Amalgam Tattoo: A Case Report

Headnote

Abstract

Amalgam tattoo is bluish black or grayish discoloration of mucosa due to impingement of silver amalgam in soft tissue during dental procedures. In modem era, with development of newer biocompatible materials, amalgam tattoo is a rare entity. In case report we want to present a case of amalgam tattoo arising due to retrograde filling of amalgam in a 45-year-old female patient.

Keywords: Amalgam tattoo; melanoma; retrograde filling; MTA; biodentine.

Introduction

Amalgam tattoo according to Stedman's medical dictionary 2nd edition is defined as "a bluish black or grey lesion of the oral mucous membrane caused by accidental implantation of silver amalgam into the tissue during tooth restoration or extraction."1 With the development of newer material like MTA, Biodentine, extinction of amalgam tattoo is an unusual finding. Amalgam tattoo is painless, soft bluish black or grayish discolouration of gingiva or alveolar ridge however it can be present on labial and buccal mucosa as well. Here, we present a case report of discolouration of the gingiva due to retrograde amalgam filling.

Case report

A 45-years-old female patient reported to the dental clinic with the chief complain of mobility of bridge and bluish black discolouration of gingiva. Patient gave a history ofroot canal treatment with apicectomy 4 years back for right and left upper lateral incisors. At that time patient also had both central incisors missing. Patient was given prosthesis from right upper lateral incisor to left upper lateral incisor. On intra oral examination a bluish black discolouration resembling melanoma in both right and left gingiva above lateral incisors was observed. On palpation bridge was mobile. Patient then underwent intraoral periapical radiograph (IOPA). IOPA revealed retrograde radiopaque restoration in both lateral incisors (Figure 1). Patient was then referred for bridge removal. Post prosthesis removal it was found that both lateral incisor were grade II mobile and the gingiva and labial mucosa showed extensive discolouration (Figure 2, 3). Both lateral incisors were then planned for extraction.

After extraction it was found out that retrograde filling was done by amalgam (Figure 4). Curettage was done and patient was kept on follow-up. Later patient underwent depigmentation for discolouration.

Discussion

Amalgam tattoo often mimics mucosal melanoma.2 Clinical signs of mucosal melanoma of the oral cavity are usually dark brown, black, or bluish-greyish plaques with irregular pigmentation and an asymmetrical, irregular border.3,4 Mucosal melanoma is a very rare entity and is aggressive in nature. It should always be ruled out. Most common site of melanoma is maxillary palatal mucosa. Amalgam tattoo are asymptomatic but in aesthetic area are of prime concern. Clinically, amalgam tattoo presents as a dark gray or blue, flat macule located adjacent to a restored tooth. It is mostly located on the gingiva and alveolar mucosa followed by the buccal mucosa and the floor of the mouth.5

A radiographic evidence of restoration of silver amalgam confirms amalgam tattoo, but absence of radiographic evidence does not rule out the possibility, since particles can often be widely dispersed to be visible on radiographs. When there is no radiographic and clinical evidence of adjacent restoration, biopsy is recommended to rule out an early melanoma. Treatment of amalgam tattoo is for aesthetic reasons and can be carried out easily with soft tissue diode lasers.

In the recent era with development of newer materials amalgam tattoo is a rare finding and can often mimic mucosal melanoma.

References

References

1. Ganapathy NM, Kuttappa MA, Anil M. Amalgam tattoo: A case report. Endodontol 2008;20:44-48.

2. Lundin K, Schmidt G, Bonde C. Amalgam Tattoo Mimicking Mucosal Melanoma: A Diagnostic Dilemma Revisited. Case Reports in Dentistry 2013, doi:10.1155/2013/787294

3. Eisen. Disorders of pigmentation in the oral cavity. Clin Dermatol 2000;18:579-87.

4. Kauzman M, Pavone N, Blanas, Bradley G. Pigmented lesions of the oral cavity: review, differential diagnosis, and case presentations. J Can Dent Assoc 2004;70:682-83.

5. Buchner A. Amalgam tattoo (amalgam pigmentation) of the oral mucosa: clinical manifestations, diagnosis and treatment. RefuatHapehVehashinayim2004;21:25-8,92.