Lichenoid Contact Stomatitis Associated with Titanium Dental Implants

Introduction & Objectives: Lichenoid contact stomatitis is a chronic inflammatory disease and it is specifically associated with both allergy and exposure to intra-oral dental metals. Materials & Methods: We describe a 54-year-old woman with progressive periodontitis in whom lichenoid mucositis, atypical facial pain, burning mouth syndrome, apparent periorbicular-paranasal soft tissue ischemia, metabolic alkalosis, and bilateral polyneuropathy developed after fixation of maxillary palladium-silver dental bridge attached to commercially pure titanium dental implants. She was patch-tested with dental series, she had a positive patch test to nickel and cobalt. Oral swab for Candida was negative. In the past, she had had Graves' disease, she was successfully treated by radioactive iodine. Results: In December 2010, soon after she had received a fixed framework of 12 cast unnoble (palladium-silver alloy) dental ceramic crowns, severe facial pain developed. Pain, itching, and burning symptoms were localized mainly to the her incisive papilla and 1.1 alveolar ridge area, and spreading up her nose and forehead. Patient decide to remove her titanium implants. A biopsy of gingival area over the titanium implant (1.1 area) was performed. Examination of the sections from the biopsy revealed findings consistent with the presence of lichenoid mucositis. Conclusion: The healing of lichenoid contact stomatitis was achieved after the removal of titanium dental implant. The complete remission of lichenoid lesion was confirmed microscopically through an additional mucosal biopsy in the same area as the previous biopsy. After titanium dental implant removal, even the atypical facial pain improved modestly in time. To the best of our knowledge, this is the first recorded case of lichenoid contact stomatitis caused by titanium dental implant associated with atypical facial pain.