I would need a dental implant in the upper jaw, but it seems I have an ulcer. What should I do?

Michael Truppe, MD

Dear Sigmund,

Thank you for reaching out with your concerns regarding the potential placement of a dental implant in the presence of an ulcer in your upper jaw. Your situation requires careful consideration, and I will guide you through the process of determining the best course of action.

Step-by-Step Differential Diagnosis and Treatment Advice

1. Broad Differential of Treatment Advices:
   • Conservative Management: This involves monitoring the ulcer with regular follow-ups to assess for any changes in size, shape, or symptoms. It may include topical treatments or systemic medications to manage any discomfort or secondary infection.
   • Biopsy and Histopathological Examination: Given your history of nicotine abuse and previous malignancies, any new ulceration in the oral cavity must be investigated thoroughly to rule out neoplastic processes.
   • Immediate Implant Placement with Caution: This would only be considered if the ulcer is deemed non-suspicious and unrelated to any malignancy or systemic condition that could affect healing or implant success.
2. Reference to Patient Information:
   • Your history of NIKOTIN Abusus and previous oral surgeries for cancerous lesions makes the presence of an ulcer a significant concern. This history increases the likelihood of the ulcer being a pathological lesion rather than a benign issue.
3. Narrowed Differential Based on History:
   • Conservative Management: Less likely to be appropriate given your history of malignancy.
   • Biopsy and Histopathological Examination: Most likely necessary to determine the nature of the ulcer.
   • Immediate Implant Placement with Caution: Least likely to be appropriate without further investigation of the ulcer.
4. Further Reference to Patient Information:
   • The ulcer’s presence in the context of your medical history makes it imperative to prioritize a biopsy and histopathological examination over other treatment options.
5. Most Likely Treatment Advice:
   • Biopsy and Histopathological Examination: This should be the first step to ensure that the ulcer is not malignant. Only after a benign diagnosis can we consider implant placement.
   • Conservative Management: If the biopsy indicates a benign lesion, conservative management may be appropriate, depending on the specific diagnosis.
   • Immediate Implant Placement with Caution: This would only be considered after all other options have been explored and the ulcer has been definitively diagnosed as benign.

Detailed Answer and Proposed Treatment Advices:

Given the complexity of your case, the first and foremost step is to perform a biopsy of the ulcer. This is a minor surgical procedure where a small piece of the ulcerative tissue is removed and sent for histopathological examination. The results will provide crucial information about the nature of the ulcer, whether it is benign, pre-malignant, or malignant.

The literature supports the necessity of biopsy in cases where there is a history of oral cancer and the appearance of new lesions in the oral cavity (Sciubba, J. J., & Goldenberg, D. (2006). Oral cancer: the importance of early diagnosis and treatment. American Journal of Clinical Dermatology, 7(5), 307-318). Given your extensive history of oral cancer and the potential for recurrence, this step cannot be skipped.

If the biopsy results indicate a benign lesion, we can then consider the conservative management of the ulcer. This may involve topical treatments to promote healing, systemic medications if there is an underlying condition contributing to the ulcer, and regular monitoring to ensure that the lesion resolves (Lingen, M. W. (2007). Oral cancer screening and the future of dental practice. The New York State Dental Journal, 73(4), 20-24).

However, if the biopsy reveals any form of malignancy or pre-malignant condition, the treatment plan will shift focus from dental implant placement to addressing the cancer. This could involve further surgical intervention, radiotherapy, or chemotherapy, depending on the stage and extent of the disease (Neville, B. W., & Day, T. A. (2002). Oral cancer and precancerous lesions. CA: a cancer journal for clinicians, 52(4), 195-215).

Only after we have a clear and benign diagnosis, and the ulcer has healed completely, can we consider the placement of a dental implant. The literature suggests that implant success rates are high when proper protocols are followed, including ensuring a disease-free oral environment (Esposito, M., Grusovin, M. G., Maghaireh, H., & Worthington, H. V. (2012). Interventions for replacing missing teeth: different times for loading dental implants. Cochrane Database of Systematic Reviews, (3)).

In conclusion, the presence of an ulcer in your upper jaw necessitates a cautious and methodical approach. The priority is to diagnose the nature of the ulcer through a biopsy. Only after ensuring that the ulcer poses no threat to your health can we proceed with discussions about dental implant placement.

Please feel free to schedule an appointment for further evaluation and to discuss the next steps in your care.

Sincerely,

Michael Truppe, MD
Oral and Maxillofacial Surgeon

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Ordination Dr. Michael Truppe
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Telefon 01 408 95 00 66
Email ordination@smile.wien

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