Prosthetic Rehabilitation of a Patient Diagnosed With Sarcoidosis Using Dental Implants: A Clinical Case Report
No previously published studies have reported on the placement and restoration of dental implants in a patient diagnosed with sarcoidosis. Patients with sarcoidosis may develop periodontitis as a manifestation of systemic disease and are therefore at increased risk of tooth loss. These patients are likely to want fixed dental prostheses, which may need to be supported by dental implants. The case presented is that of a 31-year-old female patient presenting with a missing maxillary central incisor and a sarcoidal process affecting the anterior maxilla, which had severely compromised the periodontium of the adjacent lateral incisor. The patient was successfully rehabilitated with an implant-retained prosthesis following a staged horizontal and vertical bone augmentation procedure. At the 4-year review, the implant restoration performed well with stable peri-implant bone levels. We conclude that dental implant rehabilitation in patients with sarcoidosis may be a predictable treatment option, depending on disease stability and concurrent systemic therapy, but these patients will require additional maintenance because of the possibility of an increased risk of peri-implantitis. The effects of sarcoidosis and its management on the success of dental implants are discussed to aid treatment planning for such patients.
Figure 1. At presentation. (a) Without prosthesis. (b). With prosthesis. (c) Horizontal bone deficiency. (d) Vertical bone deficiency. Figure 2. Preoperative periapical radiographs. (a, b) Ill-defined radiolucency in the anterior maxilla and almost 100% bone loss around tooth No. 10. Figure 3. Preoperative orthopantograph. Figure 4. Preoperative cone-beam computerized tomography with a radiographic stent in situ showing an osteolytic area consistent with intraosseous sarcoidosis. (a) Coronal slice. (b) Axial slice. (c) Sagittal slice though No. 21 position. (d) Sagittal slice though No. 10 region. Figure 5. Temporization. A metal-ceramic fixed resin-bonded dental prosthesis replacing teeth Nos. 9 and 10 following extraction of tooth No. 10; pink porcelain is replacing the missing hard and soft tissues.
Figure 6. Hard-tissue augmentation. (a) Muco-periosteal flap raised showing extensive vertical and horizontal bone resorption. (b) Vertical limits identified as interproximal alveolar crests. (c) Prepared allograft. (d) Stabilization with bone fixation screws. (e) Placement of porcine collagen matrix and membrane. (f) Primary closure. Figure 7. Flap dehiscence. (a) Two weeks postoperation. (b) Four weeks postoperation.
Figure 8. Preimplant cone-beam computerized tomography (CBCT) demonstrating an increase in the volume of the alveolar ridge 6 months after staged augmentation. Because of the metal artifact from the bone screws, it was not possible to reliably measure the bone width. Incidentally, bone trabeculation now looks normal in comparison with the preoperative CBCT or periapical radiographs. (a–c) Axial slices. (d–f) Coronal slices. Figure 9. Digital implant planning with 4.1-mm diameter implant for tooth No. 9 and 3.3-mm for tooth No. 10 using CBCT taken 2 weeks before implant placement. (a) Sagittal slices with implant planning overlay at site No. 9. (b) Coronal slice with implant planning overlay for sites No. 9 and 10. (c) Axial slice with implant planning overlay for sites No. 9 and 10. (d) Sagittal slices with implant planning overlay at site No. 10. (e) Orthopantomograph view with implant planning overlay. (f) Three-dimensional reconstruction with implant planning overlay.
Figure 10. Implant placement. (a) Preoperative view. (b) Healed bone graft prior to removal of fixation screws with both vertical and horizontal resorption. (c) Implant placement in an ideal buccopalatal position. (d) Fenestration and dehiscence around the implants. (e) Placement of particulate bone xenograft. (f) Placement of collagen matrix. Figure 11. Immediate postoperative radiograph showing good angulation and height 1 mm below the alveolar crest. Figure 12. Apically repositioned flap 3 months after implant placement. (a) Preoperative view. (b) Incision. (c) Partial-thickness flap. (d) Placement of allograft, which was stabilized with sutures but left completely exposed.
Figure 13. Second-stage implant surgery 18 months after implant placement. (a) Split-thickness flap raised. (b) Implants exposed. (c) Tall healing abutments placed. (d) Closure. Figure 14. Provisionalization. (a) Initial provisional crowns. (b) Modifications to the provisional crowns and improved gingival contouring after 3 months. (c, d) Final modifications to the provisional crowns and gingival contouring after 6 months. Figure 15. Periapical radiograph during provisionalization, 3 months after implant placement. Note the well-fitting provisional crowns and bone remodeling at the implant-abutment junction.
Figure 16. Definitive restorations placed 6 months after implant exposure. (a, b) Final esthetic result. (c) Pink porcelain was used to replace the lost interdental papilla. (d) Occlusal view. Figure 17. Periapical radiograph at the fitting of the definitive restoration placed 6 months after implant exposure. Note the well-fitting linked definitive crowns and no loss in bone height. Figure 18. Periapical radiograph taken 15 months following the fitting of the definitive restorations and 3 years after implant placement.
Contributor Notes