Surgical and Prosthetic Management of a Peripheral Giant Cell Granuloma Around Dental Implants: A Case Report and Review of the Literature.

A peripheral giant cell granuloma (PGCG) is a benign fibrous connective tissue entity described as a tumor-like hyperplasia that appears on the gingiva and alveolar ridges. Histopathologically, a PGCG is characterized by the presence of multinuclear giant cells and originates from periodontal membrane or periosteal cells. PGCG is considered a reactive lesion resulting from chronic traumatic or irritating factors, such as calculus accumulation, food impaction, or inadequate dental restorations. The purpose of this article is the presentation of a case of PGCG in an edentulous area around dental implants in the mandible of a male patient with no recurrence in a two-year follow-up. A 59-year-old, non-smoking male patient presented to the clinic for evaluation of a tumor-like lesion in the left side of the mandible that had appeared 1.5 months prior to the visit. The medical history consisted of pre-diabetes and hypertension, while his dental history included chronic periodontitis, which had led to the loss of his natural teeth in the infected area and their replacement with implant-supported restoration. Clinical evaluation revealed an asymptomatic, soft-consistency, red/purple tumor-like mass with a broad base, measuring 1.5-2 cm in diameter. The lesion was located on both the buccal and lingual aspects of the alveolar ridge in the mandibular region in positions #34-#35. Radiographic evaluation with periapical radiographs revealed no significant findings. Although implant-related PGCG remains a rare complication in the context of the widespread use of dental implants, its incidence may be underestimated due to underreporting and the common omission of histopathological analysis following excision of peri-implant soft tissue lesions. A possible contributing factor is that peri-implant soft tissue lesions are sometimes excised without being referred for histopathological examination. Since PGCG can be difficult to differentiate from other reactive lesions, such as pyogenic granuloma, histopathological evaluation remains essential. Further studies with larger sample sizes are needed to better understand the etiopathogenesis and optimal treatment strategies for implant-associated PGCG. These findings highlight the importance of increased awareness among clinicians, both in recognizing suspicious peri-implant lesions and in adopting surgical protocols that include complete excision with curettage and histological examination.