Dental procedures & soft tissue

augmentation

Abdullah AleidYousif Khalaf

The scenario

39 years old female presented with acute onset swelling (diffuse, hot & tender in nature) on her left cheek, following RCT visit done under local anaesthesia.

Medical history: she is non-allergic to any dental products, but the patient reported having cheek augmentation using polyacrylamide gell filler.

Soft tissue filler products

Soft tissue fillers

can be divided into short-term degradable and long-lasting permanent injectable fillers.

In the past, based on either collagen or hyaluronic acid gels

the modern fillers are based on polymerization.

Continue The main adverse effect was allergy and

hypersensitivity.

Introduction of polyalkylimide, silicon and botox reduce the incidence of allergy.

The new polymerized based product obtain denser effects.

Indication Building up the facial volume1. Facial lipoatrophy (checks, lips, chin …)

Cosmetic 1. Acne2. Scar & keloid3. Wrinkles

• Other parts of the body such as chest and gluteal region

Building up facial volume

Cosmetic

Cosmetic

Polyalkylimide gels Polyalkylimide is a polymer which belongs to the

family of acryl derivatives.

Semi permanent and can beRemoved later on.

for deeper wrinkles such as nasolabial folds or depressed scars. (endoprosthesis)

It is a synthetic product (not natural), however it Induces a layer of 0.02mm of collagen formation around it with a biofilm.

Biofilm Initial attachment Irreversible attachment Growth and protective matrix

build up Colonization & bacterial

spore Detachment and spread

Biofilm

Biofilm in Polyalkylimide 1st stage: either contaminated. Or local

bacteria will surround the gel 2nd stage: increase in population

excretion of extracellularprotective and adhesivematrix. Which will :

Increase Abx resistanceAct as barrier against leukocyte 3rd stage: shift between

active and inactive state.

Factors help in phase switchingBiofilm microbial populations can shift from

active to dormant (more resistance) depending on exogenous threats.

Trauma Injection of substances close to it Manipulations

Activation of bacteria

This can result in a clinical picture of  :

1. Inflammation2. Granuloma3. Nodules4. Systemic infection

What will determine the nature of complication?

Back to the scenario The manifestations showed it’s a kind of

diffuse inflammatory facial swelling.

Foreign body ?

Irritation by local anasthesia, irrigation agent

Disruption of the biofilm leads to the diffuse inflammation in this particular case

Adequate treatment

Intraoral incission and drainage (what are the possible complication?)

Antibiotic course

Review

Conclusion

Dental procedures can interact with Soft tissue augmentation

Such patients should be warned about the potential interaction ahead of the treatment

Thank YouReferences:

1.http://www.miinews.com/pdf/eabg_dermalfillers_oct07.pdf

2. http://www.drjordan.on.ca/pdfs/InSight_v8n3_Fall02.

pdf

3. http://www.smiledentaljournal.com/index.php?option=

com_content&view=article&id=446:diffuse-inflammatory-facial-swelling-secondary-to-local-anesthetic-injections-in-patient-with-polyalkylimide-gel-used-for-cheek-augmentation&catid=985