Department of Oral and Maxillofacial Surgery, School of Medicine, Hyogo Medical University, Nishinomiya, Japan.
Okayama University Dental School, Okayama, Japan.
Int J Implant Dent. 2024 Jul 29;10(1):37. doi: 10.1186/s40729-024-00557-8.
In older patients with progressive neurodegeneration, replacing fixed implant-supported prostheses (FIP) with implant overdentures (IOD) has been proposed to prevent future mucosal injury and create an oral environment that is easier for caregivers to clean. However, there have been no reports on the progress after replacing FIP with IOD. In this report, we present the progress of an older patient with Parkinson's disease in whom FIP was replaced with IOD.
An 81-year-old male patient with Parkinson's disease presented to our outpatient clinic with bruxism and crossbites. FIPs, with five Brånemark system implants, were placed in the bilateral lower molars. The FIP was replaced with an IOD with two locator attachments to create an oral environment that was easier for caregivers to clean and allow easy recovery of masticatory function if residual teeth were fractured in the care environment. As his systemic condition deteriorated, treatment was changed from outpatient to in-home visits. During dental care visits, professional oral cleaning and denture repair were continued, and good nutritional status was maintained. However, the patient developed cholecystitis and was hospitalized. During hospitalization, gastrostomy was performed because he developed aspiration pneumonia. After discharge from the hospital, the patient remained in bed all day and could not wear an IOD, resulting in buccal mucosa ulceration due to abrasion of the locator abutment. We decided to replace the abutment with cover screws; however, not all the implants could sleep submucosally. Although regular oral cleaning was resumed, new ulcers developed even when cover screws were installed. Additionally, swelling and drainage were observed at the peri-implant mucosal site where peri-implantitis had once occurred during an outpatient visit. The patient was readmitted to the hospital for a urinary tract infection, and subsequent visits were abandoned.
By replacing FIP with IOD in an older patient with Parkinson's disease, we addressed a barrier to caregiver-provided oral management. The removable prosthesis facilitated smooth oral care by caregivers and functional recovery in the event of trouble with residual teeth. However, it could not completely avoid the recurrence of buccal mucosal ulcers or peri-implantitis.
在患有进行性神经退行性疾病的老年患者中，将固定式种植体支持修复体（FIP）更换为种植覆盖义齿（IOD）被认为可以预防未来的黏膜损伤，并创造一个更容易被护理人员清洁的口腔环境。然而，目前还没有关于将 FIP 更换为 IOD 后进展情况的报道。在此报告中，我们介绍了一位帕金森病老年患者将 FIP 更换为 IOD 的进展情况。
一位 81 岁男性帕金森病患者因磨牙症和反颌到我院门诊就诊。在双侧下颌磨牙中植入了 5 个 Brånemark 系统种植体，安装了 FIP。为了创造一个更容易被护理人员清洁的口腔环境，并允许在护理环境中剩余牙齿发生骨折时更容易恢复咀嚼功能，将 FIP 更换为带有两个Locator 附着体的 IOD。随着患者全身状况恶化，治疗从门诊改为家庭就诊。在牙科就诊期间，继续进行专业口腔清洁和义齿修复，并保持良好的营养状态。然而，患者出现胆囊炎并住院治疗。住院期间，由于患者发生吸入性肺炎而进行了胃造口术。出院后，患者整天卧床不起，无法佩戴 IOD，导致Locator 基台磨损导致颊黏膜溃疡。我们决定更换基台为覆盖螺丝；然而，并非所有种植体都能在黏膜下愈合。虽然恢复了定期口腔清洁，但即使安装了覆盖螺丝，仍会出现新的溃疡。此外，在门诊期间曾发生过种植体周围炎的种植体周围黏膜部位观察到肿胀和引流。患者因尿路感染再次入院，随后的就诊被放弃。
通过将 FIP 更换为帕金森病老年患者的 IOD，我们解决了护理人员提供口腔管理的障碍。可摘义齿便于护理人员进行口腔护理，并在剩余牙齿出现问题时恢复功能。然而，它并不能完全避免颊黏膜溃疡或种植体周围炎的复发。
