Bratel J, Hakeberg M, Jontell M
Department of Endodontology and Oral Diagnosis, Faculty of Odontology, University of Göteborg, Sweden.
J Dent. 1996 Jan-Mar;24(1-2):41-5. doi: 10.1016/0300-5712(95)00004-6.
The objectives of this study were to investigate (i) healing of oral lichenoid reactions (OLR) following the selective replacement of restorations of dental amalgam, (ii) whether there were differences in healing between contact lesions (CL) and oral lichen planus (OLP), and (iii) whether there was a difference in healing potential when different materials were selected as a substitute for dental amalgam.
Patients included in the study presented with OLR confined to areas of the oral mucosa in close contact with amalgam restorations (CL; n = 142) or with OLR which involved other parts of the oral mucosa as well (OLP; n = 19). After examination, restorations of dental amalgam which were in contact with OLR in both patient groups were replaced. The effect of replacement was evaluated at a follow-up after 6-12 months.
In the CL group, the lesions showed a considerable improvement or had totally disappeared in 95% of the patients after replacement of the restorations of dental amalgam (n = 474). This effect was paralleled by a disappearance of symptoms, in contrast to patients with persisting CL (5%) who did not report any significant improvement. The healing response was not found to correlate with age, gender, smoking habits, subjective dryness of the mouth or current medication. However, the healing effect in patients who received gold crowns was superior compared to that of patients treated with metal-ceramic crowns (MC; P < 0.05). In the OLP group (n = 19), 63% of the patients with amalgam-associated erosive and atrophic lesions showed an improvement following selective replacement. OLP lesions in sites not in contact with amalgams were not affected. Most of the patients (53%) with OLP reported symptoms also after replacement.
From these data it can be concluded that the vast majority of CL resolve following selective replacement of restorations of dental amalgam, provided that a correct clinical diagnosis is established. It is also noteworthy that MC crowns did not facilitate healing of CL to the same extent as gold crowns.
本研究的目的是调查（i）选择性更换银汞合金修复体后口腔苔藓样反应（OLR）的愈合情况，（ii）接触性病变（CL）和口腔扁平苔藓（OLP）在愈合方面是否存在差异，以及（iii）选择不同材料替代银汞合金时愈合潜力是否存在差异。
纳入本研究的患者表现为OLR，局限于与银汞合金修复体密切接触的口腔黏膜区域（CL；n = 142）或也累及口腔黏膜其他部位的OLR（OLP；n = 19）。检查后，更换两组患者中与OLR接触的银汞合金修复体。在6 - 12个月的随访中评估更换的效果。
在CL组中，更换银汞合金修复体后，95%的患者（n = 474）病变有显著改善或完全消失。这种效果伴随着症状的消失，相比之下，持续存在CL的患者（5%）未报告任何显著改善。未发现愈合反应与年龄、性别、吸烟习惯、主观口干或当前用药相关。然而，接受金冠修复的患者的愈合效果优于接受金属烤瓷冠（MC）治疗的患者（P < 0.05）。在OLP组（n = 19）中，63%伴有银汞合金相关糜烂和萎缩性病变的患者在选择性更换后病情有所改善。未与银汞合金接触部位的OLP病变未受影响。大多数OLP患者（53%）在更换后仍报告有症状。
从这些数据可以得出结论，只要建立正确的临床诊断，绝大多数CL在选择性更换银汞合金修复体后会消退。同样值得注意的是，MC冠在促进CL愈合方面不如金冠。
