Failure of dental implants in cemento-osseous dysplasia: a critical analysis of a case

Abstract

ResumoIntrodução: Implantes dentários têm sido rotineiramente utilizados como excelente alternativa para a reabilitação oral. Pacientes com doenças ósseas displásicas representam um desafio especial para a reabilitação oral com implantes dentários. No entanto, a instalação de implantes em pacientes com displasia cemento-óssea (DCO) tem sido relatada com aparente sucesso. Objetivo: Neste artigo, apresentamos um caso de um paciente com DCO florida em que um implante dentário fora instalado em paciente com lesões da variante florida da displasia cemento-óssea, seguido de insucesso seis meses após a cirurgia. Diante dos achados clínicopatológicos, foi realizada uma análise da pertinência da indicação da instalação do implante dentário em área acometida pela lesão, considerando a natureza displásica da doença, sua patogenia e comportamento biológico. Conclusão: O presente caso é ilustrativo em caracterizar a impertinência da indicação dos procedimentos de implantes dentários em pacientes portadores da DCO, considerando imperativo fornecer informações ao paciente a propósito dos riscos em manipular tecido ósseo portador destas lesões.Descritores: Implantes dentários; osseointegração; doenças do desenvolvimento ósseo. Abstract

The importance of cone-beam computed tomography for the diagnosis and treatment plan of florid cemento-osseous dysplasia: a case report

“…This tissue can compromise post -surgical repair, directly affecting osseointegration and leading to a greater risk of osteomyelitis. 10 However, other authors found success in implant placement in a patient with FLCOD in regions where the fibro-osseous lesion was absent. 12 In the region where the lesions were present, the authors indicated rehabilitation with a fixed prosthesis, 12 corroborating the procedure adopted in the present study.…”

“…Due to the COD's avascular characteristics, surgical procedures such as biopsy, extraction, and dental implants should be avoided. 10 COD, especially in the mixed and sclerotic phases, shows a small amount of vascu- larized connective tissue and a large volume of avascular or dense hypovascular osteo-cementoid structures. This tissue can compromise post -surgical repair, directly affecting osseointegration and leading to a greater risk of osteomyelitis.…”

“…Therefore, after the tomographic diagnosis of FLCOD associated with the right maxillary central incisor, it was decided not to perform surgery for dental implant placement due to the risk of developing osteomyelitis and osseointegration failure. 10,12 However, due to the diagnosis of root crack or perforation and incipient periradicular bone rarefaction, extraction and rehabilitation using a removable partial denture was performed.…”

“…9 Elective surgeries, such as implant placement, are contraindicated due to the increased risk of bone infection and osseointegration failure. 10 On the other hand, studies have demonstrated success in dental implant placement in areas close to the fibro-osseous lesion, offering a possibility to patients affected by FLCOD. 10,11 Thus, the present case report aimed to describe the importance of CBCT in the diagnosis of FLCOD and the choice of the appropriate treatment plan for the patient.…”

Conservative Treatment of Chronic Osteomyelitis Associated with Florid Osseous Dysplasia

“…In edentulous patients, while the normal alveolar bone undergoes atrophy the sclerotic masses remain, and local trauma of the tissue-borne dentures can lead to secondary infections of FOD lesions. Additionally, due to the compromised vascularization and plasticity of the cancellous bone, implants osseointegration might be impaired (Sadda & Phelan;Oliveira et al, 2014). Orthodontic treatment may also impair in complications and should be carried with special attention with oral hygiene (Minhas et al, 2008).…”