Pyogenic granuloma associated with dental implant treated with co2 and diode laser: a case report

Introduction: Pyogenic granuloma is a common inflammatory hyperplasia of the oral cavity that usually occurs as a response to different stimulating factors such as local trauma or irritation, iatrogenic and hormonal factors. Gingival reactive lesion like pyogenic granuloma are common lesions in the natural dentition while such lesions in association with dental implants are uncommon. Materials and Methods: A 64 year old male in good general health condition referred to our clinic for a diffuse soft tissue mass around implants located in the regions of the first and second incisors, canine, first and second bicuspids in the right mandible. His dental history showed a right mandible resection for an ameloblastoma affecting premolar-molar region and its immediate reconstruction with iliac bone graft. Seven months after the reconstructive procedure 5 titanium oral implants were inserted in the reconstructed areas. Prosthetic rehabilitation was started 4 months after implant placement. Clinical examination revealed a diffuse exophytic nodular lesion with a smooth, shiny surface located on the vestibular and lingual marginal gingiva around implant supported fixed prosthesis. Lesion was excised under local anesthesia with a CO2 laser (4W, CW) in the vestibular area, and with a diode laser (5W, CW) in the lingual area. The lesion was then submitted for histologic examination. Results: Histopatologic analysis revealed an intense vascular proliferation with extensive areas of ulceration, mixed inflammatory infiltrate and abundant macrophages. The histopathologic diagnosis was pyogenic granuloma. After 1 week, an healthy, pink colored mucosa was observed. Conclusion: Laser excision of pyogenic granulomas is a safe effective and reasonable alternative to conventional therapy, with no postoperative complications or persistent pigmentary changes or scarring. Careful management of the lesion helps to prevent its recurrence, when all causative factors have been removed. Nevertheless, extended follow up is needed because recurrence rate for treated pyogenic granuloma is 16%.