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Several cases of elastofibromatous lesion affecting the oral mucosa have been reported. Clinically, these lesions may appear as small exophytic lesions or less often as white lesions. Therefore, fibrous hyperplasia and leukoplakia are not uncommonly considered in clinical differential diagnosis. Microscopically, elastic and fibrous connective tissue deposition is seen. Rarely, elastofibromatous changes can be detected when assessing intraoral lesions, including cysts, salivary gland neoplasms, and epithelial dysplasia. Here we report two oral lesions showing elastofibromatous changes, expanding their clinicopathological spectrum. The first case was a 46‐year‐old man with a history of asymptomatic nodular lesion on the palate 1 year ago, diagnosed as giant cell fibroma with elastofibromatous changes. The second case was a 79‐year‐old woman who presented a pigmented and mildly symptomatic lesion on the mandibular alveolar mucosa several months ago, diagnosed as amalgam tattoo associated with elastofibromatous changes. [ABSTRACT FROM AUTHOR]

Amalgam tattoo is a type of pigmentation that appears in the mouth due to small particles of dental amalgam becoming embedded in the soft tissues. Dental work such as placement or removal of silver fillings is the most common cause of amalgam tattoo, and it is more commonly found in people with a high number of fillings. The tattoo is usually asymptomatic and discovered during routine dental examinations. Treatment is generally not necessary, but if a patient is concerned about the appearance of the tattoo, there are a few options for removal. The histopathological picture of an amalgam tattoo typically shows the presence of small, dark granules or particles of dental amalgam within the soft tissues of the oral cavity. A proper clinical and histopathological evaluation is necessary to accurately diagnose and distinguish an amalgam tattoo from other more serious conditions. The radiographic image of an amalgam tattoo may show a radiopaque object in the soft tissues of the oral cavity. It can occur due to various factors, including dental procedures, trauma, overloading of amalgam fillings, and poor oral hygiene. [ABSTRACT FROM AUTHOR]

Oral pigmented lesions can be physiological or pathological, exogenous or endogenous, as well as focal, multifocal, or diffuse. Among them, the oral melanotic macule (OMM) is a small, well-delimited brown-to-black macule, often affecting the lip and gingiva. Amalgam tattoo (AT) is a grey or black area of discoloration on the oral mucosa as a result of entry of dental amalgam into the soft tissues, commonly gingiva and alveolar ridge. Herein, we present a patient with gingival pigmentation with features of both OMM and AT in the same location. [ABSTRACT FROM AUTHOR]

Objective: Few effective and established treatment methods can remove gingival metal or amalgam tattoos. With this case series, we aimed to demonstrate the use of a novel minimally invasive technique to remove metal tattoos using an erbium‐doped yttrium aluminum garnet (Er:YAG) laser. Materials and Methods: We retrospectively collected clinical data from 18 patients who had undergone Er:YAG laser treatment to remove metal tattoos. Minimal gingival ablation using an Er:YAG laser directed towards the pigmented area was performed, which exposed metal debris within the connective tissue that was carefully removed. A dental microscope was employed to identify the metal debris, for accurate irradiation, and to minimize wounding by reducing invasion. Postoperative gingival color and morphology, and visual analog scale as a patient‐reported outcome assessing postoperative pain were evaluated. Results: All patients' metal tattoos were removed completely and safely during short procedures. Considerable esthetic improvements and favorable wound healing were achieved with almost no postoperative pain or complications. Conclusion: The findings from this case series suggest that this novel minimally invasive therapy for metal tattoo removal that involved the Er:YAG laser is effective and safe, is associated with successful outcomes, and contributes greatly to patients' esthetic satisfaction. Clinical Significance: Metal tattoo removal using an Er:YAG laser safely and successfully improved gingival esthetics. This novel technique is much simpler and less invasive than conventional periodontal plastic surgery, and it may be more reliable regarding esthetic gingival improvements as it is associated with favorable wound healing, and it could offer significant benefits to patients by alleviating physical and mental stresses via reduced chair time and postoperative pain. [ABSTRACT FROM AUTHOR]

Objective: When pigmentations appeared in the esthetic zone and were visible during the patient's smile, they were very disconcerting. There are multiple techniques to eradicate or ameliorate these discolorations. This article will address those pigmentations caused by amalgam particles. Clinical considerations: Keratinized gingival grafts were used to cover and mask these pigmentations. In addition, connective tissue grafts were used to aid in the elimination of the external pigmentation. Conclusions: Both techniques were shown to be very effective in masking or eliminating these unesthetic pigmentations. Long‐term follow‐up has shown these results to be stable with no recurrence of the pigmentation. Clinical significance: Unesthetic pigmentations in the esthetic zone that are visible during a patient's smile are very disconcerting. Elimination of these unesthetic discolorations can make a dramatic improvement in the patient's smile. [ABSTRACT FROM AUTHOR]

Oral melanoacanthoma is an uncommon reactive condition that appears as a solitary pigmented lesion and is most often found on the buccal mucosa. For it to appear in the gingiva is extremely rare—only 11 cases are reported in the literature. This article presents a case of gingival melanoacanthoma and reviews the previously published cases. Because gingival melanoacanthoma shares clinical features with other pigmented lesions with diverse genesis, the differential diagnosis of a solitary pigmented lesion on the gingiva is also discussed. [ABSTRACT FROM AUTHOR]

Abstract: Periodontal health is defined by absence of clinically detectable inflammation. There is a biological level of immune surveillance that is consistent with clinical gingival health and homeostasis. Clinical gingival health may be found in a periodontium that is intact, i.e. without clinical attachment loss or bone loss, and on a reduced periodontium in either a non‐periodontitis patient (e.g. in patients with some form of gingival recession or following crown lengthening surgery) or in a patient with a history of periodontitis who is currently periodontally stable. Clinical gingival health can be restored following treatment of gingivitis and periodontitis. However, the treated and stable periodontitis patient with current gingival health remains at increased risk of recurrent periodontitis, and accordingly, must be closely monitored. Two broad categories of gingival diseases include non‐dental plaque biofilm–induced gingival diseases and dental plaque‐induced gingivitis. Non‐dental plaque biofilm‐induced gingival diseases include a variety of conditions that are not caused by plaque and usually do not resolve following plaque removal. Such lesions may be manifestations of a systemic condition or may be localized to the oral cavity. Dental plaque‐induced gingivitis has a variety of clinical signs and symptoms, and both local predisposing factors and systemic modifying factors can affect its extent, severity, and progression. Dental plaque‐induced gingivitis may arise on an intact periodontium or on a reduced periodontium in either a non‐periodontitis patient or in a currently stable “periodontitis patient” i.e. successfully treated, in whom clinical inflammation has been eliminated (or substantially reduced). A periodontitis patient with gingival inflammation remains a periodontitis patient (Figure 1), and comprehensive risk assessment and management are imperative to ensure early prevention and/or treatment of recurrent/progressive periodontitis. Precision dental medicine defines a patient‐centered approach to care, and therefore, creates differences in the way in which a “case” of gingival health or gingivitis is defined for clinical practice as opposed to epidemiologically in population prevalence surveys. Thus, case definitions of gingival health and gingivitis are presented for both purposes. While gingival health and gingivitis have many clinical features, case definitions are primarily predicated on presence or absence of bleeding on probing. Here we classify gingival health and gingival diseases/conditions, along with a summary table of diagnostic features for defining health and gingivitis in various clinical situations. [ABSTRACT FROM AUTHOR]

Periodontal health is defined by absence of clinically detectable inflammation. There is a biological level of immune surveillance that is consistent with clinical gingival health and homeostasis. Clinical gingival health may be found in a periodontium that is intact, i.e. without clinical attachment loss or bone loss, and on a reduced periodontium in either a non‐periodontitis patient (e.g. in patients with some form of gingival recession or following crown lengthening surgery) or in a patient with a history of periodontitis who is currently periodontally stable. Clinical gingival health can be restored following treatment of gingivitis and periodontitis. However, the treated and stable periodontitis patient with current gingival health remains at increased risk of recurrent periodontitis, and accordingly, must be closely monitored. Two broad categories of gingival diseases include non‐dental plaque biofilm–induced gingival diseases and dental plaque‐induced gingivitis. Non‐dental plaque biofilm‐induced gingival diseases include a variety of conditions that are not caused by plaque and usually do not resolve following plaque removal. Such lesions may be manifestations of a systemic condition or may be localized to the oral cavity. Dental plaque‐induced gingivitis has a variety of clinical signs and symptoms, and both local predisposing factors and systemic modifying factors can affect its extent, severity, and progression. Dental plaque‐induced gingivitis may arise on an intact periodontium or on a reduced periodontium in either a non‐periodontitis patient or in a currently stable "periodontitis patient" i.e. successfully treated, in whom clinical inflammation has been eliminated (or substantially reduced). A periodontitis patient with gingival inflammation remains a periodontitis patient (Figure 1), and comprehensive risk assessment and management are imperative to ensure early prevention and/or treatment of recurrent/progressive periodontitis. Precision dental medicine defines a patient‐centered approach to care, and therefore, creates differences in the way in which a "case" of gingival health or gingivitis is defined for clinical practice as opposed to epidemiologically in population prevalence surveys. Thus, case definitions of gingival health and gingivitis are presented for both purposes. While gingival health and gingivitis have many clinical features, case definitions are primarily predicated on presence or absence of bleeding on probing. Here we classify gingival health and gingival diseases/conditions, along with a summary table of diagnostic features for defining health and gingivitis in various clinical situations. [ABSTRACT FROM AUTHOR]

The majority of oral pigmentations are benign lesions such as nevi, melanotic macules, melanoacanthomas or amalgam tattoos. Conversely, mucosal melanomas are rare but often lethal; therefore, excluding oral melanomas in this setting is crucial. Reflectance confocal microscopy is a non-invasive in vivo imaging system with cellular resolution that has been used to distinguish benign from malignant pigmented lesions in the skin and more recently in the mucosae. However, lesions located posteriorly in the oral cavity are difficult to visually assess and biopsy due to their location. Herein we present a patient with multiple previous melanomas presenting with an oral amalgam tattoo in the buccal mucosa which was imaged using an intraoral telescopic probe attached to a commercially-available handheld RCM. In this case report we describe this novel probe, the first RCM description of an amalgam tattoo and we discuss its differences with the findings described in oral melanomas.

The case report describes an amalgam tattoo, a benign lesion in oral mucosa of iatrogenic nature but mimetic to other suspected pigmentary lesions. A 49 years-old white female patient, total edentulous for more than 15 years, had complaint of a lump in the mouth and too much disconfort in a lower alveolar ridge region when using a removable prosthesis. Clinical and radiographic examination revealed a smooth surfasse nodule, central purplish color, 10mm in diameter, fibrous consistency and presence of radiopaque metallic fragment. Surgical treatment of the lesion was performed by excisional biopsy. Histopathological examination confirmed the diagnostic hypothesis of amalgam tattoo with intense fibrosis. This case contribute to the stomatological practice with the discussion of the histopathological findings of old lesions which are not usuallly biopsied in clinical routine, and the semiologic and surgical management of the patients. [ABSTRACT FROM AUTHOR]

Introduction: An amalgam tattoo is the most common form of exogenous oral pigmentation caused by the diffusion of dental amalgam into the soft tissue. Observation: Here we describe a case of diffuse pigmentation of amalgam on the hard palate. Discussion: Mucosal hyperpigmentation can occasionally be confused with melanotic lesions, thereby requiring a biopsy for differential diagnosis. Once the diagnosis of an amalgam tattoo has been established, the removal of the lesion is not necessary, except for aesthetic reasons.

Solitary pigmented lesions are uncommon in the oral mucosa. A review of the literature reveals no information regarding the relative frequency of these lesions. The purpose of this study is to determine the relative prevalence of solitary oral pigmented lesions in a selected population of patients. This study includes 265 consecutive patients who accessed the dermatology out-patients’ surgery of the Department of Dermatology, University of Florence between March 2006 and July 2007. The sample we studied presented 5.7% of oral pigmented lesions; the most frequent being vascular lesions. Despite the various methods used, the differential diagnosis for these particular lesions is not always easy. There is some difficulty in distinguishing between a benign pigmented lesion and a growing melanoma which, though rare (1% of all oral malignancies), is a serious and often fatal disease. Therefore, biopsy with histological exam represents the diagnostic gold standard. [ABSTRACT FROM AUTHOR]

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Background: A 56-year-old female presented for periodontal treatment with a large amalgam tattoo located in alveolar mucosa on the facial aspect of her maxillary central incisors. The lesion had been present for 42 years since having endodontic surgery at teeth #8 and #9 after a traumatic childhood incident. Methods: A two-stage surgical approach was used to eliminate the lesion, beginning with a subepithelial connective tissue graft to increase tissue thickness subjacent to the amalgam tattoo. After 6 weeks of healing, the overlying pigmented tissue was removed using laser surgery to expose the underlying grafted connective tissue. Results: After 2 months of healing following laser surgery, the amalgam pigmentation was completely removed, with good color match and an increased width of keratinized tissue at the surgical site. Conclusion: A relatively large amalgam tattoo in the esthetic zone can be adequately removed by a two-stage procedure using grafted palatal connective tissue and laser deepithelialization. [ABSTRACT FROM AUTHOR]

Copyright of HNO is the property of Springer Nature and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Background: Malignant melanoma is rare in the oral cavity and accounts for less than 1% of all melanomas. Nevertheless, the disease can be fatal, and early diagnosis and treatment may improve prognosis dramatically. The purpose of this paper is to report 3 new cases of primary malignant melanoma of the oral cavity arising in the gingiva, and to review the literature regarding intraoral melanoma. Methods: Three cases are presented. One case was m the right mandibular molar area; the second in the right maxillary canine-premolar area; and the third In the left mandibular canine-premolar region. All patients were treated surgically, with postoperative radiotherapy. Results: The first patient lived for 2 years and the second for 3 years before distant metastases were diagnosed from which they subsequently died. The third patient was lost from follow-up after 18 months. Conclusion: Primary oral malignant melanoma is a deadly disease. Early suspicion of this disease will allow prompt treatment and increase the prognosis for these patients. [ABSTRACT FROM AUTHOR]

Amalgam tattoo is bluish black or grayish discoloration of mucosa due to impingement of silver amalgam in soft tissue during dental procedures. In modern era, with development of newer biocompatible materials, amalgam tattoo is a rare entity. In case report we wantto present acase of amalgam tattoo arising due to retrograde filling of amalgam in a 45-year-old female patient. [ABSTRACT FROM AUTHOR]