Patient with Hemangioma: Thoughts on implant treatment?

Disclaimer: I have never placed an implant in a hemangioma. Having said that, the chief concern is uncontrollable bleeding, depending on the volume of blood pumping through the lesion. Additionally, it it sometimes difficult to delineate the extent or the hemodynamics of a hemangioma without special imaging-- usually MR with IV contrast. This is a particular concern with large lesions, or those associated with angiomatous syndromes (e.g., Sturge-Weber). The lesion could extend to the bony areas under consideration for implant placement. In short, you should consider sending your patient to a vascular surgeon for proper evaluation and mapping of the lesion, and place implants only in those areas of soft or hard tissue where the lesion has been demonstrated to be absent.

P.S. Naturally, it would be a good idea to do the necessary imaging prior to the planed extractions.

This is not a hemangioma. You are looking at a capillary malformation aka port wine stain.

It is a Hemangioma. The pink color is because of the laser treatment in the past. Unfortunately the latter wasn't successful enough. Thanks for the comments!

With a small flap only to open a space for placement there is no problem , and as someone mentioned this is a blood vessels malformation not a hemangioma.Local situation is good enough.

This is probably Sturge -Weber syndrome Type 2 . Facial angioma (port wine stain) with a possibility of glaucoma developing( not any evidence of brain involvement). Symptoms can show at any time beyond the initial diagnosis of the facial angioma. I do not recommend to insert implants for replacing the premolars due to osseus possible involvement.I recommend facial angiography and the revue of diagnostic.

play it safe do a 3 unit bridge... that's my recommendation

thank you for posting this case

1. Did the patient have a bleeding problem when the teeth were extracted? 2. Does the osseous architecture appear normal or abnormal?

There no evidence of abnormal bleeding after extraction.

I want to insert an Ortopantomografy into the post,but I don't know how to edit it.

If there was no unusual bleeding concurrent with the extractions, there will likely not be any with implant placement. Just take a close look at the bone morphology to see if it is similar or the same to other areas of the mouth that are not affected by the vascular anomaly.

My opinion coincides with opinion of Dr. Mark Bornfeld .The question was whether you have experience with a similar case.The rest is conjecture.The risk is unjustified. Thanks everyone for the opinions.

Primary concern for this patient is to evaluate the extent of the lesion with CBCT or MRI. MRI is more applicable to check the extent. This cavernous type some times restrict in the soft and is not contraindicated for Implant surgery. According to your statement it seems involve the alveolar bone as well. If it is found with bony involvement than very difficult to control bleeding during the surgery. Moreover excessive bleeding can impair the healing process due to more iron deposition that leads to osseointegration failure.

Dr Shet is correct. An MRI will show if the site is involved. Implant should be very possible.