The Uncommon Occurrence of Squamous Cell Carcinoma Adjacent to Dental Implant: A Clinical Case Report.

relato de caso clínico

Abstract

Introduction: Among head and neck tumors, oral squamous cell carcinoma (OSCC) is the most common malignant pathology. This cancer primarily affects men over 50 years of age, particularly those who are smokers and alcoholics.¹ Regarding the location of oral OSCC, the tongue is the region that presents the highest recurrence.² Additionally, there is a significant predilection for the floor of the mouth, lip, and retromolar area.³ Genetic predisposition and harmful habits increase the risk of oral cancer, along with other factors such as sun exposure, HPV, poor diet, immunosuppression, poor oral hygiene, and chronic inflammation.¹,³ Contact with metallic dental materials, such as dental implants, is also being studied for their mutagenic potential due to the release of ions in the oral cavity.¹ In addition to the classical clinical features, OSCC can manifest as erythema and/or ulceration of soft tissues resembling peri-implantitis (PI) or peri-implant mucositis (PMI), hypertrophy, and granular hyperplastic changes.¹ It is known that most oral cancers have their initial manifestations in an asymptomatic form, and many individuals do not have the habit of undergoing preventive dental examinations. Therefore, in most cases, the diagnosis occurs when the disease has already reached an advanced stage. In this context, the aim of the present study is to present a clinical case of an uncommon occurrence of squamous cell carcinoma adjacent to a dental implant.

Case Description: A 53-year-old female patient, with fair complexion, was referred to the Stomatology Clinic of the Federal University of Vales do Jequitinhonha and Mucuri for evaluation of a lesion on the left vestibular mucosa (gum) in the region of teeth 35 and 36, where two dental implants had been installed three months prior. During the anamnesis, when inquiring about the family history, a condition of controlled hyperthyroidism was noted, and no alterations beyond normality were detected during the extraoral examination. In the intraoral examination, an ulcerated and painful lesion was identified on palpation, along with the presence of bilateral white streaks and spots on the buccal mucosa. The main diagnostic hypothesis was peri-implantitis. Consequently, a Betamethasone Elixir mouthwash was prescribed, and a request was made for the removal of the implant crowns. After seven days, a noticeable improvement was observed. However, after 30 days, the lesion was still present, with complaints of burning in the affected area and the presence of candidiasis. Furthermore, it was identified that the submandibular lymph node was tender on palpation. Consequently, excisional biopsy was planned in the region, and complementary tests were requested (TSH: 14.01 microUI/ml).

Results: The histopathological analysis performed after the excisional biopsy was consistent with squamous cell carcinoma. The microscopic examination revealed malignant neoplasia originating from the squamous cell layer of the lining epithelium of the oral mucosa, with proliferating cells invading the adjacent tissues. Corneal pearls were present on the surface, and in the deeper tissue planes, small neoplastic nests without keratinization were identified. The neoplastic cells exhibited cellular and nuclear pleomorphism. The fibrous connective tissue stroma was permeated by a chronic mononuclear inflammatory infiltrate. The patient was referred for oncological treatment and is under observation without signs of recurrence.

Final Considerations: This case highlights an OSCC in an unusual location in the gum near dental implants, emphasizing that cancer can mimic a traumatic and/or inflammatory lesion. Monitoring and performing biopsies for the definition of malignant oral lesions, even in areas with lower prevalence, are essential.