Journal of Oral Implantology April 2013 - (Page 206)

CASE REPORT Implant Failure Associated With Actinomycosis in a Medically Compromised Patient Chun-Xiao Sun, DMD, PhD, MS, MSD* Jeffrey M. Henkin, DDS, MS Craig Ririe, DDS, MS Elham Javadi, DDS Oral actinomycosis is not a common disease, but it can cause massive destruction. This article reports a case of implant failure associated with actinomycosis. A 55-year-old Caucasian male patient had tooth #20 extracted years ago and an implant placed 3 years ago. The #20 implant area developed an abscess about 1½ years after implant placement. Radiographic findings revealed a large radiolucency on the mesial aspect of the #20 implant. The implant was surgically removed and the lesion thoroughly debrided. The patient experienced severe pain when the apical soft tissue was curreted following implant removal. A periapical radiograph revealed that the lesion approached the mental foramen. A short course of antibiotics was prescribed. Histological observation found sulfur granules, which were found to be actinomycotic colonies. Peri-implant actinomycosis was diagnosed. No recurrence had occurred at the 1-year follow-up. Key Words: dental implant, implant failure, actinomycosis, case report INTRODUCTION A ctinomycosis is a chronic infectious disease characterized by abscess formation, tissue fibrosis, and draining sinuses.1 It is caused by gram-positive Actinomyces species, which have the morphological appearance of a fungus and occurs rarely in humans but more frequently in cattle as a disease called lumpy jaw.2 The intertwining bacterial filamentous colonies are called ‘‘sulfur granules’’ because they appear as yellowish specks. The colonies are made of radiating filaments and have a starburst appearance. Because of this appearance, these colonies are often referred to as ‘‘ray fungus.’’2 Actinomycosis is considered to be of low pathogenicity, causing disease only at the site of a previous tissue injury, typically following dental treatment.3 It has been reported that men 20 to 60 years of age are more susceptible to this infection. Department of Periodontics, Loma Linda University School of Dentistry, Loma Linda, Calif. * Corresponding author, e-mail: DOI: 10.1563/AAID-JOI-D-11-00028 206 Vol. XXXIX /No. Two / 2013 The occurrence of this infection is 4 times more prevalent in men than in women.4 Actinomycosis could involve cervicofacial, pulmonary or pulmothoracic, or abdominal-pelvic regions.5 Fifty-five percent of actinomycosis infections occur in the cervicofacial region.1 Although Actinomyces is part of the normal oral bacterial flora, cervicofacial actinomycosis is not a common infection. Predisposing factors include both systemic and local factors. Systemic factors are immunoincompetence, malignancy, or diabetes. Local factors could be tissue or bone trauma, poor oral hygiene, and deep caries.1 Most cervicofacial actinomycoses are of odontogenic origin. They may result from dental treatment, trauma, or poor oral hygiene,1 although non-odontogenic origin cases have been reported recently.5 The most common pathogenic species isolated from humans is Actinomyces israelii.6,7A israelii has been isolated from tonsils, dental plaque, periodontal pockets, and carious lesions. It also has been detected in stable orthodontic mini-implants but rarely found in failed implants.8Actinomyces odontolyticus was the far most prominent Actinomyces

Table of Contents for the Digital Edition of Journal of Oral Implantology April 2013

Evidence-Based Practice or Practice-Based Evidence?
Evaluation of Optimal Taper of Immediately Loaded Wide-Diameter Implants: A Finite Element Analysis
A Prospective, Randomized Controlled Preclinical Trial to Evaluate Different Formulations of Biphasic Calcium Phosphate in Combination With a Hydroxyapatite Collagen Membrane to Reconstruct Deficient Alveolar Ridges
Retention of Implant-Supported Overdenture With Bar/Clip and Stud Attachment Designs
The Clinical and Histologic Outcome of Dental Implant in Large Ridge Defect Regenerated With Alloplast: A Randomized Controlled Preclinical Trial
Fluoride-Treated Bio-Resorbable Synthetic Hydroxyapatite Promotes Proliferation and Differentiation of Human Osteoblastic MG-63 Cells
Resonance Frequency Analysis of 208 Straumann Dental Implants During the Healing Period
A Simplified Technique for Solving the Transfer Problem of Implant-Supported Fixed Partial Dentures for Patients With Microstomia
Esthetic Evaluation of Single-Tooth Morse Taper Connection Implants Placed in Fresh Extraction Sockets or Healed Sites
A Technique for Improving the Retention of Dentures Retained by Ramus Frame Implants
Treatment of Congenitally Missing Maxillary Lateral Incisors: An Interdisciplinary Approach
Use of Titanium Mesh in Lieu of a Fixation Screw to Stabilize an Autogenous Block Graft: A Case Report
A Novel Approach to Preserve the Buccal Wall in Immediate Implant Cases: A Clinical Report
Implant Failure Associated With Actinomycosis in a Medically Compromised Patient
Replacement of Mandibular Posterior Teeth With Implants in a Postmandibular Resection Case: A Case Report
Zygomatic Implants/Fixture: A Systematic Review
An Overview of Immediate Root Analogue Zirconia Implants
Letter to the Editor
Reviews of Current Literature

Journal of Oral Implantology April 2013