Beyond Xerostomia: A Two-Year Follow-Up Case Report of Periodontal and Peri-Implant Health in Primary Sjögren Syndrome

Abstract

Primary Sjögren syndrome (pSS) is an autoimmune disorder characterized by chronic salivary gland dysfunction that predisposes patients to oral complications and tooth loss.Although dental implant therapy has demonstrated favorable survival rates in patients with pSS, evidence regarding long-term peri-implant soft tissue health remains limited.This report describes the diagnosis of pSS following implant rehabilitation and highlights the impact of the disease on peri-implant health during a two-year follow-up.A 61-year-old man underwent implant placement at sites 14 and 16 with simultaneous sinus floor elevation and connective tissue grafting.Several months later, he developed progressive xerostomia, xerophthalmia, burning mouth symptoms, and dysphagia.Histopathological examination of a minor labial salivary gland biopsy revealed focal lymphocytic sialadenitis (Chisholm and Mason grade 3), with findings considered compatible with Sjögren syndrome in the clinical context.Following rheumatologic management with hydroxychloroquine and pilocarpine, the patient was monitored for two years.Clinical examination demonstrated persistent xerostomia and generalized gingival and peri-implant mucosal inflammation, whereas radiographic evaluation showed stable peri-implant bone levels without marginal bone loss.This case supports current evidence indicating that implant osseointegration and short-term survival can be maintained in patients with pSS despite chronic hyposalivation.However, it also illustrates that persistent salivary dysfunction and immune dysregulation may predispose peri-implant tissues to mucosal inflammation in the absence of radiographic bone loss, emphasizing that peri-implant tissue health should be evaluated independently of implant survival.Dental implants appear to represent a reliable rehabilitation option for patients with pSS when combined with individualized supportive care.Nevertheless, long-term success should be assessed not only by implant survival and marginal bone stability but also by careful monitoring of peri-implant soft tissue health.Early recognition of Sjögren syndrome by dental practitioners and multidisciplinary management are essential for optimizing both systemic and implant-related outcomes.