Division of Periodontology, Department of Oral Medicine, Infection and Immunity, Harvard School of Dental Medicine, Boston, Massachusetts, USA.
Clin Adv Periodontics. 2023 Mar;13(1):50-55. doi: 10.1002/cap.10219. Epub 2022 Aug 26.
Oral pyogenic granulomas (PGs) presenting in association with dental implants are uncommon occurrences. While tooth-associated PGs are well-documented in the literature, there are only seven case reports with biopsy-confirmed diagnoses of PG related to dental implants. This case report details the treatment of an intraoral PG related to dental implants that had been osseointegrated and asymptomatic for 10 years.
A 39-year-old female presented with a hyperplastic erythematous mass that encompassed the dental implants in the position of the maxillary central incisors. Surgical exploration of the site revealed nonintegrated, particulate bone material distributed throughout the peri-implant tissues approximating the granuloma. Treatment involved surgical excision of the lesion, elimination of all nonintegrated bone material, and implant surface debridement. Laser therapy was later used to manage a recurrence. Histology of the biopsied tissue confirmed the diagnosis of PG and described the presence of multiple exogenous, refractile, particulate materials in the specimen.
The combination of surgical excision, implant debridement, and conservative laser therapy resulted in the elimination of a dental implant-related PG and successful soft tissue management. The localized presence of nonintegrated particulate bone material surrounding the granuloma appears to have functioned as a chronic irritant to the peri-implant soft tissues over time and is likely, along with oral bacteria, the primary etiological agents.
Why is this case new information? There is a paucity of reports describing the management of dental implant-related pyogenic granulomas especially in the esthetic region. The present case demonstrates that particulate bone materials used in guided bone regeneration have the capacity to behave as a low-grade irritant to the gingival tissues. It also demonstrates the successful elimination of the tissues and management of the peri-implant soft tissues for an esthetic result. What are the keys to successful management of this case? The key to successful management of this case was adequate removal of the exogenous irritant, proper implant surface debridement, and decontamination and adequate gingivoplasty to remove all residual hyperplastic granulomatous tissues. Additionally, patient education and appropriate oral hygiene instructions were important to proper healing and maintenance of the area. What are the primary limitations to success in this case? The ambiguity of the clinical boundaries of PGs makes it challenging to guarantee complete excision beyond the base of the lesion, leading to recurrence.
口腔化脓性肉芽肿（PG）与牙种植体相关的情况并不常见。虽然文献中有大量关于与牙齿相关的 PG 的报道，但仅有 7 例活检证实与牙种植体相关的 PG 的病例报告。本病例报告详细介绍了治疗一个已与牙种植体骨整合并无症状 10 年的口腔内 PG 的情况。
一名 39 岁女性因覆盖上颌中切牙位置的牙种植体的增生性红斑肿块就诊。该部位的手术探查显示，非整合的颗粒状骨材料分布在整个种植体周围组织中，类似于肉芽肿。治疗方法包括切除病变、清除所有非整合骨材料和种植体表面清创。后来使用激光治疗来控制复发。活检组织的组织学检查证实了 PG 的诊断，并描述了标本中存在多个外来的、有折射性的颗粒状物质。
手术切除、种植体清创和保守的激光治疗相结合，成功消除了与牙种植体相关的 PG，并有效管理了软组织。随着时间的推移，肉芽肿周围存在的非整合颗粒状骨材料似乎一直是种植体周围软组织的慢性刺激物，并且可能与口腔细菌一起成为主要的病因。
为什么这个病例是新信息？描述与牙种植体相关的化脓性肉芽肿的管理方法的报告很少，特别是在美学区域。本病例表明，在引导骨再生中使用的颗粒状骨材料有能力成为牙龈组织的低级刺激物。它还展示了成功消除组织和管理种植体周围软组织以获得美学效果的方法。成功管理这个病例的关键是什么？成功管理这个病例的关键是充分去除外源性刺激物、适当进行种植体表面清创和去污以及进行足够的牙龈成形术以去除所有残留的增生性肉芽肿组织。此外，患者教育和适当的口腔卫生指导对于适当的愈合和该区域的维护很重要。这个病例成功的主要限制是什么？PG 的临床边界不明确，难以保证在病变基底以外完全切除，导致复发。
