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DIGO Around Implant — ORE Part 1 MCQ

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ModerateDental MaterialsDIGO Around ImplantORE Part 1

A 50-year-old woman taking amlodipine attends for review of a single implant-supported crown. She has firm enlargement of the interdental papillae adjacent to the implant. There is plaque retention beneath the crown contact area, but oral hygiene is good elsewhere. Peri-implant probing causes no bleeding or suppuration, probing depths are unchanged from baseline, and a periapical radiograph shows no marginal bone loss. What is the most likely cause of the gingival enlargement?

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Correct answer: B — Amlodipine-associated gingival overgrowth modified by local plaque retention

Explanation lettering: D = shown as A · A = shown as B · E = shown as D · B = shown as E

A is correct. Amlodipine can cause gingival overgrowth, and expression of this drug-related change is promoted by local plaque retention; here, enlargement is confined to a plaque-retentive implant-crown contact area. Peri-implantitis is not supported because it requires peri-implant inflammation with bleeding and/or suppuration, increased probing depth and radiographic bone loss. These are specifically absent. Implant failure would usually involve mobility or loss of osseointegration rather than isolated papillary enlargement. Normal peri-implant tissue maturation does not produce new, localised papillary overgrowth in this setting. Titanium hypersensitivity is uncommon and would not be the leading explanation when a recognised medication effect and local plaque-retentive factor are present. The key distinction is that local plaque can modify amlodipine-associated enlargement without establishing peri-implantitis.

Reference: Scottish Dental Clinical Effectiveness Programme. Prevention and Treatment of Periodontal Diseases in Primary Care: Treatment of peri-implant mucositis, 2025. https://www.periodontalcare.sdcep.org.uk/guidance/dental-implants/treatment-of-peri-implant-mucositis/