Implants · patient case question
She asks about implants to replace #19 and #20. What is the principal risk of placing implants into this bone?
Patient case: “I need some teeth here”
Patient: Female, 45 years old
Chief Complaint: “I need some teeth here.”
Background: Healthy, no medications, non-smoker. Teeth #19 and #20 were extracted more than ten years ago and never replaced. She has no pain and has never noticed a swelling.
Vital Signs: BP 118/76 mmHg · HR 70 bpm
Findings: The posterior left mandibular ridge is edentulous, firm and of normal contour with no expansion. In that edentulous bone the panoramic radiograph shows a well-defined lesion roughly 1.5 cm across, mixed radiolucent and radiopaque, with a thin radiolucent rim. The adjacent teeth are caries-free and respond normally to cold. The lesion was not present on a radiograph she brought from another office some years ago in the same location, which showed a lucency there.
Show answer and explanation
Correct answer: A. Osteomyelitis
- A. CORRECT. Dysplastic cemento-osseous tissue is HYPOVASCULAR and relatively acellular. Any surgical entry — an implant osteotomy, an extraction, even a biopsy — introduces bacteria into tissue that cannot mount a normal vascular and inflammatory response, so infection is poorly cleared. The recognised consequence is a chronic, painful OSTEOMYELITIS with sequestration and a non-healing defect. That same reasoning is why biopsy of a radiographically classic lesion is contraindicated, and why the diagnosis is made on imaging and clinical stability alone.
- B. Cemento-osseous dysplasia is a reactive, self-limiting condition. Malignant transformation is not part of its recognised behaviour.
- C. Osseointegration is precisely what an implant is designed to achieve, so ‘ankylosis’ is not a complication of implant placement. The term belongs to natural teeth fused to bone with a lost periodontal ligament.
- D. A dentigerous cyst forms around the crown of an UNERUPTED tooth. There is no unerupted tooth in this site.