Background: An amalgam tattoo is an iatrogenic lesion that can lead to esthetic concerns. This paper presents a literature review aimed at exploring treatment options available to clinicians for addressing this unesthetic issue.
Methods: The initial search identified 209 potentially relevant publications. After applying specific inclusion and exclusion criteria, 18 papers were analyzed and summarized in a comprehensive table, highlighting significant aspects for comparison.
Results: The findings indicate various treatment options reported in the existing literature. Additionally, this paper includes a case report detailing the procedure performed on a 47-year-old female with an amalgam tattoo on the buccal aspect of her upper right premolars. Following muco-abrasion to remove the oral pigmented lesion, a bilaminar mucogingival procedure was performed.
Conclusions: At the 8-year follow-up, the gingival color and texture blended well with the surrounding soft tissues, the periodontal structures appeared healthy, and the patient was satisfied with the esthetic outcomes.
Key points: Discoloration of the oral mucosa caused by amalgam can result in esthetic dissatisfaction for patients. A review of the literature indicates that the bilaminar technique is a more reliable surgical approach for achieving cosmetic results in a single operation. An 8-year follow-up case report supports this finding, detailing a procedure that involved muco-abrasion of the lesion followed by a sliding pedicle flap.
Plain language summary: An amalgam tattoo is an iatrogenic lesion associated with esthetic concerns. This paper reviews treatment options for this issue, analyzing 18 relevant publications from an initial search of 209. Additionally, a case report details the treatment of a 47-year-old female patient with an amalgam tattoo on her upper right premolars. After muco-abrasion to remove the lesion, a plastic surgery procedure with a connective tissue graft from the palate was performed. At the 8-year follow-up, the gingival color and texture matched the surrounding tissues, the periodontal structures appeared healthy, and the patient was satisfied with the results.
Background: Enamel-renal-gingival syndrome (ERGS) is an autosomal recessive disorder caused by mutations in the FAMily with sequence similarity 20A (FAM20A) gene, and is characterized by amelogenesis imperfecta, delayed or failed tooth eruption, and periodontitis. This study aims to profile the salivary microbiome and monitor the clinical progression in a young adult patient with FAM20A mutations.
Methods: Treatment involved non-surgical therapy including scaling and root planing (SRP) and systemic amoxicillin and metronidazole, and reviewed for 1.5 years.
Results: Probing depth reduction with no sites of 5 mm or deeper was achieved at 1.5 years post-treatment. Saliva microbiome profiles of the patient revealed a decrease in periodontitis-associated pathogenic bacteria including Tannerella forsythia, Treponema denticola, Prevotella intermedia, and Treponema parvum, and a repopulation of health-associated species at 6 months. Predictive analysis revealed a decrease in the cell motility pathway relative to the 2-month time point and baseline.
Conclusions: FAM20A mutations may alter the periodontal microenvironment, potentially contributing to microbial dysbiosis. However, therapy consisting of SRP and systemic antibiotics may result in clinical improvements, demonstrating that the microbiome plays a role in health and disease even in syndromic cases.
Key points: Patients presenting with amelogenesis imperfecta may present with periodontitis as a manifestation of systemic disease. Such cases are treatable without the need for extensive serial extractions of teeth.
Plain language summary: People with enamel-renal-gingival syndrome, a rare genetic condition, experience problems such as poorly formed enamel, delayed tooth eruption, and severe gum disease. In this study, a 22-year-old adult with enamel-renal-gingival syndrome was followed up to understand how her saliva microbiome changed after treatment. The patient received professional deep cleaning and systemic antibiotics and was followed up for 1.5 years. Treatment successfully led to probing depth reduction. Analysis of the saliva microbiome showed a reduction in bacteria associated with periodontitis and an increase in bacteria associated with health. These findings suggest that enamel-renal-gingival syndrome may create an oral environment that encourages bacterial imbalance in the mouth, contributing to gum disease. However, the results also show that standard gum disease treatment can still be effective. Changes in the microbiome were observed alongside clinical improvement, pointing to the microbiome's potential relevance in both disease and recovery.
Background: Chronic granulomatous disease (CGD) is an inborn error of immunity characterized by life-threatening infections and inflammation. Allogeneic hematopoietic stem cell transplantation (alloHSCT) is potentially curative. Necrotizing periodontal diseases (NPDs) are rare and can be seen in immunocompromised/immunosuppressed individuals but have not been reported in patients with CGD. We report NPD in the form of necrotizing stomatitis (NS) in a patient transplanted for CGD.
Methods: A 12-year-old male presented with severe gingival pain. The patient's medical history was significant for X-linked CGD diagnosed at 4 years of age and a heterozygous RIPK1 mutation. The patient underwent alloHSCT from a mismatched unrelated donor. Intraoral examination on day +61 post-alloHSCT revealed multifocal gingival ulceration, which did not respond to a short course of prednisone and topical dexamethasone oral solution. The ulcers progressed to involve the lip mucosa and soft palate/tonsil (day +88).
Results: Biopsy from the soft palate/tonsillar area showed deep acute inflammation and abscesses consistent with the diagnosis of NS. The patient underwent deep gingival scaling on day +103 and received amoxicillin and metronidazole. The patient had complete resolution of the oral ulcers by day +125 but developed chronic graft-versus-host disease involving the oral mucosa on day +314 post-alloHSCT.
Conclusion: We report the first case of NS as a complication of alloHSCT in a patient transplanted for CGD which was successfully managed with antibiotic therapy, periodontal debridement, and discontinuation of potentially triggering agents. Our report demonstrates that NS/NPD may occur in post-alloHSCT setting.
Key points: Chronic granulomatous disease is an inherited multisystem autoinflammatory condition. Patients with chronic granulomatous disease may have oral manifestations including oral ulcerations and gingivitis/periodontitis. Necrotizing ulcerative stomatitis may arise in the post-hematopoietic stem cell transplantation setting.
Plain language summary: Chronic granulomatous disease (CGD) is a condition that impairs the immune system and can be managed with bone marrow transplantation. Necrotizing periodontal disease (NPD) are a group of rare conditions that affect the mouth and cause tissue death (necrosis) and present clinically as oral ulcers (mouth sores). In this article, we report NPD in a child who received bone marrow transplantation for his CGD. This report broadens the differential diagnosis of oral ulcers in the post-transplant setting.
Background: Vertically fractured teeth often have a poor prognosis, and extraction is considered the most predictable treatment. Conventional management has consisted of preservation therapy involving extraction, bonding, root restoration, and replantation of fractured teeth. However, these methods fail to adequately address the periodontal tissue damage associated with root fractures. This report describes successful periodontal tissue regeneration using basic fibroblast growth factor (FGF-2) combined with a carbonate apatite-based bone graft material (CaAp) as a scaffold during the replantation of vertically fractured teeth.
Methods: Our series included four patients: a 57-year-old woman, a 59-year-old woman, a 45-year-old man, and a 41-year-old woman, all diagnosed with vertically fractured teeth. The fractured teeth were extracted, bonded using 4-methacryloxyethyl trimellitate anhydride in methyl methacrylate initiated by tri-n-butyl borane (4-META/MMA-TBB) resin, and replanted. CaAp was applied to the extraction sockets; FGF-2 was administered to the periodontal ligament-deficient root areas prior to replantation.
Results: In all cases, periodontal pocket depths were reduced to 3 mm or less, and no signs of inflammation were evident. Cone-beam computed tomography revealed substantial regeneration of periodontal tissues.
Conclusions: The combination of FGF-2 and CaAp during the replantation of vertically fractured teeth promotes periodontal tissue regeneration and demonstrates potential for long-term tooth preservation.
Key points: What new information do these cases provide? This is the first report to our knowledge demonstrating that replantation of a root-fractured tooth, historically considered suitable only for extraction, can achieve substantial periodontal tissue regeneration. This regeneration was accomplished by bonding and restoring the tooth using 4-methacryloxyethyl trimellitate anhydride in methyl methacrylate initiated by tri-n-butyl borane (4-META/MMA-TBB) resin in combination with fibroblast growth factor (FGF-2) and carbonate apatite-based bone graft material (CaAp). What are the keys to successful management of these cases? Atraumatic tooth extraction Thorough curettage of the extraction socket Comprehensive debridement of the fractured root surface Precise bonding and restoration of the fractured tooth Effective application of FGF-2 and CaAp, with accurate positioning and stabilization of the replanted tooth What are the primary limitations to success in these cases? The mechanical factors that can cause root fracture need to be eliminated for this treatment to succeed. The long-term prognosis depends on consistent follow-up and monitoring. The procedure is highly technique-sensitive; outcomes are closely associated with operator skill and experience.
Background: The interforaminal space is frequently used for dental implant placement due to its strategic location between the bilateral mental foramina. However, neurosensory disturbances following surgical intervention near the mental foramen (MF) can occur in up to 43% of cases. Understanding anatomical variations of the MF is crucial to preventing surgical complications. Traditional two-dimensional radiographs have limitations in accurately visualizing anatomical structures, whereas cone-beam computed tomography (CBCT) provides high-resolution three-dimensional imaging that enhances diagnostic accuracy and clinical decision making. This case report highlights such a scenario.
Methods: A 54-year-old male referred for implant placement underwent preoperative evaluation with CBCT, which revealed a rare anatomical variation: the MF was positioned distal to the right mandibular second incisor (distal to #25) roughly 3 mm from the crest of the ridge, rather than its typical between the apices first and second premolars. The mental nerve exhibited an aberrant course, traversing in a superficial, buccal direction along the alveolar crest of site #25. This variability placed the neurovascular bundle at an extremely high risk for intraoperative injury. Consequently, the implant treatment plan was modified to reposition the implants away from the nerve pathway, and a customized CBCT-based surgical guide was utilized to facilitate accurate implant placement while preserving neurovascular integrity.
Results: The patient exhibited no neurosensory disturbances postoperatively, and a 2-week follow-up showed normal healing. The adjusted implant placement strategy successfully avoided nerve injury.
Conclusion: Conventional radiographs are limited in detecting neurovascular structures and anatomical variations. CBCT serves as an essential diagnostic tool for identifying rare variations of the MF, ensuring precise implant placement, and preventing surgical complications.
Plain language summary: Before placing dental implants, its important to know exactly where key structures are located to avoid causing injury. This case reports on a 54-year-old man who needed dental implants in his lower front jaw. The mental nerve was not identified with conventional radiography, but this was not a crucial issue since the implants planned were lower front teeth. Cone-beam computed tomography (CBCT) revealed that the mental foramen was in an unusual spot-closer to the front teeth, where the implant was planned. If this had gone unnoticed, the surgery could have certainly damaged the nerve, potentially causing permanent numbness. Thanks to the detailed imaging from the CBCT scan, the treatment plan was changed to avoid the nerve. The surgery went smoothly, the patient had no nerve problems afterward, and healing was normal.
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