A routine follow-up on a maxillary premolar implant has led to an unexpected medical discovery, highlighting how oral findings can sometimes unveil deeper systemic disease. A recently published case report documents what appears to be the first instance of dental implant failure revealing previously undiagnosed pulmonary sarcoidosis.
The case involves a 43-year-old woman who presented with mild recession and a small ulceration around an otherwise painless maxillary implant. Radiographs showed sparsely trabeculated bone and a severe vertical defect along the distal implant surface, disproportionate to the clinical presentation, and the absence of the usual risk factors for peri-implantitis. The implant was removed, and tissue samples were submitted for histopathologic examination.
Microscopy revealed well-organized noncaseating granulomas with epithelioid histiocytes and Langhans-type multinucleated giant cells. Special stains ruled out fungal and mycobacterial infections, and immunohistochemistry showed strong CD68 positivity, supporting a granulomatous inflammatory process. With no evidence of Crohn’s disease or orofacial granulomatosis, the findings raised suspicion of systemic sarcoidosis.
A subsequent chest CT—performed purely because of the oral pathology—identified bilateral hilar and mediastinal lymphadenopathy with multiple patchy nodular densities throughout both lungs. Elevated serum angiotensin-converting enzyme levels confirmed a diagnosis of pulmonary sarcoidosis, discovered incidentally through a failing dental implant.
Follow-up maxillofacial imaging over the next year noted progressive osseous involvement across the left maxilla, extending from teeth 10 through 14, with cortical erosion and loss of lamina dura. Despite the severity of maxillary disease, the patient remained asymptomatic from a respiratory perspective and is currently under pulmonology and rheumatology surveillance.
Sarcoidosis involving the jaws is rare and frequently accompanies established systemic disease rather than precedes it. Even fewer reports exist where dental implants acted as the first clue to an underlying granulomatous disorder. This case therefore, underscores a crucial clinical takeaway: when peri-implant bone loss lacks a clear etiology, biopsy is not optional—it is essential. Several conditions, including malignancies, granulomatous disease, and systemic immune disorders, can mimic peri-implantitis radiographically and clinically.
Current literature identifies only one previously documented instance of implant loss attributed to mandibular sarcoidosis. This new report contributes a second case—and the first in which implant failure directly led to diagnosing occult pulmonary involvement. With implant therapy now ubiquitous, such unexpected systemic revelations may become more apparent if clinicians maintain a low threshold for suspicion.
Although the long-term prognosis for implant placement in a sarcoid-affected jaw remains unclear, the authors emphasize the need for heightened vigilance and thorough histopathologic evaluation whenever bone loss appears atypical or disproportionate to local factors.
Source: National Library of Medicine
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