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Keane Tahmaseb GC, Keane AM, Foppiani JA, Myckatyn TM. An Update on Implant-Associated Malignancies and Their Biocompatibility. Int J Mol Sci 2024; 25:4653. [PMID: 38731871 PMCID: PMC11083590 DOI: 10.3390/ijms25094653] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2024] [Revised: 04/14/2024] [Accepted: 04/22/2024] [Indexed: 05/13/2024] Open
Abstract
Implanted medical devices are widely used across various medical specialties for numerous applications, ranging from cardiovascular supports to orthopedic prostheses and cosmetic enhancements. However, recent observations have raised concerns about the potential of these implants to induce malignancies in the tissues surrounding them. There have been several case reports documenting the occurrence of cancers adjacent to these devices, prompting a closer examination of their safety. This review delves into the epidemiology, clinical presentations, pathological findings, and hypothesized mechanisms of carcinogenesis related to implanted devices. It also explores how the surgical domain and the intrinsic properties and biocompatibility of the implants might influence the development of these rare but serious malignancies. Understanding these associations is crucial for assessing the risks associated with the use of medical implants, and for developing strategies to mitigate potential adverse outcomes.
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Affiliation(s)
- Grace C. Keane Tahmaseb
- Division of Plastic and Reconstructive Surgery, Washington University School of Medicine, St. Louis, MO 63130, USA; (G.C.K.T.); (A.M.K.)
| | - Alexandra M. Keane
- Division of Plastic and Reconstructive Surgery, Washington University School of Medicine, St. Louis, MO 63130, USA; (G.C.K.T.); (A.M.K.)
| | - Jose A. Foppiani
- Division of Plastic Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA 02215, USA;
| | - Terence M. Myckatyn
- Division of Plastic and Reconstructive Surgery, Washington University School of Medicine, St. Louis, MO 63130, USA; (G.C.K.T.); (A.M.K.)
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Seo MH, Eo MY, Park MW, Myoung H, Lee JH, Kim SM. Clinical retrospective analysis of peri-implant oral malignancies. Int J Implant Dent 2024; 10:5. [PMID: 38321262 PMCID: PMC10847072 DOI: 10.1186/s40729-024-00527-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2023] [Accepted: 01/30/2024] [Indexed: 02/08/2024] Open
Abstract
PURPOSE Complications of implant prostheses have direct correlation with the increased use of implants for dental rehabilitation. In this study, we present cases of peri-implant oral malignancies (PIOM) around dental implants and a retrospective analysis of patients treated for PIOM. METHODS The retrospective analysis was performed with patients treated for PIOM at the Department of Oral and Maxillofacial Surgery of the Seoul National University Dental Hospital between 2006 and 2014. The patient records were thoroughly screened for previous medical issues, human papilloma virus infections, and other clinical data with a focus on relevant information such as localization, time from implant insertion to the development of the carcinoma, implant type and prosthetic rehabilitation. RESULTS Twenty-one patients were diagnosed with PIOM. The male-to-female ratio was 1.625. The mean age of the patients was 60.42 ± 9.35 years old. Three patients reported ongoing alcohol/tobacco consumption. Five patients had a history of previous oral cancer surgery or exhibited mucosal lesions. The time from implant placement until carcinoma diagnosis was 49.13 ± 33.63 months on average. Most PIOM patients (95.2%) were diagnosed with SCC. All patients had previously been treated for peri-implantitis. In 85.7% of the patients, prostheses were observed on the opposing teeth where PIOM occurred. CONCLUSION Based on the review of these cases, it can be deduced that there is a possibility that implant treatment and galvanic currents between prosthesis may constitute an irritant and/or inflammatory cofactor which contributes to the formation and/or development of malignant tumors. Patients at potential risk may benefit from individualized recall intervals and careful evaluations.
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Affiliation(s)
- Mi Hyun Seo
- Department of Oral and Maxillofacial Surgery, Dental Research Institute, School of Dentistry, Seoul National University, 101 Daehak-ro, Jongno-gu, Seoul, 110-768, South Korea
| | - Mi Young Eo
- Department of Oral and Maxillofacial Surgery, Dental Research Institute, School of Dentistry, Seoul National University, 101 Daehak-ro, Jongno-gu, Seoul, 110-768, South Korea
| | - Min Woo Park
- Department of Oral and Maxillofacial Surgery, Dental Research Institute, School of Dentistry, Seoul National University, 101 Daehak-ro, Jongno-gu, Seoul, 110-768, South Korea
| | - Hoon Myoung
- Department of Oral and Maxillofacial Surgery, Dental Research Institute, School of Dentistry, Seoul National University, 101 Daehak-ro, Jongno-gu, Seoul, 110-768, South Korea
| | - Jong Ho Lee
- Department of Oral and Maxillofacial Surgery, Dental Research Institute, School of Dentistry, Seoul National University, 101 Daehak-ro, Jongno-gu, Seoul, 110-768, South Korea
| | - Soung Min Kim
- Department of Oral and Maxillofacial Surgery, Dental Research Institute, School of Dentistry, Seoul National University, 101 Daehak-ro, Jongno-gu, Seoul, 110-768, South Korea.
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Metastatic Lung Cancer to the Head and Neck: A Clinico-Pathological Study on 21 Cases with Narrative Review of the Literature. J Clin Med 2023; 12:jcm12041429. [PMID: 36835963 PMCID: PMC9965358 DOI: 10.3390/jcm12041429] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2022] [Revised: 02/06/2023] [Accepted: 02/09/2023] [Indexed: 02/15/2023] Open
Abstract
Metastases from lung cancer to the oral cavity and to the head and neck generally are very infrequent and usually manifest in advanced stages of the disease. Even more rarely, they are the first sign of an unknown metastatic disease. Nevertheless, their occurrence always represents a challenging situation both for clinicians, in the management of very unusual lesions, and for pathologists, in the recognition of the primary site. We retrospectively studied 21 cases of metastases to the head and neck from lung cancer (sixteen males and five females, age range 43-80 years; eight cases localized to the gingiva [two of these to the peri-implant gingiva], seven to the sub-mandibular lymph nodes, two to the mandible, three to the tongue, one case to the parotid gland; in eight patients, metastasis was the first clinical manifestation of an occult lung cancer) and proposed a wide immunohistochemical panel for a proper identification of the primary tumor histotype, including CK5/6, CK8/18, CK7, CK20, p40, p63, TTF-1, CDX2, Chromogranin A, Synaptophysin, GATA-3, Estrogen Receptors, PAX8, PSA. Furthermore, we collected data from previously published studies and narratively reviewed the relevant literature.
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Afrashtehfar KI, Almomani MM, Momani M. Lack of association between dental implants and oral squamous cell carcinoma. Evid Based Dent 2022; 23:40-42. [PMID: 35338331 DOI: 10.1038/s41432-022-0250-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2022] [Accepted: 02/21/2022] [Indexed: 06/14/2023]
Abstract
Design A systematic review of the literature to identify and evaluate the epidemiologic profile, and screen for possible risk factors and spectrum of clinical characteristics of oral squamous cell carcinoma (OSCC) surrounding dental implants, was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement guidelines.Data sources A search of two databases, Medline and CENTRAL, was undertaken, limited to articles published in English from the oldest records until 10 July 2018. Google Scholar was the grey literature searched. The references list in the included articles was assessed for further inclusion suitability.Study selection Participants included patients diagnosed with OSCC surrounding dental implants. The comparator or control was patients diagnosed with OSCC without dental implants. The outcome was epidemiology and carcinogenesis. The considered study designs were case reports, case series and retrospective studies. Article selection was performed by screening titles and abstracts individually by two blind review authors using the Rayyan platform based on the inclusion criteria. Then, the full text of the selected articles was assessed to identify the eligible articles, and the reasons for exclusion were reported. When a consensus was not achieved between the review authors, a third review author, who acted as a tiebreaker, was consulted.Data extraction Two independent review authors extracted the data using a specific extraction form in Microsoft Office Excel (Microsoft Corporation, Redmond, WA, USA). The extraction form consisted of authors, publication year, country, study design, number of cases, age, sex, risk factors, region of interest, the clinical aspect of the lesion, radiographic findings, the period between implant placement and tumour diagnosis, treatment, and follow-up. The time reported in the studies was converted to months for comparison. A third review author validated the accuracy of the information collected.Synthesis Two independent review authors assessed the risk of bias by applying the Joanna Briggs Institute (JBI) Critical Appraisal Checklist (CAP) for Case Reports and the JBI CAP for Prevalence Studies (for example, retrospective studies). Disagreements were resolved by consulting a third co-author. The Grading of Recommendation, Assessment, Development and Evaluation (GRADE) tool evaluated the certainty of the evidence of the main outcomes. A PRISMA flow diagram was presented, and a table summary of descriptive characteristics of the 33 included studies. Among the figures available, bar graphs represented the 'clinical features' according to the previous history of oral potentially malignant disorders and regarding the malignancy of oral potentially malignant disorders. In addition, a stacked line with markers represented the sex of the number of cases, displaying the time until diagnosis after implant placement and the time to disease progression.Data analysis A qualitative synthesis was provided. No quantitative data synthesis nor inter-rater agreement assessment was conducted.Results Thirty-one case reports and two retrospective studies, published between 1983 and 2020, met the eligibility criteria. The total sample consisted of 63 patients (male = 44.5%) with an average of 66.7 years (range = 42 to 90 years). Oral potentially malignant disorders were found in 29 patients (46%), of which 65.5% were female patients. The most common lesions were oral lichen planus and leukoplakia in female patients (52.6% and 31.5%) and male patients (20% and 60%). In 25 patients (39.6%), there was information missing about the presence of potentially malignant oral disorders, and oral hygiene status was reported in only 17.4% of the cases. Fifty-six patients (88.8%) of OSCC with dental implants were located in the mandible, and the most common clinical presentations of OSCC with implants were exophytic mass (46%) and ulceration (36.5%). Peri-implant bone loss assessment was performed in 51 patients (80.9%), of which 44 (86.2%) had peri-implant bone loss. Thus, most of these lesions were originally treated as peri-implantitis.Conclusions Most patients with OSCC next to their dental implants were female patients lacking known risk factors, and the common location was the mandible with an exophytic mass or ulceration presentation. A major concern is that the clinical and radiographic features of OSCC could be misdiagnosed as peri-implantitis. Thus, OSCC should be considered in persistent lesions surrounding dental implants. Several of the included reports were missing previous medical history and follow-up information. Hence, better case series and studies are required to support or reject the notion of an association between dental implants and OSCC.
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Affiliation(s)
- Kelvin I Afrashtehfar
- Assistant Professor in Prosthodontics and Implantology, Director of the Evidence-Based Practice Unit, Ajman University College of Dentistry, Ajman City, UAE; Associate Senior Scientist, Department of Reconstructive Dentistry and Gerodontology, School of Dental Medicine, University of Bern, Bern, Switzerland.
| | - Mai M Almomani
- General Dental Practice Intern, Gulf Medical University (GMU) College of Dentistry, Thumbay Dental Hospital, Ajman City, UAE
| | - Moath Momani
- Senior Specialist in Prosthodontics, Royal Medical Services Dental Department, Al Hussain King Hospital, Amman, Jordan
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A Biocompatible Ultrananocrystalline Diamond (UNCD) Coating for a New Generation of Dental Implants. NANOMATERIALS 2022; 12:nano12050782. [PMID: 35269268 PMCID: PMC8911871 DOI: 10.3390/nano12050782] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/31/2021] [Revised: 02/09/2022] [Accepted: 02/17/2022] [Indexed: 02/04/2023]
Abstract
Implant therapy using osseointegratable titanium (Ti) dental implants has revolutionized clinical dental practice and has shown a high rate of success. However, because a metallic implant is in contact with body tissues and fluids in vivo, ions/particles can be released into the biological milieu as a result of corrosion or biotribocorrosion. Ultrananocrystalline diamond (UNCD) coatings possess a synergistic combination of mechanical, tribological, and chemical properties, which makes UNCD highly biocompatible. In addition, because the UNCD coating is made of carbon (C), a component of human DNA, cells, and molecules, it is potentially a highly biocompatible coating for medical implant devices. The aim of the present research was to evaluate tissue response to UNCD-coated titanium micro-implants using a murine model designed to evaluate biocompatibility. Non-coated (n = 10) and UNCD-coated (n = 10) orthodontic Ti micro-implants were placed in the hematopoietic bone marrow of the tibia of male Wistar rats. The animals were euthanized 30 days post implantation. The tibiae were resected, and ground histologic sections were obtained and stained with toluidine blue. Histologically, both groups showed lamellar bone tissue in contact with the implants (osseointegration). No inflammatory or multinucleated giant cells were observed. Histomorphometric evaluation showed no statistically significant differences in the percentage of BIC between groups (C: 53.40 ± 13% vs. UNCD: 58.82 ± 9%, p > 0.05). UNCD showed good biocompatibility properties. Although the percentage of BIC (osseointegration) was similar in UNCD-coated and control Ti micro-implants, the documented tribological properties of UNCD make it a superior implant coating material. Given the current surge in the use of nano-coatings, nanofilms, and nanostructured surfaces to enhance the biocompatibility of biomedical implants, the results of the present study contribute valuable data for the manufacture of UNCD coatings as a new generation of superior dental implants.
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Retrospective Clinicopathological Analysis of 65 Peri-Implant Lesions. ACTA ACUST UNITED AC 2021; 57:medicina57101069. [PMID: 34684106 PMCID: PMC8539918 DOI: 10.3390/medicina57101069] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2021] [Revised: 10/02/2021] [Accepted: 10/04/2021] [Indexed: 11/17/2022]
Abstract
Background and Objectives: Peri-implantitis is a common finding among patients with dental implants. There is no consensus regarding the treatment of this disease, but in many cases, surgical treatment is common practice. A histopathological analysis is not an integral part of suggested protocols. The present study investigated the clinical and histopathological parameters of lesions mimicking peri-implantitis and correlated them with the outcome and follow-up data. Materials and Methods: The study included 65 consecutive biopsies taken from peri-implantitis patients between 2008-2019. Results: The three common diagnoses were fibro-epithelial hyperplasia 20 (30.7%), pyogenic granuloma 16 (24.6%), and peripheral giant cell granuloma 15 (23%). There were 18 cases of recurrent lesions in the study group (27.7%). The recurrence rate was the highest in peripheral giant cell granuloma (8, 12.3%), versus 6% in pyogenic granuloma and fibro-epithelial hyperplasia. These differences in the recurrence rate were statistically significant (p = 0.014). Conclusions: This study emphasizes the necessity of submitting tissue of peri-implantitis cases for histopathological analysis since the more locally aggressive lesions (peripheral giant cell granuloma and pyogenic granuloma), which comprise nearly half of the cases in this study, do not differ in clinical or radiographic characteristics from other peri-implant lesions.
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Paparella ML, Domingo MG, Puia SA, Jacobi-Gresser E, Olmedo DG. Titanium dental implant-related pathologies: A retrospective histopathological study. Oral Dis 2021; 28:503-512. [PMID: 33544935 DOI: 10.1111/odi.13794] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2020] [Revised: 01/28/2021] [Accepted: 01/31/2021] [Indexed: 12/17/2022]
Abstract
OBJECTIVES To perform a retrospective, descriptive, histopathological study of peri-implant tissue pathologies associated with titanium dental implants (TDI), and to evaluate the presence of metallic particles in samples from a single diagnostic center. METHODS Sixty-eight cases of TDI-associated lesions were retrieved from the Surgical Pathology Laboratory archives, School of Dentistry, University of Buenos Aires (UBA) (1990-2018). The study included re-examining the histopathological features of the biopsy samples, analyzing the inflammatory infiltrate, and examining the samples to detect metallic particles whose chemical composition was determined spectrophotometrically (EDS). Available clinical and radiographic data were also reviewed. RESULTS The retrieved cases ranged from lesions of inflammatory origin to neoplastic lesions. Metallic particles were observed in 36 cases (52.9%), all of which showed inflammation. Particle length ranged from 2 to 85µm. EDS analysis of the particles/deposits observed in the tissues showed the presence of aluminum, titanium, iron, and nickel, among other elements. CONCLUSIONS A significant number of TDI-associated lesions, including cases not reported to date and diagnosed at a single diagnostic center, are shown here. Cases showing particles exhibited an inflammatory response, irrespective of the histopathological diagnosis. The role of metallic particles in the development of TDI-associated lesion is yet to be established.
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Affiliation(s)
- María Luisa Paparella
- Universidad de Buenos Aires, Facultad de Odontología, Cátedra de Anatomía Patológica, Buenos Aires, Argentina
| | - Mariela Gisele Domingo
- Universidad de Buenos Aires, Facultad de Odontología, Cátedra de Anatomía Patológica, Buenos Aires, Argentina.,Research Fellow of the University of Buenos Aires, Buenos Aires, Argentina
| | - Sebastián Ariel Puia
- Universidad de Buenos Aires, Facultad de Odontología, Cátedra de Cirugía I, Buenos Aires, Argentina
| | | | - Daniel Gustavo Olmedo
- Universidad de Buenos Aires, Facultad de Odontología, Cátedra de Anatomía Patológica, Buenos Aires, Argentina.,National Council of Scientific and Technical Research (CONICET), Buenos Aires, Argentina
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Martin‐Cabezas R. Peri-implantitis management in a patient with erosive oral lichen planus. A case report. Clin Case Rep 2021; 9:718-724. [PMID: 33598232 PMCID: PMC7869359 DOI: 10.1002/ccr3.3617] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2020] [Revised: 11/05/2020] [Accepted: 11/13/2020] [Indexed: 12/27/2022] Open
Abstract
Oral lichen planus did not seem to influence the peri-implant healing. Oral lesions with malignant potential can mimic peri-implantitis, and a biopsy should be performed in cases of progression or nonregression of the lesion after initial treatment.
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Ramos JC, Dos Santos ES, Normando AGC, Alves FA, Kowalski LP, Santos-Silva AR, Vargas PA, Lopes MA. Oral squamous cell carcinoma around dental implants: a systematic review. Oral Surg Oral Med Oral Pathol Oral Radiol 2021; 131:660-674. [PMID: 33653646 DOI: 10.1016/j.oooo.2021.01.019] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2020] [Revised: 12/21/2020] [Accepted: 01/21/2021] [Indexed: 01/04/2023]
Abstract
OBJECTIVE This systematic review aimed to evaluate the epidemiologic profile, screen for possible risk factors, and evaluate the spectrum of clinical characteristics of oral squamous cell carcinoma (OSCC) around dental implants (DIs). METHODS The systematic review was performed according to the Preferred Reporting Items for Systematic Reviews and Meta- Analyses statement. RESULTS Thirty-three articles met the eligibility criteria. In total, the sample consisted of 63 patients, and women comprised the majority (55.5%). The mean age of patients was 66.7 years. Oral potentially malignant disorders were reported in 46% of patients, of which 65.5% occurred in women. The most common lesion found in women was oral lichen planus (52.6%). In 88.8% of patients OSCC around DIs occurred in the mandible, and the most common clinical appearance of the lesions was an exophytic mass (46%). Most of these lesions were initially treated as peri-implantitis. CONCLUSIONS Most patients with OSCC around DIs were women without known risk factors. It is important to emphasize that these lesions may present clinical and radiographic features that could resemble peri-implantitis, which can lead to delay in the diagnosis and subsequent treatment.
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Affiliation(s)
- Joab Cabral Ramos
- Department of Oral Diagnosis, Piracicaba Dental School, University of Campinas, Piracicaba, Brazil
| | | | | | - Fábio Abreu Alves
- Department of Stomatology, A.C. Camargo Cancer Center, São Paulo, Brazil
| | - Luiz Paulo Kowalski
- Department of Head and Neck Surgery and Otorhinolaryngology, A.C. Camargo Cancer Center, and Head and Neck Surgery Department, University of Sao Paulo Medical School, São Paulo, Brazil
| | - Alan Roger Santos-Silva
- Department of Oral Diagnosis, Piracicaba Dental School, University of Campinas, Piracicaba, Brazil
| | - Pablo Agustin Vargas
- Department of Oral Diagnosis, Piracicaba Dental School, University of Campinas, Piracicaba, Brazil
| | - Marcio Ajudarte Lopes
- Department of Oral Diagnosis, Piracicaba Dental School, University of Campinas, Piracicaba, Brazil.
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Ramos JC, Alves FA, Kowalski LP, Dos Santos-Silva AR, Vargas PA, Lopes MA. Epidemiological profile and clinical implications of oral squamous cell carcinoma adjacent to dental implants. Oral Dis 2020; 27:1687-1698. [PMID: 33140896 DOI: 10.1111/odi.13710] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2020] [Revised: 10/20/2020] [Accepted: 10/27/2020] [Indexed: 12/30/2022]
Abstract
OBJECTIVES Describe the epidemiological profile of patients with oral squamous cell carcinoma (OSCC) around dental implants (DI), investigate the spectrum of clinical and pathological characteristics, and discuss the implications of diagnosis delay of these lesions. METHODS Retrospective analysis of patients treated of OSCC adjacent to DI at A.C. Camargo Cancer Center between 2009 and 2020. RESULTS Thirty one patients were identified, being women the majority (58.1%). The mean age of the patients was 68.8 years. Never smoker corresponds to 46.9% and never alcohol consumer to 54.9% of the sample. OPMD was reported in 45.2% of patients, affecting mainly women (78.5%). Leukoplakia (63.7%) followed by oral lichen planus (36.3%) was the most common OPMD found in women. OSCC adjacent to DI occurred in the inferior gingiva/alveolar mucosa in 48.3% of cases, and ulceration was the most common clinical appearance (87%). Peri-implantitis (PI) was initial clinical diagnosis in 16.1% of cases. CONCLUSIONS Oral squamous cell carcinoma adjacent to DI was more common in women over 70 years old, non-smokers and non-drinker, and the majority had oral leukoplakia before the diagnosis of OSCC. OSCC may present clinical and radiographic features that resemble PI which can delay the diagnosis and impair the prognosis.
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Affiliation(s)
- Joab Cabral Ramos
- Department of Oral Diagnosis, Piracicaba Dental School, University of Campinas, Piracicaba, Brazil
| | - Fábio Abreu Alves
- Department of Stomatology, A.C. Camargo Cancer Center, São Paulo, Brazil
| | - Luiz Paulo Kowalski
- Department of Head and Neck Surgery and Otorhinolaryngology, A.C. Camargo Cancer Center, and Head and Neck Surgery Department, University of Sao Paulo Medical School São Paulo, São Paulo, Brazil
| | | | - Pablo Agustin Vargas
- Department of Oral Diagnosis, Piracicaba Dental School, University of Campinas, Piracicaba, Brazil
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Miranda Galvis M, Schausltz Pereira Faustino I, Cabral Ramos J, Dos Santos Silva AR, de Abreu Alves F, Kowalski LP, Ajudarte Lopes M. Oral cancer adjacent to dental implants mimicking benign lesions: a case series study. Aust Dent J 2020; 66:112-118. [PMID: 32939781 DOI: 10.1111/adj.12793] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/04/2020] [Indexed: 12/24/2022]
Abstract
Despite the long-term survival rates of osseointegrated dental implants, several biological complications are known to affect the peri-implant tissues, such as peri-implant mucositis and peri-implantitis. Occasionally, the clinical features of these more common benign lesions, or others nonrelated to implants, might be similar to oral malignancies, leading to misdiagnosis. The objective of this study was to present a case series of oral cancer located adjacent to dental implants, aimed to identify the reasons for initial misinterpretation of diagnosis. Thirteen patients, 10 females and 3 males, aged 59 to 90, were assessed. Among the differential diagnoses established, a malignant or premalignant lesion was not considered in 10 out of the 13 patients. Peri-implantitis was the most common preliminary diagnosis, followed by fungal infection, viral infections, and traumatic ulcers. The meantime for the diagnosis of oral cancer was 21.5 months. The clinical presentation of peri-implant malignancy, such as ulceration, white and red plaques, and exophytic lesions, might mimic benign diseases that are more common in the oral cavity. Suspicious lesions with treatment failure that persist for more than 2 weeks require biopsy and histopathological analysis to establish an early definitive diagnosis to improve the prognosis and quality of life of the patients.
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Affiliation(s)
- Marisol Miranda Galvis
- Department of Oral Diagnosis, Piracicaba Dental School, University of Campinas, Piracicaba, Brazil
| | | | - Joab Cabral Ramos
- Department of Oral Diagnosis, Piracicaba Dental School, University of Campinas, Piracicaba, Brazil
| | | | | | - Luiz Paulo Kowalski
- Department of Head and Neck Surgery and Otorhinolaryngology, A.C. Camargo Cancer Center, São Paulo, Brazil.,Head and Neck Surgery Department, Medical School, University of São Paulo, São Paulo, Brazil
| | - Marcio Ajudarte Lopes
- Department of Oral Diagnosis, Piracicaba Dental School, University of Campinas, Piracicaba, Brazil
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Salgado-Peralvo AO, Serrano-Sánchez V, Vaello-Checa I, Helm A, Mateos-Moreno MV, Salgado-Velázquez A. Cancerous lesions in the vicinity of dental implants: a systematic review. JOURNAL OF ORAL MEDICINE AND ORAL SURGERY 2020. [DOI: 10.1051/mbcb/2020040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Introduction: The massive diffusion of dental implant treatments in the last decades leads to the appearance of complications, most of them inflammatory, although important complications have been described as malignant lesions in the vicinity of dental implants. The objective of this article is to describe the cases described in the literature of oral squamous cell carcinoma (OSCC) or clinical variants and metastases, in the vicinity of dental implants and to analyze the possible etiological agents involved. Material and methods: The criteria used were those described in the PRISMA® Declaration for performing systematic reviews. An electronic search was performed on MEDLINE (via PubMed) using the terms MeSH: “dental implants” AND “squamous cell carcinoma” OR “dental implant complications” AND “squamous cell carcinoma”. Results: Thirty-eight articles describing a total of 76 cases of OSCC or clinical variants, as well as metastasis in the vicinity of dental implants, were included. Conclusions: It is not possible to establish a cause-effect relationship between dental implants and the development of OSCC. Its clinical appearance can be confused with periimplantitis, so that, in cases of sudden onset, which do not respond to conventional treatment and/or have associated alterations in sensitivity, a biopsy should be performed.
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Sotorra-Figuerola D, Lafuente-Ibáñez de Mendoza I, Parra-Pérez C, Aguirre-Urizar JM. Histopathological analysis of biopsies of "peri-implant inflammatory lesions." Everything is not what it seems. Clin Implant Dent Relat Res 2020; 22:366-372. [PMID: 32378812 DOI: 10.1111/cid.12905] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2019] [Revised: 03/12/2020] [Accepted: 03/17/2020] [Indexed: 11/30/2022]
Abstract
BACKGROUND Peri-implantitis is the inflammatory process, which most commonly affects the therapy with dental implants. However, there are other reactive and neoplastic entities, mainly benign but also malignant, which also take place in the peri-implant mucosa. There is little information about the histopathological analysis of these peri-implant inflammatory diseases. PURPOSE To analyze the histopathological diagnosis of biopsies located in the peri-implant mucosa that showed an inflammatory clinical appearance. MATERIALS AND METHODS We have made a retrospective study of 111 peri-implant biopsies analyzed in the Oral and Maxillofacial Pathology Unit of the Dental Clinic Service at the University of the Basque Country, from January 2001 to December 2018. These samples corresponded to 84 women and 27 men, whose mean age was 59 years. We performed a standard histological processing with paraffin embedding, and sections were stained with H&E and PAS. All cases were analyzed following a specific diagnostic histopathological protocol. A descriptive statistical analysis was carried out with the obtained data. RESULTS Lesions located in the mandible (64.8%) were more frequent and 34.2% of the biopsies arrived without a presumptive clinical diagnosis. "Inflammatory peri-implant lesion" or peri-implantitis was the most common clinical diagnosis. Histopathologically, the majority of the lesions were peri-implant nonspecific inflammatory hyperplasia (60.3%), followed by peripheral giant cell granuloma (18.1%), pyogenic granuloma (lobular capillary hemangioma) (14.4%), actinomicotic infection (3.6%), and squamous cell carcinoma (3.6%). Individually, peri-implant lesions were more common among women and in the mandible, except for actinomicotic infection and squamous cell carcinoma. CONCLUSIONS An important percentage of cases whose initial presumptive clinical diagnosis was "peri-implant inflammatory lesion" truly corresponded to other reactive and neoplastic processes. Thus, it is key to always submit all the tissue removed during the implant surgery, in order to perform a good histopathological study and achieve the correct final diagnosis.
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Affiliation(s)
- Didac Sotorra-Figuerola
- Oral Pathology Master Programme, Oral and Maxillofacial Pathology Unit, Dental Clinic Service, Department of Stomatology II, University of the Basque Country (UPV/EHU), Leioa, Spain
| | - Irene Lafuente-Ibáñez de Mendoza
- Oral Pathology Master Programme, Oral and Maxillofacial Pathology Unit, Dental Clinic Service, Department of Stomatology II, University of the Basque Country (UPV/EHU), Leioa, Spain
| | - Carmen Parra-Pérez
- Oral Pathology Master Programme, Oral and Maxillofacial Pathology Unit, Dental Clinic Service, Department of Stomatology II, University of the Basque Country (UPV/EHU), Leioa, Spain
| | - José Manuel Aguirre-Urizar
- Oral Pathology Master Programme, Oral and Maxillofacial Pathology Unit, Dental Clinic Service, Department of Stomatology II, University of the Basque Country (UPV/EHU), Leioa, Spain
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Oral squamous cell carcinoma around dental implant mimicking peri-implantitis. Oral Oncol 2020; 105:104759. [PMID: 32386923 DOI: 10.1016/j.oraloncology.2020.104759] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2020] [Accepted: 04/28/2020] [Indexed: 11/23/2022]
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Martins-Chaves RR, Guimarães LM, Pereira TDSF, Pereira NB, Chrcanovic BR, Fonseca FP, Lafuente-Ibáñez de Mendoza I, Aguirre-Urizar JM, Gomes CC, Gomez RS. KRAS mutations in implant-associated peripheral giant cell granuloma. Oral Dis 2019; 26:334-340. [PMID: 31758745 DOI: 10.1111/odi.13241] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2019] [Revised: 11/06/2019] [Accepted: 11/14/2019] [Indexed: 12/31/2022]
Abstract
OBJECTIVES To investigate the molecular pathogenesis of implant-associated peripheral giant cell granuloma (IA-PGCG). METHODS A convenience sample of 15 IA-PGCG cases was selected. Hotspot mutations of KRAS, FGFR1, and TRPV4 genes, previously reported in conventional giant cell lesions of the jaws, were investigated by Sanger sequencing. As these mutations could activate MAPK/ERK pathway, the expression of phospho-ERK1/2 was also evaluated by immunohistochemistry. RESULTS KRAS mutations were detected in 8/15 (53.4%) samples. Similar to conventional peripheral giant cell granuloma, the KRAS mutations most frequently occurred in codon 146 (p.A146V, n = 3), followed by codon 12 (p.G12A and p.G12D, n = 1 each) and codon 14 (p.V14L, n = 1). Variants of unknown significance (VUS) were also detected in two cases, affecting codons 37 (p.E37K) and 127 (p.T127I). All samples showed wild-type (WT) sequences for FGFR1 and TRPV4 genes. Consistent with MAPK/ERK pathway activation, all mononuclear cells of the lesion showed strong staining for phospho-ERK1/2 protein in the immunohistochemical analysis. CONCLUSIONS KRAS mutations and activation of the MAPK-ERK signaling pathway occur in IA-PGCG. This is the first study to demonstrate cancer-associated gene mutations in a non-neoplastic reactive condition associated with dental implants.
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Affiliation(s)
- Roberta Rayra Martins-Chaves
- Department of Oral Surgery and Pathology, School of Dentistry, Universidade Federal de Minas Gerais (UFMG), Belo Horizonte, Brazil
| | - Letícia Martins Guimarães
- Department of Oral Surgery and Pathology, School of Dentistry, Universidade Federal de Minas Gerais (UFMG), Belo Horizonte, Brazil
| | - Thaís Dos Santos Fontes Pereira
- Department of Oral Surgery and Pathology, School of Dentistry, Universidade Federal de Minas Gerais (UFMG), Belo Horizonte, Brazil
| | - Núbia Braga Pereira
- Department of Pathology, Biological Sciences Institute, Universidade Federal de Minas Gerais (UFMG), Belo Horizonte, Brazil
| | | | - Felipe Paiva Fonseca
- Department of Oral Surgery and Pathology, School of Dentistry, Universidade Federal de Minas Gerais (UFMG), Belo Horizonte, Brazil
| | - Irene Lafuente-Ibáñez de Mendoza
- Unit of Oral and Maxillofacial Pathology of the Dental Clinic Service, Department of Stomatology II, University of the Basque Country (UPV-EHU), Bizkaia, Spain
| | - José Manuel Aguirre-Urizar
- Unit of Oral and Maxillofacial Pathology of the Dental Clinic Service, Department of Stomatology II, University of the Basque Country (UPV-EHU), Bizkaia, Spain
| | - Carolina Cavaliéri Gomes
- Department of Pathology, Biological Sciences Institute, Universidade Federal de Minas Gerais (UFMG), Belo Horizonte, Brazil
| | - Ricardo Santiago Gomez
- Department of Oral Surgery and Pathology, School of Dentistry, Universidade Federal de Minas Gerais (UFMG), Belo Horizonte, Brazil
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16
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Seo MH, Myoung H, Lee JH, Kim SM, Lee SK. Changes in oncogenic protein levels in peri-implant oral malignancy: a case report. Maxillofac Plast Reconstr Surg 2019; 41:46. [PMID: 31763327 PMCID: PMC6838285 DOI: 10.1186/s40902-019-0235-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2019] [Accepted: 10/16/2019] [Indexed: 12/25/2022] Open
Abstract
Background Oral squamous cell carcinoma (OSCC) constitutes a group of tumors that exhibit heterogeneous biology, histopathology, and clinical behaviors. Case presentation A 73-year-old male had a whitish leukoplakia-like lesion around inflamed peri-implant area (#42, #43, and #44), and this lesion had transformed to OSCC within 3 years. He underwent mass resection, selective neck dissection, and reconstructive surgery. To detect any carcinogenesis progression, we examined the removed tumor tissue as well as the patient’s preoperative and postoperative sera to identify causative oncogenic proteins using immunoprecipitation high-performance liquid chromatography (IP-HPLC). Conclusions The protein expression levels of p53, E-cadherin, β-catenin, MMP-10, HER2, NRAS, Met, HER2, and ERb were significantly lower in the serum collected on postoperative day 10 than in the preoperative serum, and if these proteins are consistently not elevated in the serum 3 months after surgery compared with the preoperative serum, these proteins can be potential oncogenic proteins. However, we also found that the serum extracted 3 months after the operation had elevated levels of oncogenic proteins compared with that of the preoperative and 10-day postoperative serum indicating the possibility of tumor recurrence. At postoperative follow-up period, ipsilateral neck metastasis and second primary lesion were found and additional surgery was performed to the patient. IP-HPLC using the patient’s serum shows the possibility of oncogenic protein detection. However, follow-up IP-HPLC data is needed to find out patient-specific prognostic factors.
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Affiliation(s)
- Mi Hyun Seo
- 1Department of Oral and Maxillofacial Surgery, Dental Research Institute, School of Dentistry, Seoul National University, 101 Daehak-ro, Jongno-gu, Seoul, 110-768 South Korea
| | - Hoon Myoung
- 1Department of Oral and Maxillofacial Surgery, Dental Research Institute, School of Dentistry, Seoul National University, 101 Daehak-ro, Jongno-gu, Seoul, 110-768 South Korea
| | - Jong Ho Lee
- 1Department of Oral and Maxillofacial Surgery, Dental Research Institute, School of Dentistry, Seoul National University, 101 Daehak-ro, Jongno-gu, Seoul, 110-768 South Korea
| | - Soung Min Kim
- 1Department of Oral and Maxillofacial Surgery, Dental Research Institute, School of Dentistry, Seoul National University, 101 Daehak-ro, Jongno-gu, Seoul, 110-768 South Korea
| | - Suk Keun Lee
- 2Department of Oral Pathology, College of Dentistry, Gangneung-Wonju National University, 7, Jukheon-gil, Gangneung-si, Gangwon-do South Korea
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Noguchi K, Moridera K, Sotsuka Y, Yamanegi K, Takaoka K, Kishimoto H. Oral squamous cell carcinoma occurring secondary to oral lichen planus around the dental implant: A case report. ACTA ACUST UNITED AC 2019. [DOI: 10.1002/osi2.1008] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Affiliation(s)
- Kazuma Noguchi
- Department of Oral and Maxillofacial SurgeryHyogo College of Medicine Hyogo Japan
| | - Kuniyasu Moridera
- Department of Oral and Maxillofacial SurgeryHyogo College of Medicine Hyogo Japan
| | - Yohei Sotsuka
- Department of Plastic and Reconstructive SurgeryHyogo College of Medicine Hyogo Japan
| | - Koji Yamanegi
- Department of PathologyHyogo College of Medicine Hyogo Japan
| | - Kazuki Takaoka
- Department of Oral and Maxillofacial SurgeryHyogo College of Medicine Hyogo Japan
| | - Hiromitsu Kishimoto
- Department of Oral and Maxillofacial SurgeryHyogo College of Medicine Hyogo Japan
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Sánchez-Torres A, Mota I, Alberdi-Navarro J, Cercadillo-Ibarguren I, Figueiredo R, Valmaseda-Castellón E. Inflammatory fibro-epithelial hyperplasia related to a fixed implant-supported prosthesis: A case report. J Clin Exp Dent 2018; 10:e945-e948. [PMID: 30386530 PMCID: PMC6203924 DOI: 10.4317/jced.54921] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2018] [Accepted: 06/08/2018] [Indexed: 11/25/2022] Open
Abstract
The gingival overgrowth is a common finding in the clinical practice with a diverse etiology. There are no treatment guidelines defined for this oral lesions. These can provoke discomfort to the patient and often, can alter the function of the stomatologic system. This article presents a case report of a bilateral gingival overgrowth in a 68 years old woman wearing a fixed upper-arch implant-supported prosthesis placed five years ago. The clinical exam after removing the prosthesis showed an intense accumulation of plaque around the intermediate abutments associated to a mucosal enlargement with suppuration on touching the buccal area of the implant in position 1.5 and a probing depth of 8mm. The 2.4 and 2.5 implants also showed vestibular mucosal enlargement and a probing depth of 6mm. No changes were observed in the peri-implant bone level measured in the periapical radiographs. An incisional biopsy was made on second quadrant and sent for the histopathological study. The definitive diagnosis was inflammatory fibro-epithelial hyperplasia. No recurrence has been reported after a 6 month follow-up.
Key words:Fibro-epithelial hyperplasia, gingival enlargement, gingival overgrowth, full-arch implant-supported prosthesis.
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Affiliation(s)
- Alba Sánchez-Torres
- DDS, MS, Master of Oral Surgery and Implantology. Associate Professor of Oral Surgery, School of Medicine and Health Sciences, University of Barcelona. Researcher at the IDIBELL Institute. Barcelona, Spain
| | - Inês Mota
- DDS, Fellow of Master of Oral Surgery and Implantology. School of Medicine and Health Sciences, University of Barcelona, Spain
| | - Javier Alberdi-Navarro
- DDS, MS, PhD, Oral Medicine and Oral and Maxillofacial Pathology Units, Dental Clinic Service. Department of Stomatology II. University of the Basque Country (UPV/EHU)
| | - Iñaki Cercadillo-Ibarguren
- DDS, MS, Master of Oral Surgery and Implantology. Associate Professor of Oral Surgery, School of Medicine and Health Sciences, University of Barcelona. Researcher at the IDIBELL Institute. Barcelona, Spain
| | - Rui Figueiredo
- DDS, MS, PhD, Master of Oral Surgery and Implantology. Associate Professor of Oral Surgery, School of Medicine and Health Sciences, University of Barcelona, Barcelona. Researcher at the IDIBELL Institute. Barcelona, Spain
| | - Eduard Valmaseda-Castellón
- DDS, MS, PhD, EBOS. Professor of Oral Surgery, Professor of the Master of Oral Surgery and Implantology. School of Medicine and Health Sciences, University of Barcelona. Researcher at the IDIBELL Institute. Barcelona, Spain
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Ito K, Takahashi K, Eda T, Kondoh T, Goss A. Peri-implant squamous cell carcinoma. Aust Dent J 2018; 63:261-264. [DOI: 10.1111/adj.12581] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/17/2017] [Indexed: 12/22/2022]
Affiliation(s)
- K Ito
- Oral and Maxillofacial Surgery Unit; Faculty of Health Science; University of Adelaide; Adelaide South Australia Australia
- Department of Maxillofacial Surgery; Nihon University School of Dentistry at Matsudo; Matsudo Japan
| | - K Takahashi
- Department of Maxillofacial Surgery; Nihon University School of Dentistry at Matsudo; Matsudo Japan
| | - T Eda
- Department of Maxillofacial Surgery; Nihon University School of Dentistry at Matsudo; Matsudo Japan
| | - T Kondoh
- Department of Maxillofacial Surgery; Nihon University School of Dentistry at Matsudo; Matsudo Japan
| | - A Goss
- Oral and Maxillofacial Surgery Unit; Faculty of Health Science; University of Adelaide; Adelaide South Australia Australia
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20
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Kalogirou EM, Sklavounou A. Is dental implantation indicated in patients with oral mucosal diseases. BALKAN JOURNAL OF DENTAL MEDICINE 2017. [DOI: 10.1515/bjdm-2017-0013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Background/Aim: Dental implants are a reliable treatment choice for rehabilitation of healthy patients as well as subjects with several systemic conditions. Patients with oral mucosal diseases often exhibit oral mucosal fragility and dryness, erosions, blisters, ulcers or microstomia that complicate the use of removable dentures and emphasize the need for dental implants. The aim of the current study is to review the pertinent literature regarding the dental implantation prospects for patients with oral mucosal diseases. Material and Method: The English literature was searched through PubMed and Google Scholar electronic databases with key words: dental implants, oral mucosal diseases, oral lichen planus (OLP), epidermolysis bullosa (EB), Sjögren’s syndrome (SS), cicatricial pemphigoid, bullous pemphigoid, pemphigus vulgaris, scleroderma/systemic sclerosis, lupus erythematosus, leukoplakia, oral potentially malignant disorders, oral premalignant lesions, oral cancer and oral squamous cell carcinoma (SCC). Results: Literature review revealed dental implantation in patients with OLP (14 articles), EB (11 articles), pemphigus vulgaris (1 article), SS (14 articles), systemic sclerosis (11 articles), systemic lupus erythematosus (3 articles) and oral SCC development associated with leukoplakia (5 articles). No articles regarding dental implants in patients with pemphigoid or leukoplakia without SCC development were identified. Most articles were case-reports, while only a few retrospective, prospective or observational studies were identified. Conclusions: Dental implants represent an acceptable treatment option with a high success rate in patients with chronic mucocutaneous and autoimmune diseases with oral manifestations, such as OLP, SS, EB and systemic sclerosis. Patients with oral possibly malignant disorders should be closely monitored to rule out the development of periimplant malignancy. Further studies with long follow-up, clinical and radiographic dental data are required to predict with accuracy the outcome of dental implants in patients with oral mucosal diseases.
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