Indian J Stomatol 2014;5(4):153-54

Amalgam Tattoo: A Case Report

Namish Batra1, Renu Batra2, Dharti Bhatt3

Abstract
Amalgam tattoo is bluish black or grayish discoloration of mucosa due to impingement of silver amalgam in soft tissue during
dental procedures. In modern 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 dictiona-
ry 2nd edition is defined as “a bluish black or grey lesion of
the oral mucous membrane caused by accidental implant-
ation of silver amalgam into the tissue during tooth restora-
tion or extraction.”1 With the development of newer mater-
ial 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 bl-
ack discolouration of gingiva. Patient gave a history of root
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 resem-
bling 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 ging-
iva 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 pati-
ent was kept on follow-up. Later patient underwent depig-
mentation for discolouration.
Discussion
Amalgam tattoo often mimics mucosal melanoma.2 Clini-
cal signs of mucosal melanoma of the oral cavity are usua-
lly dark brown, black, or bluish-greyish plaques with irreg-
3,4
ular pigmentation and an asymmetrical, irregular border.
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 conc-
ern. 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 follo-
wed 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 evi-
dence does not rule out the possibility, since particles can
often be widely dispersed to be visible on radiographs. Wh-
en there is no radiographic and clinical evidence of adjac-
ent restoration, biopsy is recommended to rule out an early

Figure 1: Radiographic evidence of

Figure 2: Pre-operative, after
periapical radiopaque restoration in right
removal of bridge
and left upper lateral incisors
1
Department of Oral and Maxillofacial Surgery, 2Department of Conservative Dentistry and Endodontics, Manubhai Patel Dental College and
Hospital, 3Batra Dental Clinic and Implant Centre, Vadodara, India. Correspondence: Dr. Namish Batra, email: drnamish_mds@yahoo.com

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Figure 3: Gingiva and labial mucosa
showing extensive amalgam tattoo
melanoma. Treatment of amalgam tattoo is for aesthetic re-
asons and can be carried out easily with soft tissue diode
lasers.
In the recent era with development of newer materials ama-
lgam tattoo is a rare finding and can often mimic mucosal
melanoma.
References
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Indian J Stomatol 2014;5(4):153-54
Figure 4: Extracted tooth showing
retrograde amalgam filling
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