A Rare Case of Pyogenic Granuloma in the Tooth Extraction Socket

Abstract

Pyogenic granuloma (PG) refers to a common, acquired, benign, and vascular tumor that arises in tissues such as the skin and mucous membranes. However, it is extremely rare for PG to arise from an empty socket after tooth extraction. Herein, we describe a rare case of PG that arose from the empty extraction socket of the second molar adjacent to a dentigerous cyst of the left mandibular wisdom tooth in a 57-year-old man. The patient’s second molar was extracted during the same procedure in which the wisdom tooth and cyst were removed. Subsequently, at 42 days after surgery, an exophytic mass was found in the socket of the second molar. An excisional biopsy was performed, and the histopathological diagnosis was PG. Since the PG recurred 90 days after the surgery, a complete excision with bone curettage was performed. During the 12 months of follow-up, there has been no recurrence observed. In conclusion, as tooth extraction is a routine dental practice, clinicians should be aware that PGs can also develop from an extraction socket.

Pyogenic Granuloma: A Literature Review and A Case Report

“…A manual search of recently published journals was also conducted. The keywords used Growth Factor Receptor (EGFR) inhibitors and anticancer agents such as pyrimidine analogs, taxanes, epidermal growth factor receptor inhibitors, tyrosine kinase inhibitor and B-Rapidly Accelerated Fibrosarcoma (BRAF) inhibitors, and immunosuppressants such as Tumor Necrosis Factor alpha (TNF-alpha) antagonists and mammalian Target Of Rapamycin (mTOR) inhibitors [7], [8], food impaction and trauma, as a result of wrong toothbrushing technique can act as stimuli [1], [3].…”

“…The most applied method of diagnosis of PG is the biopsy. Histopathologically, hematoxylin-eosin (H&E) stained section reveals lobular aggregates of capillary-sized vessels, which are lined by plump endothelial cells, with scattered fibroblasts and various amounts of inflammatory infiltrate [7]. The classification of PG's developments consists of (i) cellular phase, (ii) capillary phase or vascular phase, and (iii) involutionary phase [6].…”

“…The classification of PG's developments consists of (i) cellular phase, (ii) capillary phase or vascular phase, and (iii) involutionary phase [6]. Furthermore, the Immunohistochemistry (IHC), using VEGF marker, presents the endothelial cells positive for vascular markers such as CD31, CD34, ICAM-1, VCAM-1, factor VIII antigen, and WT-1, they were negative for glucose transporter protein isoform-1 (GLUT-1) [6], [7]. Some more specialized techniques are associated with marking components of Renin-Angiotensin System (RAS), such as 3,3 -Diaminobenzidine (DAB) immunohistochemical (IHC) staining, PG-Derived Primary Cell Lines, NanoString mRNA analysis, RT-qPCR and Western blotting (WB) performed on total protein extracts [18].…”

Pyogenic Granuloma of the Oral Cavity: Clinical and Histopathological Features, Etiopathogenesis, and Management

“…Various factors are suggested to be implicated in the etiopathogenesis of PG, such as chronic low-level local irritation from overhanging restorations or calculus, trauma, hormonal changes, bone marrow transplants, reactions to grafts, and certain drugs, including calcium channel antagonists, immunosuppressants, antiseizure drugs, and anticancer medications. Among the latter are "TNF-α antagonists, BRAF inhibitors, tyrosine kinase inhibitors, epidermal growth factor receptor inhibitors, mTOR inhibitors, taxanes, and pyrimidine analogs 14,18 . "…”