Oral Cancer Masquerading as Peri-Implantitis
Dr. Christopher
By: Lourdes Ann Christopher, DDS, MS, Academy News Consultant
In October of 2024, one of my referring doctors referred an implant patient back to me for evaluation and treatment. Our mutual patient had experienced oral and facial swelling of the right vestibule buccal of tooth No. 29 and a recently restored implant, No. 30i, for a period of one month. Because of fear of being told she might have to have another tooth removed, she sought care from an ENT instead of returning to either her general dentist or me, her periodontist. She had been on antibiotics for the entire month, to no avail. Her right cheek remained swollen.
I removed the now-hopeless tooth No. 29 and thoroughly debrided the extraction socket. A CBCT scan and visual examination of the bone surrounding implant No. 30 revealed no bone loss; however, there was so much erythema and cellulitis in the area that the true status
of 30i was impossible to determine. At the two-week postoperative visit, there was no appreciable improvement in swelling or cellulitis. At this point, the patient was immediately referred for biopsy and, within days, was diagnosed with squamous cell carcinoma. Tragically, we lost the patient within six months.
Oral squamous cell carcinoma (OSCC) and other oral malignancies can present with clinical features similar to peri-implantitis, including symptoms such as inflammation, swelling, and bone loss around the implant site (Verstraeten et al., 2023; Srinivasan et al., 2025). A meta-analysis revealed that 50% of peri-implant oral malignancy cases were initially misdiagnosed as peri-implantitis, with squamous cell carcinoma being the most common final diagnosis (81% in case reports and 97% in retrospective studies) (Srinivasan et al., 2025). A review of 47 published cases of oral malignancies involving dental implants found that 85.1% were SCC, 61.7% were primary malignancies, and 8.5% were metastases from distant tumors (Kaplan, 2017).
A review of 54 cases from 25 articles found that 42.6% of patients with peri-implant malignancy had a previous history of OSCC, while 33.3% had no past oncological history or premalignant lesion, with some lacking any risk factors (Brabyn et al., 2018).
Chronic, nonhealing inflammation around implants may provide an environment conducive to malignant transformation, although a direct causal link between peri-implantitis and oral cancer has not been definitively established (Verstraeten et al., 2023; McGuff et al., 2008; Bhandari et al., 2016; Srinivasan et al., 2025).
Vigilance is required. Clinicians are advised to maintain a high index of suspicion for malignancy in persistent peri-implant lesions, especially those unresponsive to conventional therapy, regardless of the presence or absence of traditional risk factors such as tobacco or
alcohol use (Verstraeten et al., 2023; Srinivasan et al., 2025). The presence of a tumor must be excluded in suspicious peri-implant lesions, typically requiring a biopsy for definitive diagnosis.
