoms in bone lesions associated with failed dental implants.
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Affiliation(s)
- Anna Shnaiderman-Shapiro
- Department of Oral Pathology and Oral Medicine, School of Dental Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Dan Dayan
- Department of Oral Pathology and Oral Medicine, School of Dental Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Amos Buchner
- Department of Oral Pathology and Oral Medicine, School of Dental Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Ignat Schwartz
- Institute of Pathology, The Chaim Sheba Medical Center, Tel Hashomer, Israel
| | - Ran Yahalom
- Department of Oral and Maxillofacial Surgery, The Chaim Sheba Medical Center, Tel Hashomer, Israel
| | - Marilena Vered
- Department of Oral Pathology and Oral Medicine, School of Dental Medicine, Tel Aviv University, Tel Aviv, Israel ,Institute of Pathology, The Chaim Sheba Medical Center, Tel Hashomer, Israel
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24
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Galindo-Moreno P, Hernández-Cortés P, Ríos R, Sánchez-Fernández E, Cámara M, O'Valle F. Immunophenotype of Dental Implant-Associated Peripheral Giant Cell Reparative Granuloma in a Representative Case Report. J ORAL IMPLANTOL 2013; 42:55-60. [PMID: 24059329 DOI: 10.1563/aaid-joi-d-13-00155] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
We report the case of a 74-year-old white male patient who had worn an overdenture for the previous 6 years, retained by 4 screwed implants and a bar, who presented with an exophytic multilobed lesion of 2.5 × 2.0 cm on the anterior aspect of 1 implant neck, which was surrounded by pink-reddish tissue. All of the soft tissue around the implant was removed until the periosteum was reached. Histologic examination of the lamina propria revealed a cellular proliferation with imprecise boundaries, dense stromal component composed of spindle- to round-shaped mononucleated cells (fibroblasts and monocytes/macrophages), abundant multinucleated giant cells surrounding microscopic hemorrhagic foci, and deposits of hemosiderin; the diagnosis was peripheral giant-cell reparative granuloma (PGCG). Giant cells share the immunohistochemical expression of monocyte/macrophage markers (CD68, calprotectin [Mc387]) and osteoclastic cell markers (tartrate-resistant acid phosphatase, cathepsin K, and microphthalmia-associated transcription factor). After 6 months of follow-up, no bone resorption or recurrence of implant loss was observed. There have been only 12 case reports on dental implant-associated PGCG. Research results to date indicate that there may be little difference in immunophenotype among the giant cells of PGCG, central giant cell reparative granuloma, and peri-implant osteolysis. In conclusion, the immunohistochemical study confirms an osteoclast like giant cells phenotype differentiation in PGCG.
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Affiliation(s)
- Pablo Galindo-Moreno
- 1 Oral Surgery and Implant Dentistry Department, School of Dentistry, University of Granada, Spain
| | - Pedro Hernández-Cortés
- 2 Department of Traumatology and Orthopedic Surgery, San Cecilio Clinical Hospital, University of Granada, Spain
| | - Rosa Ríos
- 3 Pathology Department, San Cecilio Clinical Hospital, University of Granada University of Granada, Spain
| | - Elena Sánchez-Fernández
- 1 Oral Surgery and Implant Dentistry Department, School of Dentistry, University of Granada, Spain
| | - Miguel Cámara
- 3 Pathology Department, San Cecilio Clinical Hospital, University of Granada University of Granada, Spain
| | - Francisco O'Valle
- 4 Pathology Department, School of Medicine, and IBIMER, University of Granada, Spain
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25
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Kaplan I, Hirshberg A, Shlomi B, Platner O, Kozlovsky A, Ofec R, Schwartz-Arad D. The Importance of Histopathological Diagnosis in the Management of Lesions Presenting as Peri-Implantitis. Clin Implant Dent Relat Res 2013; 17 Suppl 1:e126-33. [DOI: 10.1111/cid.12137] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Ilana Kaplan
- Tel-Aviv Sourasky Medical Center; Tel-Aviv
- Department of Pathology; Sackler School of Medicine; Tel-Aviv University; Ramat-Aviv Israel
| | - Avraham Hirshberg
- Department of Oral Pathology and Oral Medicine; The Maurice and Gabriela Goldschleger School of Dental Medicine; Tel Aviv University; Tel Aviv Israel
| | - Benjamin Shlomi
- Tel-Aviv Sourasky Medical Center; Tel-Aviv and Goldschleger School of Dental Medicine; Tel Aviv University; Tel Aviv Israel
| | - Ori Platner
- Department of Periodontology; Goldschleger School of Dental Medicine; Tel-Aviv University; Ramat-Aviv Israel
| | - Avital Kozlovsky
- Department of Periodontology; Goldschleger School of Dental Medicine; Tel-Aviv University; Ramat-Aviv Israel
| | - Ronen Ofec
- private dental practice and Biostatistics; Tel-Aviv Israel
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