Abstract：
BACKGROUND: Actinomycosis can be caused by periapical endodontic infection, trauma, or surgical dental procedures. Due to its rare occurrence in a healthy adult patient, persistent actinomycotic osteomyelitis around implants presenting as severe peri-implantitis may be challenging to diagnose.
METHODS: A 26-year-old male patient with non-contributory medical history presented to the Oral and Maxillofacial Surgery Clinic in 2018 with pain and edema associated with endodontically treated maxillary premolar teeth with poor prognosis. Oral examination revealed fair oral hygiene, heavily restored dentition, multiple carious teeth, failing restorations, endodontic treatments in both maxillary quadrants, and normal periodontal examination.
RESULTS: Two years following extractions and restoration with implants, the patient returned with a bony sequestrum and fistula in the buccal gingiva adjacent to the implants. The patient reported shifting of implants and slight change in his occlusion. Clinical, radiographic, and endodontic examinations did not demonstrate a clear origin of the fistula. A periodontist was consulted regarding the possibility of peri-implantitis and tracing of the fistula suggested intraosseous involvement of the implant surface. Flap surgery, biopsy, culture, implant removal, and surgical debridement were performed. Histologic examination revealed colonies of actinomycotic organisms and confirmed likely diagnosis of actinomycosis. The patient was placed on a long course of penicillin VK.
CONCLUSIONS: The occurrence of actinomycosis in a healthy adult patient is rare. This case report describes persistent actinomycosis presenting as osteomyelitis with severe peri-implantitis in a healthy patient, which may have been associated with a previously existing periapical endodontic infection.
METHODS: A 26-year-old male patient with non-contributory medical history presented to the Oral and Maxillofacial Surgery Clinic in 2018 with pain and edema associated with endodontically treated maxillary premolar teeth with poor prognosis. Oral examination revealed fair oral hygiene, heavily restored dentition, multiple carious teeth, failing restorations, endodontic treatments in both maxillary quadrants, and normal periodontal examination.
RESULTS: Two years following extractions and restoration with implants, the patient returned with a bony sequestrum and fistula in the buccal gingiva adjacent to the implants. The patient reported shifting of implants and slight change in his occlusion. Clinical, radiographic, and endodontic examinations did not demonstrate a clear origin of the fistula. A periodontist was consulted regarding the possibility of peri-implantitis and tracing of the fistula suggested intraosseous involvement of the implant surface. Flap surgery, biopsy, culture, implant removal, and surgical debridement were performed. Histologic examination revealed colonies of actinomycotic organisms and confirmed likely diagnosis of actinomycosis. The patient was placed on a long course of penicillin VK.
CONCLUSIONS: The occurrence of actinomycosis in a healthy adult patient is rare. This case report describes persistent actinomycosis presenting as osteomyelitis with severe peri-implantitis in a healthy patient, which may have been associated with a previously existing periapical endodontic infection.
摘要：
背景：放线菌病可由根尖周牙髓感染引起，创伤,或牙科手术。由于它在健康的成年患者中很少发生，表现为严重种植体周围炎的种植体周围持续性放线菌骨髓炎可能难以诊断.
方法：一名26岁男性患者，具有非贡献病史，于2018年在口腔颌面外科诊所就诊，疼痛和水肿与经牙髓治疗的上颌前磨牙相关，预后不良。口腔检查显示口腔卫生公平，大量恢复的牙列，多颗龋齿，失败的修复，两个上颌象限的牙髓治疗，和正常的牙周检查.
结果：拔除和植入物修复后两年，患者返回时，在植入物附近的颊侧牙龈中存在骨后遗症和瘘管。患者报告植入物移位和其闭塞的轻微变化。临床,射线照相,牙髓检查未显示瘘管的明确起源.就种植体周围炎的可能性和瘘管的追踪建议种植体表面骨内受累的可能性咨询了牙周病学家。皮瓣手术,活检,文化,移除植入物,并进行了手术清创术。组织学检查显示放线菌菌落，并证实可能诊断为放线菌病。患者接受了长时间的青霉素VK治疗。
结论：健康成人患者放线菌病的发生很少。该病例报告描述了健康患者的持续性放线菌病，表现为骨髓炎伴严重的种植体周围炎。这可能与先前存在的根尖周牙髓感染有关。
方法：一名26岁男性患者，具有非贡献病史，于2018年在口腔颌面外科诊所就诊，疼痛和水肿与经牙髓治疗的上颌前磨牙相关，预后不良。口腔检查显示口腔卫生公平，大量恢复的牙列，多颗龋齿，失败的修复，两个上颌象限的牙髓治疗，和正常的牙周检查.
结果：拔除和植入物修复后两年，患者返回时，在植入物附近的颊侧牙龈中存在骨后遗症和瘘管。患者报告植入物移位和其闭塞的轻微变化。临床,射线照相,牙髓检查未显示瘘管的明确起源.就种植体周围炎的可能性和瘘管的追踪建议种植体表面骨内受累的可能性咨询了牙周病学家。皮瓣手术,活检,文化,移除植入物,并进行了手术清创术。组织学检查显示放线菌菌落，并证实可能诊断为放线菌病。患者接受了长时间的青霉素VK治疗。
结论：健康成人患者放线菌病的发生很少。该病例报告描述了健康患者的持续性放线菌病，表现为骨髓炎伴严重的种植体周围炎。这可能与先前存在的根尖周牙髓感染有关。
