Kang Young-Hoon, Byun June-Ho, Choi Mun-Jeong, Lee Jong-Sil, Jang Jung-Hui, Kim Young-Il, Park Bong-Wook
Department of Oral and Maxillofacial Surgery, Institute of Health Science, School of Medicine, Gyeongsang National University, Jinju, Korea.
J Med Case Rep. 2014 Jun 16;8:192. doi: 10.1186/1752-1947-8-192.
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.
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.
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.
与牙种植体相关的各种良性口腔黏膜病变的发展，如化脓性肉芽肿或外周巨细胞肉芽肿，鲜有报道。然而，文献中尚未探讨与牙种植体相关的血管疾病，如血管瘤的发生情况。在本研究中，我们报告了一例正在接受抗血栓治疗的患者，其牙槽嵴上与牙种植体相关的化脓性肉芽肿和毛细血管瘤共同发展的病例。据我们所知，这是首例与牙种植体相关的血管瘤形成病例。
一名68岁的韩国男性因上牙槽嵴间歇性出血和圆顶状增生性肿物前来就诊。他5年前接受了牙种植，1年前因脑梗死开始服用华法林。在服用华法林6个月后，他出现牙龈出血和牙龈肿物形成；随后，他的种植体被取出。然而，他的牙龈肿物逐渐增大。牙龈肿物经手术切除，在标本的组织学分析中显示化脓性肉芽肿和毛细血管瘤并存。该病变一年多来未复发。
关于免疫染色特征，内皮细胞标志物CD34和CD31以及间充质细胞标志物波形蛋白被强烈检测到，但细胞增殖标志物Ki-67在血管瘤部分的内皮细胞中呈阴性表达。然而，在化脓性肉芽肿部分，CD34几乎呈阴性检测，而波形蛋白和Ki-67在成纤维细胞样肿瘤细胞中高度检测到。根据病变的这些异质性特征，该患者被诊断为附着龈上与牙种植体相关的化脓性肉芽肿和毛细血管瘤并存。我们建议，对抗血栓治疗下患有慢性种植体周围炎的牙种植患者应密切随访，以确保早期发现口腔黏膜异常。
