Dental Biomaterials Department, Faculty of Dentistry, Alexandria University, Alexandria, Egypt.
Fine Measurements Lab, Dental Biomaterials Department, Faculty of Dentistry, Alexandria University, Alexandria, Egypt.
J Prosthodont. 2017 Jan;26(1):29-33. doi: 10.1111/jopr.12379. Epub 2016 Feb 24.
To propose a treatment protocol for management of implant candidates suffering from active lichen planus.
Twenty-three patients who were diagnosed with active lichen planus were referred to a dental practice seeking dental implants. Patients received dental implants using open flap technique and sequential osteotomy. After a healing time of 6 weeks, implants were put into occlusal contact using interim prostheses. Of the 55 inserted implants, 42 failed after a short clinical service time (7 to 11 weeks). Failed implants were surgically removed, and osteotomy sites were carefully cleaned using manual curettes and scrubbing of osteotomy walls. CD4/CD8 cell count and gingival biopsies were collected from the surgical sites. Patients were put on an ascending dose (5 mg/10 days) of oral corticosteroids until a daily dose of 20 mg/day was achieved and maintained for 2 weeks. All patients received ten sessions of low-energy soft tissue laser irradiation at the implant insertion sites to assess soft tissue healing through improving blood circulation, reduction of inflammation, and sterilization of the osteotomy region. After approximately 8 weeks, a new set of 42 implants was placed, and definitive restorations were cemented using early loading technique. Marginal bone levels around inserted implants were periodically evaluated every 3 months using digital periapical radiographs (α = 0.05).
Primary blood tests revealed a high CD8 cell count, while soft tissue biopsies revealed infiltration of inflammatory cells at the epithelium soft tissue interface of the examined tissue. Repetition of immunological investigations after administration of the oral corticosteroids and soft tissue laser irradiation revealed reduction of CD8 cell counts and disappearance of inflammatory cell infiltration of the examined soft tissue biopsy. Patients reported marked improvement of the oral mucosa after treatment. All implants (n = 42) were functional after 3 years of clinical observation. There was an initial reduction in marginal bone level after 3 months from insertion time, after which it remained constant during the following observation periods.
Active lichen planus should be managed with oral corticosteroids and soft tissue laser irradiation before insertion of dental implants.
提出一种针对患有活动性扁平苔藓的种植体候选者的治疗方案。
23 名被诊断为活动性扁平苔藓的患者因需要种植体而被转诊到一家牙科诊所。患者使用开放式翻瓣技术和序贯截骨术接受牙种植体。经过 6 周的愈合期，使用临时义齿使植入物达到咬合接触。在插入的 55 个种植体中，有 42 个在短的临床使用时间（7 至 11 周）后失败。失败的种植体通过手术取出，并用手动刮匙和截骨壁擦洗仔细清洁截骨部位。从手术部位采集 CD4/CD8 细胞计数和牙龈活检。患者开始服用递增剂量（5mg/10 天）的口服皮质类固醇，直至达到每天 20mg 的剂量并维持 2 周。所有患者在种植体插入部位接受 10 次低能量软组织激光照射，以通过改善血液循环、减少炎症和对截骨区域进行消毒来评估软组织愈合情况。大约 8 周后，放置了另一组 42 个种植体，并使用早期负载技术将最终修复体粘接到种植体上。使用数字根尖射线照相（α=0.05）定期每 3 个月评估插入种植体周围的边缘骨水平。
初步血液检查显示 CD8 细胞计数较高，而软组织活检显示检查组织上皮软组织界面处有炎症细胞浸润。在给予口服皮质类固醇和软组织激光照射后重复进行免疫检查，显示 CD8 细胞计数减少，检查的软组织活检中炎症细胞浸润消失。治疗后，患者报告口腔黏膜明显改善。所有植入物（n=42）在 3 年的临床观察后均具有功能。在插入后的 3 个月，边缘骨水平最初降低，之后在随后的观察期内保持稳定。
在植入牙种植体之前，应使用口服皮质类固醇和软组织激光照射来治疗活动性扁平苔藓。
