Oral Health Prev Dent. 2024 Nov 18;22:583-594. doi: 10.3290/j.ohpd.b5828022.
Multifocal motor neuropathy (MMN) is a rare immune-mediated neuropathy causing progressive, asymmetric weakness without sensory loss. Long-term administration of intravenous (IVIg) or subcutaneous (SCIg) immunoglobulins is the primary therapeutic approach. Despite this, therapy failure can result in a decline in strength, particularly in the hands, impacting daily activities. This review and case report presents the current literature on this complex dental and medical topic and explores the novel use of dental implants for full-mouth rehabilitation in MMN patients undergoing long-term IVIg therapy.
A patient with MMN underwent 15 years of long-term treatment with intravenous immunoglobulin (IVIg), starting with an initial dose of 0.4 g/kg for 5 days every 4 months in 2008. The maintenance dosage of 0.2 g/kg as a single dose every 3 months was established as a long-term therapy. In 2017, the patient received a maxillary and mandibular complete-arch implant-supported prosthesis.
MMN showed no progression until the IVIg interval was extended to every 4 months in 2022. Significant deterioration in dental health resulted from a loss of right-hand dexterity, which affected toothbrush use and interproximal brushing, resulting in poor oral hygiene. Dental hygiene and dental health, which were not optimal anyway, were considerably worsened by the loss of dexterity in the right hand, which impaired the use of the toothbrush and the cleaning of the interdental spaces.
Dental implants are a well-established treatment for edentulous patients, but their success in those with MMN requires careful consideration of oral health practices. Effective maintenance protocols and optimised prosthetic designs are crucial for long-term implant therapy success in MMN patients. Peri-implant diseases pose risks influenced by various factors. In the case of MMN and its neurological considerations, implications for dental implant provision warrant further exploration, considering clinical symptoms, therapy, and potential progression.
多灶性运动神经病（MMN）是一种罕见的免疫介导性神经病，导致进行性、不对称性肌无力而无感觉丧失。静脉注射（IVIg）或皮下（SCIg）免疫球蛋白的长期给药是主要的治疗方法。尽管如此，治疗失败可能导致力量下降，特别是在手部，影响日常活动。本综述和病例报告介绍了这一复杂的牙科和医学主题的当前文献，并探讨了在接受长期 IVIg 治疗的 MMN 患者中，使用牙科种植体进行全口修复的新方法。
一位 MMN 患者在 2008 年开始接受长达 15 年的静脉免疫球蛋白（IVIg）治疗，初始剂量为 0.4 g/kg，每 4 个月连续 5 天，随后建立了每 3 个月 0.2 g/kg 的单剂量作为长期治疗。2017 年，患者接受了上颌和下颌全弓种植体支持义齿。
直到 2022 年 IVIg 间隔延长至每 4 个月，MMN 没有进展。由于右手灵活性丧失，导致牙齿健康状况显著恶化，影响了牙刷的使用和邻面清洁，导致口腔卫生不佳。无论如何，右手灵活性丧失使口腔卫生和牙齿健康状况恶化，因为这会影响牙刷的使用和牙齿间的清洁。
种植体是无牙患者的一种成熟治疗方法，但在 MMN 患者中成功应用需要仔细考虑口腔卫生习惯。对于 MMN 患者，有效的维护方案和优化的修复设计对于长期种植体治疗的成功至关重要。种植体周围疾病的风险受多种因素影响。在 MMN 及其神经学考虑的情况下，为 MMN 患者提供牙科种植体的相关问题需要进一步探讨，包括临床症状、治疗和潜在进展。
