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Rees T, Levine R. Systematic drugs as a risk factor for periodontal disease initiation and progression. Compendium. 1995; 16:20-26
Jorgensen MG. Prevalence of amlodipine-related gingival hyperplasia. J Periodontol. 1997; 68:676-678
Ellis J, Seymour R, Thomason JM Gingival sequestration of amlodipine and amlodipine-induced gingival overgrowth. Lancet. 1993; 341:(8852)1102-1103
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Nyska A, Shemesh M, Tal H Gingival hyperplasia induced by calcium channel blockers: mode of action. Med Hypotheses. 1994; 43:115-118
Armitage GC. Development of a classification system for periodontal diseases and conditions. Ann Periodontol. 1999; 4:1-6
Doong H, Dissanayake S, Gowrishankar T The 1996 Lindberg Award. Calcium antagonists alter cell shape and induce procollagenase synthesis in keloid and normal human dermal fibroblasts. J Burn Care Rehabil. 1996; 17:497-514
Monkman S, Ellis J, Cholerton S Automated gas chromatographic assay for amlodipine in plasma and gingival crevicular fluid. J Chromatogr B Biomed Appl. 1996; 678:360-364
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Amlodipine-induced gingival overgrowth in the peri-implant region: a review and case report

From Volume 46, Issue 3, March 2019 | Pages 280-284

Authors

Neil MacBeth

BDS, MSc, FFGDP, MGDS, MFGDP, MFDS, FDS(Rest), Consultant in Restorative Dentistry, Defence Primary Health Care Centre for Restorative Dentistry, Evelyn Woods Road, Aldershot, GU11 2LS, UK

Articles by Neil MacBeth

Stephen Sterlitz

Clinical Assistant Professor, University of Michigan School of Dentistry, 1011 N University, Ann Arbor, MI 48109, USA

Articles by Stephen Sterlitz

Graeme Bryce

BDS, MSc, MEndoRCS, MRD RCPSG, FDS (Rest Dent), FFDT, BDS, MSc, MEndoRCS, MRD RCPSG, FDS (Rest Dent), FDTFEd

Surgeon Commander (D) Graeme Bryce Royal Navy, Consultant in Restorative Dentistry, Centre for Restorative Dentistry, Defence Primary Health Care (Dental), Evelyn Woods Road, Aldershot, GU11 2LS

Articles by Graeme Bryce

Abstract

Gingival overgrowth is a known side-effect of the antihypertensive drug amlodipine, but the risk of mucosal overgrowth around dental implants has been less well documented. This article discusses the role of calcium channel blockers in drug-induced mucosal overgrowth around dental implants and describes the preventive and surgical management of the case.

CPD/Clinical Relevance: The report describes the management of a patient with an implant-supported restoration who presented with peri-implantitis and drug-induced mucosal overgrowth. The review discusses how amlodipine and other medications, commonly associated with drug-induced gingival overgrowth, impact on the management of implant patients.

Article

Several different medications have been reported to induce gingival overgrowth,1 with the three most common being: anticonvulsants, immunosuppressants and calcium channel blockers (CCBs). Despite differences in the pharmacological actions of each protagonist group, they are similar in that they alter the host tissue response, resulting in an increase in collagen synthesis and cellular changes within the connective tissue. The prevalence of gingival overgrowth varies, with a reporting incidence of 50% for phenytoin (anticonvulsant), 25–30% for cyclosporine (immunosuppressant), 5–20% for nifedepine and 3% for amlodipine (CCBs).2 The incidence of gingival overgrowth is three times higher in males,3,4 with the difference attributed to the effect of testosterone on fibroblast proliferation and collagen stimulus.5 The influence of plaque as an associated factor in gingival overgrowth is well established and acknowledged in the Armitage classification of periodontal disease.6

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