Probable biofilm formation in the cheek as a complication of soft tissue filler resulting from improper endodontic treatment of tooth 16

Abstract

Injectable filling agents offer the promise of a better appearance without surgery and, among them, hyaluronic acid is the most commonly used. Although complications are rare, it is necessary to know the possible side effects and complications in order to be prepared for their management. That is why many researchers have been focusing on the interactions between hyaluronic acid and pathogens, inflammatory mediators, the immune system, and markers of oxidative stress to achieve efficient drug delivery, given that hyaluronic acid has widening applications in the field of nanomedicine. Here we report the case of a 37-year-old female patient who returned to our clinic with an abscess in her left cheek 3 months after a deep injection of 1 mL of stabilized hyaluronic acid in both cheeks. Steroid and antibiotic therapy was initiated without success, and abscess drainage was performed. Extraction of tooth 16 was performed 11 days after insertion of drains into the abscess. Laboratory blood tests showed acute inflammation of presumed bacterial etiology. Microbiological examination of pus was negative. Bacterial cultures were found in the extracted tooth. After antibiotic therapy, a complete reversal of the pathological process was observed. The present report highlights the need to assess periodontal problems prior to any aesthetic facial treatment. Analyses of further case reports and clinical studies are necessary to understand the potential role of hyaluronic acid in the formation of biofilm, and how to avoid this complication, thereby increasing the safety of hyaluronic acid-based procedures.

Injections through skin colonized with Staphylococcus aureus biofilm introduce contamination despite standard antimicrobial preparation procedures

“…More sophisticated ways to improve performance might include novel antimicrobials to help penetrate or dissolve biofilm. Recent studies have shown that infection is more likely when a bolus of biofilm is injected than individual planktonic cells345459. Filler materials that resist colonization or contain anti-biofilm components may also interfere with colonization.…”

“…Wounds or dermatitis may also harbor increased bioburden. Another source of contamination is injection through colonized oral or nasal mucosa, which is more likely to have mature biofilm34.…”

Corticosteroid transdermal delivery to target swelling, edema and inflammation following facial rejuvenation procedures

“…Addressing the above mentioned complications is crucial due to the increase in the clinical use of hyaluronic acid, not only in the aesthetic medicine clinic,17,18,19 but also in restorative medicine20 and for the treatment of other pathologies, such as lower-leg telangiectasia,21 premature ejaculation,22 and osteoarthritis 23,24,25…”

A hyaluronic acid- and chondroitin sulfate-based medical device improves gastritis pain, discomfort, and endoscopic features

“…Further studies have also shown that HA possesses antibacterial, antifungal [ 17 ], and antiviral activities [ 18 ]. Due to its biological properties, HA has been extensively used in experimental and clinical osteoarthritis [ 19 – 21 ], lower-leg telangiectasia [ 22 ], premature ejaculation [ 23 ], and restorative and esthetic surgery [ 24 – 26 ]. However, to date, no clinical study has shown an effectiveness of a compound based on HA and CS on gastritis-related upper abdominal pain/discomfort and endoscopic features.…”