{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,27]],"date-time":"2026-05-27T15:37:54Z","timestamp":1779896274868,"version":"3.53.1"},"reference-count":15,"publisher":"Wiley","issue":"1","license":[{"start":{"date-parts":[[2023,4,7]],"date-time":"2023-04-07T00:00:00Z","timestamp":1680825600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["aap.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Clin Adv Periodontics"],"published-print":{"date-parts":[[2024,3]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Background<\/jats:title><jats:p>The utilization of dermal fillers for cosmetic procedures has increased dramatically in the past several years, and so is the number of reported adverse events and complications. Most of these reports are centered on extraoral facial structures such as skin, nose, forehead, and eyes. However, as this report illustrates, intraoral complications are also possible and require appropriate management. Our extensive search of the medical and dental literature has failed to yield any such report.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods and Results<\/jats:title><jats:p>An injection of dermal filler composed of hyaluronic acid for managing a deep nasolabial fold resulting in an arterial occlusion is presented. Patient exhibited facial skin necrosis, with ecchymoses and crusting, extending to the right eye. Transient diplopia and vision changes were also present. Additionally, intraoral necrosis of the palatal mucosa extending from the right central incisor to the molars and approaching the midline was noted. Patient was managed palliatively until complete re\u2010epithelization was noted, with no further loss of periodontal attachment.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>This case illustrates a rare oral complication of extraoral injection of a dermal filler, and its management. The clinicians should be aware of the potential risks of these cosmetic procedures. Early detection and timely management may prevent lasting damage and discomfort. Additionally, some of these complications may require a well\u2010coordinated multidisciplinary involvement to restore health and functions (plastic surgeon, dermatologist, ophthalmologist, and a periodontist).<\/jats:p><\/jats:sec><jats:sec><jats:title>Key points<\/jats:title><jats:p><jats:bold>Why is this case new information?<\/jats:bold>\n<jats:list list-type=\"bullet\">\n<jats:list-item><jats:p>Previous reports of adverse effects linked to dermal fillers were limited to extraoral structures such as the facial skin, nose, forehead, and eye. To the authors\u2019 best knowledge, this is the first and only documented case of intraoral necrosis following dermal filler injection<\/jats:p><\/jats:list-item>\n<\/jats:list><\/jats:p><jats:p><jats:bold>What are the keys to successful management of this case?<\/jats:bold>\n<jats:list list-type=\"bullet\">\n<jats:list-item><jats:p>The most important step in managing intra\u2010arterial filler injection and occlusion is the immediate injection of hyaluronidase enzyme to minimize the extent of tissue necrosis. In the case of ocular involvement, immediate referral to an ophthalmologist is required<\/jats:p><\/jats:list-item>\n<\/jats:list><\/jats:p><jats:p><jats:bold>What are the primary limitations to success in this case?<\/jats:bold>\n<jats:list list-type=\"bullet\">\n<jats:list-item><jats:p>Success of managing the adverse effects of vascular occlusion following filler injection depends on several factors, including the anatomical area of occlusion, its extend, along with timely treatment<\/jats:p><\/jats:list-item>\n<\/jats:list><\/jats:p><\/jats:sec>","DOI":"10.1002\/cap.10243","type":"journal-article","created":{"date-parts":[[2023,2,24]],"date-time":"2023-02-24T11:54:22Z","timestamp":1677239662000},"page":"26-29","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["A rare case of gingival necrosis following an extraoral injection of dermal filler"],"prefix":"10.1002","volume":"14","author":[{"given":"Rania","family":"Livada","sequence":"first","affiliation":[{"name":"School of Dentistry University of Maryland  Baltimore Maryland USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jacob","family":"Shiloah","sequence":"additional","affiliation":[{"name":"Department of Periodontology College of Dentistry University of Tennessee Health Science Center  Memphis Tennessee USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2023,4,7]]},"reference":[{"key":"e_1_2_8_2_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00266-004-0037-1"},{"key":"e_1_2_8_3_1","unstructured":"American Society for Aesthetic Plastic Surgery. ASAPS. Cosmetic surgery national databank statistics. Available from:https:\/\/cdn.surgery.org\/media\/statistics\/2021\u2010TheAestheticSocietyStatistics.pdfLast accessed2022"},{"issue":"11","key":"e_1_2_8_4_1","first-page":"26","article-title":"What you need to know about dermal fillers","volume":"19","author":"Livada R","year":"2021","journal-title":"Dimens Dent Hyg"},{"key":"e_1_2_8_5_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jdds.2016.01.001"},{"key":"e_1_2_8_6_1","doi-asserted-by":"publisher","DOI":"10.4103\/0974-2077.63222"},{"key":"e_1_2_8_7_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1524-4725.2009.01346.x"},{"key":"e_1_2_8_8_1","doi-asserted-by":"publisher","DOI":"10.1177\/1090820X14525035"},{"key":"e_1_2_8_9_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1529-8019.2012.01455.x"},{"key":"e_1_2_8_10_1","doi-asserted-by":"publisher","DOI":"10.5935\/0004\u20102749.20190092"},{"issue":"6","key":"e_1_2_8_11_1","first-page":"587","article-title":"Arterial occlusion and necrosis following hyaluronic acid injection and a review of the literature","volume":"18","author":"Doerfler L","year":"2019","journal-title":"J Drugs Dermatol"},{"key":"e_1_2_8_12_1","doi-asserted-by":"publisher","DOI":"10.1097\/PRS.0000000000000754"},{"key":"e_1_2_8_13_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1473-2165.2011.00562.x"},{"issue":"9","key":"e_1_2_8_14_1","first-page":"1069","article-title":"The basic science of dermal fillers: past and present Part II: adverse effects","volume":"11","author":"Gilbert E","year":"2012","journal-title":"J Drugs Dermatol"},{"issue":"5","key":"e_1_2_8_15_1","first-page":"44","article-title":"A treatment protocol for vascular occlusion from particulate soft tissue augmentation","volume":"5","author":"Beer K","year":"2012","journal-title":"J Clin Aesthet Dermatol"},{"issue":"9","key":"e_1_2_8_16_1","first-page":"1007","article-title":"Management of impending necrosis associated with soft tissue filler injections","volume":"10","author":"Dayan SH","year":"2011","journal-title":"J Drugs Dermatol"}],"container-title":["Clinical Advances in Periodontics"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/cap.10243","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/aap.onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/cap.10243","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,9]],"date-time":"2025-10-09T19:31:16Z","timestamp":1760038276000},"score":1,"resource":{"primary":{"URL":"https:\/\/aap.onlinelibrary.wiley.com\/doi\/10.1002\/cap.10243"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,4,7]]},"references-count":15,"journal-issue":{"issue":"1","published-print":{"date-parts":[[2024,3]]}},"alternative-id":["10.1002\/cap.10243"],"URL":"https:\/\/doi.org\/10.1002\/cap.10243","archive":["Portico"],"relation":{},"ISSN":["2573-8046","2163-0097"],"issn-type":[{"value":"2573-8046","type":"print"},{"value":"2163-0097","type":"electronic"}],"subject":[],"published":{"date-parts":[[2023,4,7]]},"assertion":[{"value":"2022-11-01","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2023-02-19","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2023-04-07","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}]}}