Esthetic Management of Peripheral Giant Cell Granuloma Affecting a Dental Implant in the Esthetic Zone

Abstract

Introduction A size increase of the gingiva can be a manifestation of gingival disease. While gingival lesions can affect periodontal tissue, only few reports described the association between peripheral giant‐cell granuloma (PGCG) with dental implants and their clinical management. Their clinical relevance is of a great interest since some lesions may lead to extensive bone resorption, esthetic alterations, or even tooth/implant loss. To the author's best knowledge, no specific guidelines for the treatment of PGCG affecting dental implant in the esthetic zone have been reported. The aim of this paper was to report an extensive PGCG associated with a dental implant in the esthetic area and its surgical management. Case Presentation A 39‐year‐old suffered from concussive trauma on her anterior maxillary dentition leading to an expanded, purplish soft tissue lesion surrounding the implant provisional crown on right central maxillary incisor. After complete lesion excision, the implant neck was carefully and gently debrided. Histological analysis confirmed the diagnosis of PGCG. The patient was then evaluated weekly for the first 3 weeks then monthly. No episodes of recurrence were identified. After 16 weeks of undisturbed healing, a soft tissue augmentation via tunnel technique was elected as the first treatment option to improve esthetics. Final implant restoration was delivered. Follow up at 22 months from biopsy excluded any recurrence of PGCG with stability of peri‐implant soft tissues. Conclusion Excisional biopsy, careful removal of irritating factors, monitoring, and connective tissue grafting can esthetically improve a malpositioned implant and showed no recurrence over a period of 22 months.

Peripheral giant cell granuloma associated with dental implants: Case‐series

“…In the present literature, the association between dental implants and PGCG was not well documented due to the low number of cases reported 4 . A total of 79 cases have reported in the English literature, the largest case series included 20 cases 3,6–11 …”

“…4 A total of 79 cases have reported in the English literature, the largest case series included 20 cases. 3,[6][7][8][9][10][11] The present study represents the largest case series in the literature as yet and was performed in a pathology laboratory dedicated only to oral pathology and a medical center with an oral pathologist on board (Ilana Kaplan). Results of the study indicate that among periimplant lesions biopsied and submitted for analysis, PGCG is not rare, with a prevalence of 15.5% of all peri-implant lesions biopsied.…”

An analysis of the prevalence of peripheral giant cell granuloma and pyogenic granuloma in relation to a dental implant

“…The 20 papers analyzed [4,9,11,17,[19][20][21][22][23][24][25][26][27][28][29][30][31][32][33][34]] reported 30 patients with 32 lesions around 51 implants involved, and 2 patients reported two lesions. Histologically, 10 lesions were diagnosed as PG [9, 22, 24-26, 28, 30, 31], 21 as PGCG [4, 9, 11, 17, 19-21, 23, 29, 32-34] and one combined PGCG with an ossifying peripheral fibroma [24].…”

“…In 75% of cases [4, 9, 11, 17, 19, 21-24, 28-31, 33, 34] bone loss was observed (Table 2). 10 cases (41.6%) reported severe [4,11,17,21,22,29,31], 9 cases (37.5%) reported moderate [9,11,19,28,30,31,33] and 5 cases (20.8%) reported mild bone loss [23,24,34]. Of the 24 cases with bone loss, implants involved were explanted in 45.8% [4,11,17,[21][22][23]31]; of which 81.8% had severe bone loss [4,11,17,21,22,29,31] and 81.8% were PGCG [4,11,17,21,23] (Table 2).…”