Clinical Medicine I, Department of Medicine, University of Padua, Padua, Italy.
Section of Dentistry, Department of Neurosciences, University of Padua, Padua, Italy.
Haemophilia. 2019 Jul;25(4):693-698. doi: 10.1111/hae.13745. Epub 2019 Apr 17.
Severe plasminogen (PLG) deficiency causes ligneous conjunctivitis, a rare disease characterized by the growth of fibrin-rich pseudomembranes on mucosal surfaces; gums involvement leads to ligneous gingivitis (LG). Specific therapy for LG is not available yet. We report a prophylactic treatment with enoxaparin and fresh frozen plasma (FFP) for invasive dental procedures in a patient with LG, and a review of literature on LG treatment.
A 43-year-old female with LG was studied. In order to prevent LG recurrence after dental care, FFP before and the day after the procedure, and enoxaparin were administered in addition to proper minimally invasive dentistry techniques and implant surgery.
Plasminogen deficiency was confirmed by reduced PLG antigen (25 μg/mL) and activity (20%) levels, and genetic analysis. PLG levels rose to 46% after FFP transfusion and returned to baseline after 48 hours. Minimally invasive dental procedures and implants were performed. Small gingival pseudomembranes developed soon thereafter in some cases but disappeared within a few weeks; no bleeding complications were observed.
In our patient with LG, the adoption of combined haematological and dentistry protocols appeared to be safe and effective in preventing abnormal gingival pseudomembranes growth after dental interventions, maintaining a healthy periodontal condition.
严重的纤溶酶原（PLG）缺乏可导致木质化结膜炎，这是一种罕见疾病，其特征是黏膜表面生长富含纤维蛋白的假膜；牙龈受累可导致木质化龈炎（LG）。目前尚无针对 LG 的特定治疗方法。我们报告了一例 LG 患者在进行侵入性牙科手术时使用依诺肝素和新鲜冷冻血浆（FFP）进行预防性治疗的情况，并对 LG 治疗的文献进行了回顾。
研究了一名 43 岁的 LG 女性患者。为了防止牙科护理后 LG 复发，在手术前和手术后当天给予 FFP 和依诺肝素，同时采用适当的微创牙科技术和种植牙手术。
PLG 抗原（25μg/ml）和活性（20%）水平以及基因分析证实存在纤溶酶原缺乏。FFP 输注后 PLG 水平升高至 46%，48 小时后恢复基线水平。进行了微创牙科手术和种植牙。此后不久，在某些情况下出现了小的牙龈假膜，但在数周内消失；未观察到出血并发症。
在我们的 LG 患者中，采用联合血液学和牙科方案似乎安全有效，可预防牙科干预后异常牙龈假膜生长，维持健康的牙周状况。
