Abstract
A 78-year-old woman presented at our clinic with a 6-year history of discomfort in the gums. An implant had been placed in the affected region four years before, and the pain had increased in the last 2 months. Intraoral examination revealed a white, fibroelastic, pedicle lesion, 4 cm in diameter, on the marginal and attached gingiva and at the bottom of buccal grooves 35 and 36. Radiographic examination showed two implants in the region. Suspecting pyogenic granuloma and peripheral giant cell lesion, we performed an incisional biopsy. Histopathologic examination of the biopsied tissue revealed chronic ulcer with extensive granulation tissue formation and fibrous hyperplasia. Eight days postoperatively, 80% of the lesion had regressed and 30 days postoperatively, it had healed completely without any treatment. After 6 years of follow-up, she returned with the same complaint and with a lesion with similar clinical characteristics. She was being treated for chronic atrial fibrillation with daily doses of warfarin. Again, an incisional biopsy was performed. The AP showed extensive granulation tissue associated with ulceration. The lesion was removed completely by bone curettage. The buccal and lingual lesions were removed by intense scraping of the implants. After 8 days, the lesion had not healed. Finally, pyogenic granuloma was diagnosed.
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