A rare manifestation of dental implant failure associated with sarcoidosis

Sarcoidosis is an uncommon systemic immune-mediated inflammatory disorder associated with noncaseating granulomas, most often in the lungs and less frequently in other visceral sites and the brain, skin, and lymph nodes.

A 43-year-old woman sought evaluation of a painless maxillary premolar implant that exhibited a deep vertical bony defect with reduced trabeculation. The implant was removed and analysis of harvested tissue revealed microscopic evidence of noncaseating granulomatous inflammation in the bone and soft tissue. Subsequent pulmonary assessment was salient for incidental sarcoidosis associated with bilateral enlarged hilar and mediastinal lymphadenopathy and numerous diffuse aggregates. Elevated serum angiotensin-converting enzyme confirmed sarcoidosis. To the authors' knowledge, this report represents the first case of dental implant failure due to sarcoidosis that led to the discovery of pulmonary sarcoid disease.

Surgical removal of a failing dental implant without readily identifiable etiology warrants biopsy and histopathologic review to ascertain causation and rule out underlying systemic involvement, including sarcoidosis.