Oral squamous cell carcinoma associated with symphyseal dental implants

Oral Squamous Cell Carcinoma Associated With Symphyseal Dental Implants
An Unusual Case Report
Lorena Gallego, MD, Luis Junquera, MD, DDS, PhD, Jaime Baladrón, MD, DDS, PhD and Pedro Villarreal, MD, DDS, PhD
ABSTRACT
Background. The development of squamous cell carcinoma (SCCa) around dental implants is an uncommon pathological manifestation. This case report describes a patient withhistory of oral lichen planus (OLP) and previous SCCa of the gingiva who developed SCCa adjacent to symphyseal implants.
Case Description. An 81-year-old edentulous woman with history of OLP developed an in situ SCCa on the left mandibular edentulous ridge. One of the authors, an oral and maxillofacial surgeon, performed a marginal mandibular resection of the lesion. Functional oral rehabilitationwas achieved by means of two endosseous symphyseal implants. Three years after the patient underwent implant-supported reconstruction, the oral and maxillofacial surgeon detected an exophytic mass adjacent to the right implant and diagnosed it as recurrent SCCa. Two of the authors performed a marginal mandibular resection. One year later, the patient developed a recurrence over the resected area,requiring segmental mandibulectomy.
Clinical Implications. This case report demonstrates that recurrent primary malignancy can masquerade as benign peri-implant complications. A high degree of vigilance is required in the follow-up of patients with previous cancer or premalignant lesions.
Key Words: Dental implants; oral carcinoma; oral lichen planus
Abbreviations:CT: Computed tomography •OLP: Oral lichen planus • SCCa: Squamous cell carcinoma
The development of squamous cell carcinoma (SCCa) around dental implants, either endosseous or transosseous, is an uncommon pathological manifestation with only a few cases described in the literature.1–6 Usually, these cases are associated with a history of oral cancer or smoking.
Studies have shown an association between oral lichen planus(OLP) and SCCa, with an incidence of cancer development in patients with OLP ranging from 0.4 to 5.6 percent7–9 in periods of observation from 0.5 to 20 years. This seems to be independent of the clinical type of OLP or the treatment used.8 Malignant transformation of OLP in association with dental implants has been reported.9 Spontaneous occurrence of oral cancer around implants in patients withno history of oral malignancy, to our knowledge, has been reported only in one article.6 The case report we present here describes a patient with a longstanding history of OLP and gingival SCCa in the mandibular molar region who developed a SCCa adjacent to symphyseal implants.
CASE REPORT
An 81-year-old edentulous woman came to an oral and maxillofacial clinic in Oviedo, Spain, in 1999 fordiagnosis, evaluation and treatment of white lesions in her palate, tongue and left buccal mucosa. She had had the lesions for one year. The oral and maxillofacial surgeon (J.B.) recorded her medical history, which included no smoking or alcohol consumption. He diagnosed this as a predominantly plaque-type OLP with a slight erosive component. He performed an incisional biopsy from the left buccalmucosa that revealed OLP with no dysplastic epithelial changes. He prescribed prednisone to manage the lesions. The oral and maxillofacial surgeon and another clinician, a professor in the Department of Oral and Maxillofacial Surgery at the Dental School at Oviedo University (L.J.), followed up the patient carefully for two years.
In 2001, the presence of a suspicious lesion on the mandibular leftedentulous ridge (Figure 1A) prompted the oral and maxillofacial surgeon to perform a second biopsy. Microscopic examination revealed in situ carcinoma. The two clinicians (J.B. and L.J.) performed a marginal mandibular resection of the lesion while the patient was under local anesthesia (Figure 1B). The pathology tests did not confirm the presence of cancer cells on the resected margins of the...