Calcium channel blocker induced gingival enlargement following implant placement in a fibula free flap reconstruction of the mandible: a case report

Arijit Ray-Chaudhuri,Henry Quach

doi:10.1186/s40729-020-00242-6

Arijit Ray-Chaudhuri, Henry Quach

Open Access

https://doi.org/10.1186/s40729-020-00242-6

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Abstract

BackgroundGingival tissue enlargement is a common side effect of antiepileptic medications (e.g. phenytoin and sodium valproate), immunosuppressing drugs (e.g. cyclosporine) and calcium channel blockers (e.g. nifedipine, verapamil, amlodipine) (Murakami et al. 2018, Clin Periodontol 45:S17–S27, 2018). The clinical and histological appearances of lesions caused by these drugs are indistinguishable from one another (Murakami et al. 2018, Clin Periodontol 45:S17–S27, 2018). Drug-induced gingival enlargement is rarely seen in edentulous patients.Case presentationThis case presents a 72-year-old female with a history of squamous cell carcinoma of the floor of the mouth treated with surgical excision and fibula-free flap reconstruction. Following the uncovering of osseointegrated implants placed in the fibular-free flap, the patient developed gingival enlargement of the floor of the mouth. Cessation of amlodipine and switching to an alternative medication lead to a resolution of the enlarged tissue.ConclusionsThis case illustrates that gingival enlargement can occur around dental implants, most notably in rehabilitation cases in patients who have had head and neck cancer. Clinicians should be aware of the risk of gingival enlargement in hypertensive patients taking calcium channel blockers prior to implant placement.

Highlights

ConclusionsThis case illustrates that gingival enlargement can occur around dental implants, most notably in rehabilitation cases in patients who have had head and neck cancer
Gingival tissue enlargement is a common side effect of antiepileptic medications, immunosuppressing drugs and calcium channel blockers (Murakami et al 2018, Clin Periodontol 45:S17–S27, 2018)
Drug-induced gingival enlargement around natural teeth in patients on calcium channel blocker (CCB) therapy is widely reported in the literature, but fewer reports exist for effects of CCBs on the gingivae around dental implants

Summary

Conclusions

CCB-induced gingival enlargement is a rare presentation in edentulous patients and can be triggered by placement of dental implants to allow for oral rehabilitation or their exposure. This potential complication may be overlooked by dentists and surgeons when informing patients of potential risks. Clinicians should be aware of the presentation of this condition and its management through cessation of the CCB and non-surgical or surgical periodontal treatment if indicated

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