The management of an oral pyogenic granuloma around osseointegrated dental implants

Abstract

Introduction: 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 biopsyconfirmed 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. Case Presentation: 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. Conclusion: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.