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

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.dental implants, peri-implantitis, peripheral giant cell granuloma What is known• Peripheral giant cell granuloma have been reported to present around dental implants in single cases or small series, with undetermined prognosis • Fragments of metal have been suggested as a possible etiology What this study adds• The present study included 52 cases of peri-implant giant cell granuloma • These lesions comprise 15.5% of biopsied peri-implant lesions, and result in implant loss in 58.8% of cases • Small fragments of foreign material, probably titanium shreds are a frequent finding but are not ingested by the multinuclear giant cells and do not elicit a specific inflammatory response

Lesão periférica de células gigantes intrabucal

“…Contudo, ainda, não há evidências claras para apoiar essas possibilidades (Abofoul et al, 2022;Chrcanovic et al, 2018;Sánchez-Torres et al, 2021). Má angulação do implante, faixa estreita de mucosa ceratinizada, coberturas de pilares ineficientes e próteses mal adaptadas influenciam o desenvolvimento das lesões peri-implantes (Baesso et al, 2019;Chrcanovic et al, 2019).…”

“…No caso de LPCG peri-implantares a taxa de recorrência é frequente e pode estar relacionada à cirurgia conservadora ou inadequada na tentativa de preservar o implante dentário. (Abofoul et al, 2022;Ahmed & Haggag, 2022;Chrcanovic et al, 2018).…”

“…Embora, a lesão possa causar reabsorção óssea e ter recorrência, é considerada menos agressiva que a lesão central de células gigantes e por alguns autores é considerada uma variante do mesmo processo. É uma lesão reacional, surgindo em função de trauma ou irritação localizada na gengiva ao redor dos dentes ou implantes dentários (Abofoul et al, 2022;Ahmed & Naidu, 2021;Ahmed & Haggag, 2022;Baesso et al, 2019;Chapple et al, 2018;Chrcanovic, Gomes, & Gomez, 2019;Sánchez-Torres et al, 2021).…”

“…Clinicamente, a LPCG apresenta-se como uma lesão nodular intrabucal, variando sua coloração de vermelho-escura a roxo-azulada, podendo apresentar áreas de ulceração, sendo mais comum na mandíbula do que na maxila (Abofoul et al, 2022;Ahmed & Naidu, 2021;Ahmed & Haggag, 2022;Katsikeris, Kakarantza-Angelopoulou, & Angelopoulos, 1988;Shadman, Ebrahimi, Jafari, & Eslami, 2009). Pela semelhança clínica, o diagnóstico diferencial deve ser feito especialmente entre o granuloma piogênico e o fibroma ossificante periférico (Lester, Cordell, Rosebush, Palaiologou, & Maney, 2014).…”

10,600 nm High Level-Laser Therapy Dosimetry in Management of Unresponsive Persistent Peripheral Giant Cell Granuloma to Standard Surgical Approach: A Case Report with 6-Month Follow-Up

“…Recurrent episodes of PGCG with conventional treatment modalities such as scalpel are attributed to a lack of deep excision to include the periodontal ligament [9], which can be related to the surgical technique [9][10][11], whereby re-excision ought to be performed [12]. PGCG lesions are normally self-limited [13], but the lesion in our case report study was persistent and required excision on multiple occasions with rapid eruption of the lesion within two weeks of its excision.…”