Editorial Type:
Article Category: Case Report
 | 
Online Publication Date: 05 Apr 2024

Peri-Implant Mucosal Fenestration and Histologic Observation of Bone Xenograft Material 7-Years After Implant Installation: A Case Report

BDS, MSc,
BDS, MSc, and
BDS, MSc, PhD
Page Range: 18 – 23
DOI: 10.1563/aaid-joi-D-23-00038
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Bone augmentation is often required before the installation of dental implants. Here, we report a case for a patient who previously received bone augmentation at the upper right jaw using a xenogenic graft, followed by successful implant installation. Seven years later, the patient presented with mucosal fenestration with bone exposure at the area and gave a history of a recent diagnosis of cutaneous lichen planus. Several attempts were made to manage the situation, and finally, we resorted to connective tissue graft placement at the site. A piece of bone was sent for histologic evaluation, where the results indicated the presence of un-resorbed graft material surrounded by inflammatory cells, with no evidence of bone formation in the area. The case presents histologic evidence for the lack of new bone formation using xenograft over the evaluation period. The case also shows lichen planus, a possible cause for oral complication for patients undergoing augmentation and implant installation.

Figure 1.
Figure 1.

Pre-operative presentation: (a) the upper arch and (b) the right side.


Figure 2.
Figure 2.

Guided bone regeneration (GBR) using xenogenic graft adapted to the ridge (a) and collagen membrane (b). Suture removal after 2 weeks revealed small membrane exposure (c).


Figure 3.
Figure 3.

Surgical installation of dental implants at #14 and #13.


Figure 4.
Figure 4.

Mucosal fenestration. (a) Initial presentation during 2016–2017, (b and c) fenestration increased in size, (d) attempt for non-invasive management, (e) radiographic examination presenting normal bone level.


Figure 5.
Figure 5.

The final result after connective tissue graft. The mucosal fenestration had disappeared, small recession is present.


Figure 6.
Figure 6.

(a) Histopathology of infected bone graft material showing lack of new bone formation. Signs of infection of bone graft material: (b) neutrophils infiltrating bone graft material; (c) bacterial clumps invading bone graft material.


Contributor Notes

Corresponding author, e-mail: Dr-Ajlan2006@hotmail.com
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