Page 29 - GP Fall 2020

Treatment of Drug-Induced Gingival Hyperplasia Around Full
Maxillary and Mandibular Screw-Retained Fixed Prostheses Over

Titanium Dental Implants: A Clinical Case Report

By Raid Sadda DDS, MS, MFDRCSI and Aram R. Sadda, DDS, MS

Abstract of OM-HCTZ include dizziness, diarrhea,
Drug-induced gingival hyperplasia is a stomach pain, joint pain and dry cough.
known side effect caused by several med- Gingival hyperplasia associated with nat-
ications and is a physiologic response to a ural dentition occurs in 0.0497 percent of
variety of local and systemic conditions. patients taking OM-HCTZ, but has not been
Gingival overgrowth around natural teeth reported as a side effect around dental im-
has been previously reported in the litera- plants secondary to its use.
ture with patients taking calcium channel
blockers (CCBs), anticonvulsants and im- Case Report
munosuppressants, but has not been docu- Figure 1. Eight external hex titanium implants A 55-year-old woman was treated with max-
mented with angiotensin II receptor block- paced in the maxillary arch. illary and mandibular fixed titanium implant
ers (ARBs) as a significant cause. CCBs, supported prostheses. Seven endosseous ti-
as a group, have been implicated as an tanium external hex implants were placed to
etiologic factor for drug-induced gingival support a screw retained mandibular pros-
enlargement. This enlargement can be lo- thesis. Four weeks later, eight implants of
calized or generalized and can range from the same brand were placed to support a
mild to extremely severe, affecting patient’s screw retained maxillary prosthesis (Figure
esthetics and function. However, there has 1 and 2) The patient was satisfied with the
not been any documented case of gingival appearance and function of the restorations
hyperplasia secondary to angiotensin II re- and was placed on periodic six month recall
ceptor blockers. This case report describes Figure 2. Panoramic x-ray revealed visits.
the development and treatment of gingival endosseous titanium external hex implants
hyperplasia around dental implants in a pa- of the maxilla and mandible. Approximately ten years following the com-
tient taking a combination of hydrochloro- pletion of her implant prosthesis, the patient
thiazide and angiotensin II receptor blocker implicated culprit in drug-induced gingival was diagnosed with hypertension and was
3
one year after the insertion of fixed maxil- hyperplasia. As for amlodipine, the prev- prescribed amlodipine by her physician.
lary and mandibular prostheses. alence is significantly lower than that of Despite dose adjustments, the patient did
nifedipine. Drug-induced gingival enlarge- not have proper blood pressure control, so
Key words: Peri-implant gingival hyper- ment could be detected clinically as early her cardiologist began treating her hyperten-
plasia, angiotensin II receptor blocker, cal- as one to three months following the initial sion with OM-HCTZ. The patient returned
cium channel blocker dose of a calcium channel blocker. for implant and prosthesis re-evaluation
one year after having taken OM-HCTZ. On
Literature Review Among hypertensive medications, ARBs clinical exam, the patient was found to have
Gingival hyperplasia is one of the side ef- have not been documented as a cause for gingival enlargement, which was general-
fects associated with the administration of gingival hyperplasia in regards to peri-im- ized and presented as firm nodular enlarge-
several medications such as anticonvul- plant tissues. Thiazide diuretics also do ment of the interdental papilla and gingival
sants (phenytoin), CCBs (nifedipine), and not typically play a role in the development margins. It was greater in the anterior area
immunosuppressants (cyclosporine). The of peri-implant hyperplastic gingiva. One and more pronounced on the buccal than
Fig.7 – Ten
years after
mechanism by which any of the above men- agent, olmesartan medoxomil-hydrochlo- lingual surfaces. A full mouth radiograph-
4
insertion of
tioned medications induce the formation of rothiazide (OM-HCTZ), is a combination ic series revealed no active bone resorption
prostheses.
hyperplastic gingiva is not well understood of an angiotensin II receptor antagonist and around the dental implants (Figure 3). To
and may be distinct for each drug; however, a thiazide diuretic. Common side effects rule out pathology, an incisional biopsy of
the clinical features of gingival enlargement
that are observed with these medications
are similar. It is well documented that the
periodontium around natural teeth and den-
tal implants are similar and, therefore, will
react to both local and systemic factors in a
similar way. Interestingly, not all patients Figure 3. Ten years
1
taking these medications, together or sep- after insertion of
arately, develop gingival enlargement, and prostheses.
the reason is not well understood.
2
Not all hypertensive medications are known
to cause gingival hyperplasia. Among
CCBs, nifedipine is the most frequently !
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