Join Us | Latest Articles | Contact

Journal Home


Editorial Board


Recent Articles


Submit to this journal


Special Issues


Current issue

International Journal of Oral and Dental Health





DOI: 10.23937/2469-5734/1510003



Dental Implant Therapy in Patients Affected by Oral Mucosal Diseases

Sertan Ergun*


Department of Oral Surgery, Faculty of Dentistry, Istanbul University, Turkey


*Corresponding author: Sertan Ergun, Department of Oral Surgery, Faculty of Dentistry, Istanbul University, Turkey, E-mail: sertanergun@gmail.com
Int J Oral Dent Health, IJODH-1-003, (Volume 1, Issue 1), Short Communication; ISSN: 2469-5734
Received: February 26, 2015 | Accepted: February 28, 2015 | Published: March 02, 2015
Citation: Ergun S (2015) Dental Implant Therapy in Patients Affected by Oral Mucosal Diseases. Int J Oral Dent Health 1:003. 10.23937/2469-5734/1510003
Copyright: © 2015 Ergun S. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.



Dental implants are increasingly used for the treatment of complete and /or partial eduntulism. Related literature search revealed that dental implants are associated with high survival rates of close 92-98% after 10 years [1,2]. The success of implant therapy is very close associated with the appropriate patient selection [3,4]. Oral mucosal disorders and/or systemic diseases with oral mucosal involvements such as systemic lupus erythematosus, pemphigus vulgaris, Sjögren's syndrome, oral lichen planus, oral lichenoid reactions, epidermolysis bullosa and scleroderma could complicate dental implant surgery.

Systemic lupus erythematosus (SLE) is a multisystem autoimmune disease associated with connective tisuue and blood vessel disorder [5]. More than 40% patients with SLE experience oral lesions with clinical presentations of red macula, plaque or even ulcerations localized on pigmented mucosa involving the hard palate, lips and buccal mucosa [6]. In addition to oral lesions, temporomandibular joint disorders together with caries, oral candidiasis, gingivitis or even periodontitis due to poor oral hygiene as a result of painful oral lesions or genetic susceptibility are possible oral manifestations. We previously reported that the only issue which complicates the surgical and prosthetic procedures of the implant therapy in the patients with SLE is the limited mouth opening [7]. Antibiotic prophylaxis could be required in this type of patients if the vital organ involvement is present [7]. Zirconium oxide ceramic crowns should be the first choice for these patients due to their high biocompatibility [7]. No remarkable difference in the healing period postoperatively and in the marginal bone loss around the implants at the 24th month follow-up were reported [7].

Pemphigus vulgaris (PV) is a term derived from the Greek pemphix (bubble or blister) for a group of potentially life-threatening autoimmune mucocutaneous diseases characterized by epithelial blistering affecting cutaneous and/or mucosal surfaces [8]. Pemphigus is classified as pemphigus vulgaris (PV), with suprabasalacantholysis causing separation of basal cells from keratinocytes of the stratum spinosum and pemphigus foliaceus (PF), with acantholysis in the granular layers of the epidermis [9]. PV is the most common type of pemphigus, accounting for approximately 70% of pemphigus cases. PV typically runs a chronic course, almost invariably causing blisters, erosions, and ulcers on the oral mucosa and skin [10]. Dental implant treatment for a patient with PV can be complicated by the side effects of long-term use of systemic corticosteroids. Patients on systemic corticosteroid therapy may have suppressed immunity and decreased bone mineralization [11]. The use of systemic corticoids might have exacerbated the patient's type 4 maxillary bone, compromised the healing capability, and consequently made implant surgery a challenge [12]. Ill-fitting dentures can cause vesiculobullous and ulcerative lesions. Prosthetic rehabilitation with implant-retained prostheses improves stabilization of the prosthesis in patients with PV and prevents formation of such lesions. We previously reported that this treatment choice could be considered as a good alternative for removable complete dentures in PV patients [13].

Sjogren's syndrome (SS) is an autoimmune disease affecting the function of exocrine glands, including salivary glands which leads to excessive xerostomia. The patients with SS face difficulties in swallowing and taste alterations together with ulcerations on oral mucosa due to trauma because of lack of protective effect of saliva [14]. Therefore, implant supported prosthetic dentures should be considered as a treatment of choice instead of removable prosthesis. Literature search revealed that there is no definitive contraindication to implant surgery in patients with SS and a success rate up to 100% at 13 years has been reported [15] Attention should be paid to the severity of the disease, especially to the secondary forms of SS which may complicate the surgery as well as the prosthetic treatment [16].

Oral lichen planus (OLP) is a chronic, inflammatory, mucocutaneous disease with a wide range of clinical manifestations, involving T lymphocytes with cytotoxicactivity against the epithelial cells affecting skin and mucosa [17]. OLP is characterized by relapses and remissions and six clinical variants as reticular, plaque-like, erosive, papular, atrophic and bullous have been described [18]. The prevalence of OLP is 1.27% in the general population (0.96% in men and 1.57% in women) [19]. The disease has often been reported in adults over 40 years of age and affects women more than men (Roopashree MR 2010). Treatment of OLP depends on symptoms, the extent of oral and extra-oral clinical involvement, medical history and other factors [20]. The frequency of malignant transformation of OLP varies between 0% to 12.5% but it still remains controversial [21].

Lichenoid reaction is a term used for lesions that resemble OLP clinically and histologically but have an identifiable aetiology and include oral lichenoid lesions (OLL), chronic graft-versus-host disease (cGVHD), oral lichenoid contact reactions (OLCR) or drug reactions [20]. OLCR are caused by dental restorative materials, most commonly amalgam, found in direct topographic relationship with oral mucosa.Contact of the oral mucosa to dental restorative materials may induce a sensitivity response resulting in immune-mediated damage of the basal epithelial keratinocytes [22,23]. They are commonly unilateral and erosive and histological examination show more diffuse lymphocytic infiltrate with eosinophils and plasma cells and with more colloid bodies than in classic OLP [20,24,25]. Skin patch testing against dental restorative materials help to distinguish those patients and after removal of the secausative materials the majority of lesions resolve with in several months [23].

The capacity of the epithelium to adhere to the titanium surface of the implant has been reported to be altered [26]. The pathognomic changes both in epithelium and the subepithelial layer of connective tissue could possibly affect the mucosal-titanium interface and impair the barrier function of the implant/epithelial junction allowing for easier bacterial access to the peri-implant tissues [27]. The placement of dental implants for the fitting of overdentures may reduce the incidence of erosive lesions as well as increase the oral function and patient comfort [26]. No clear guidelines regarding the placement of implants in these patients has been reported to date and that status leads to dilemma which retains many clinicians prefer to avoid placing implants in patients with OLP and oral lichenoid reactions. Literature search revealed that implant survival among OLP patients is essentially the same as the survival rate of the implants in healthy people [27-29].

Epidermolysis Bullosa (EB) is a group of rare, genetic skin disorders characterized by fragility and blistering to minimal trauma. Common oral findings of the disease include microstomia, intraoral ulcerations and bullae formation, ankyloglossia, tongue atrophy, elimination of buccal and vestibular sulci, lingual depapillation and atrophy of the palatal folds [30]. The use of dental implants in the prosthetic rehabilitation of edentulous patients with EB might provide a considerably better outcome than traditional prosthetic methods due to the decreased risk of trauma to the mucosa [31]. On the other hand, implant surgery may pose an additional problem;along with soft tissue incision and flap detachment, which can produce bullae, sterile saline solution irrigation is required [32]. Lubricating the patient's lip and any other tissues susceptible to contact can help reduce the risk of shear forces and resulting tissue damage [32].

Scleroderma is a chronic, debilitating connective tissue disease characterized by hardening and contracture of the skinwith unknown aetiology [33]. The patients with scleroderma present with yellow, smooth, shiny and firm skin. The clinical and radiographical evaluation often reveal caries and periodontal disease. The limitation in the mouth opening may complicate the dental treatment [34]. The use of dental implants has been reported to solve the caries problem and periodontal problems.

In summary, rehabilitation with implants in the patients with these diseases mentioned above has been proven to be a valid treatment option with a survival rate which is no statistically different when compared with the survival rate in healthy subjects. But this does not mean that these diseases do not play a role in the survival and/or success rate of dental implants. We, as dentsists, should always balance the advantages and the disadvantages of the surgical procedures and treatment modelities. Additionally, risk factors for implant failure should be identified.


References
  1. Lindquist LW, Carlsson GE, Jemt T (1996) A prospective 15-year follow-up study of mandibular fixed prostheses supported by osseointegrated implants. Clinical results and marginal bone loss. Clin Oral Implants Res 7: 329-336.

  2. Van Steenberghe D (2005) Interactive imaging for implant planning. J Oral Maxillofac Surg 63: 883-884.

  3. Retzepi M, Donos N (2010) Guided Bone Regeneration: biological principle and therapeutic applications. Clin Oral Implants Res 21: 567-576.

  4. Donos N, Mardas N, Chadha V (2008) Clinical outcomes of implants following lateral bone augmentation: systematic assessment of available options (barrier membranes, bone grafts, split osteotomy). J Clin Periodontol 35: 173-202.

  5. Von Feldt JM (1995) Systemic lupus erythematosus. Recognizing its various presentations. Postgrad Med 97: 79, 83, 86 passim.

  6. Urman JD, Lowenstein MB, Abeles M, Weinstein A (1978) Oral mucosal ulceration in systemic lupus erythematosus. Arthritis Rheum 21: 58-61.

  7. Ergun S, Katz J, Cifter ED, Koray M, Esen BA, et al. (2010) Implant-supported oral rehabilitation of a patient with systemic lupus erythematosus: case report and review of the literature. Quintessence Int 41: 863-867.

  8. Pradeep AR, Thorat MS, Raju A (2009) Pemphigus vulgaris associated with significant periodontal findings: a case report. Int J Med Med Sci 1: 297-301.

  9. Harman KE, Gratian MJ, Seed PT, Bhogal BS, Challacombe SJ, et al. (2000) Diagnosis of pemphigus by ELISA: a critical evaluation of two ELISAs for the detection of antibodies to the major pemphigus antigens, desmoglein 1 and 3. Clin Exp Dermatol 25: 236-240.

  10. Cetkovska P (2004) Autoimunitnibuloznidermatozy. Ces-slov Derm 81: 188-196

  11. Pan J, Shirota T, Ohno K, Michi K (2000) Effect of ovariectomy on bone remodeling adjacent to hydroxyapatite-coated implants in the tibia of mature rats. J Oral Maxillofac Surg 58: 877-882.

  12. Altin N, Ergun S, Katz J, Sancakli E, Koray M, et al. (2013) Implant-supported oral rehabilitation of a patient with pemphigus vulgaris: a clinical report. J Prosthodont 22: 581-586.

  13. Donos N, Calciolari E1 (2014) Dental implants in patients affected by systemic diseases. Br Dent J 217: 425-430.

  14. Binon PP (2005) Thirteen-year follow-up of a mandibular implant-supported fixed complete denture in a patient with Sjogren's syndrome: a clinical report. J Prosthet Dent 94: 409-413.

  15. Candel-Marti ME, Ata-Ali J, Peñarrocha-Oltra D, Peñarrocha-Diago M, Bagán JV (2011) Dental implants in patients with oral mucosal alterations: An update. Med Oral Patol Oral Cir Bucal 16: e787-793.

  16. Lodi G, Scully C, Carrozzo M, Griffiths M, Sugerman PB, et al. (2005). Current controversies in oral lichen planus: report of an international consensus meeting. Part 2. Clinical management and malignant transformation. Oral Surg Oral Med Oral Pathol Oral RadiolEndod 100: 164-178

  17. Ismail SB, Kumar SKS, Zain RB (2007) Oral lichen planus and lichenoid reactions: etiopathogenesis, diagnosis, management and malignant transformation. J Oral Sci 49: 89-106.

  18. McCartan BE, Healy CM (2008) The reported prevalence of oral lichen planus: a review and critique. J Oral Pathol Med 37: 447-453.

  19. Scully C, Carrozzo M (2008) Oral mucosal disease: Lichen planus. Br J Oral Maxillofac Surg 46: 15-21.

  20. Gonzalez-Moles MA, Scully C, Gil-Montoya JA (2008) Oral lichen planus: controversies surrounding malignant transformation. Oral Dis 14: 229-243.

  21. Thornhill MH, Pemberton MN, Simmons RK, Theaker ED (2003) Amalgam-contact hypersensitivity lesions and oral lichen planus. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 95: 291-299.

  22. Al-Hashimi I, Schifter M, Lockhart PB, Wray D, Brennan M, et al. (2007) Oral lichen planus and oral lichenoid lesions: diagnostic and therapeutic considerations. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 103 Suppl: S25.

  23. Lamey PJ, McCartan BE, MacDonald DG, MacKie RM (1995) Basal cell cytoplasmic autoantibodies in oral lichenoid reactions. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 79: 44-49.

  24. Potts AJ, Hamburger J, Scully C (1987) The medication of patients with oral lichen planus and the association of nonsteroidal anti-inflammatory drugs with erosive lesions. Oral Surg Oral Med Oral Pathol 64: 541-543.

  25. Esposito SJ, Camisa C, Morgan M (2003) Implant retained overdentures for two patients with severe lichen planus: a clinical report. J Prosthet Dent 89: 6-10.

  26. Czerninski R, Eliezer M, Wilensky A, Soskolne A (2013) Oral lichen planus and dental implants--a retrospective study. Clin Implant Dent Relat Res 15: 234-242.

  27. Sharma AB, Vargervik K (2006) Using implants for the growing child. J Calif Dent Assoc 34: 719-724.

  28. Percinoto C, Vieira AE, Barbieri CM, Melhado FL, Moreira KS (2001) Use of dental implants in children: a literature review. Quintessence Int 32: 381-383.

  29. Daay C, Bezgin T, A-zalp N (2014) Dental management of patients with epidermolysis bullosa. Oral Health Dent Manag 13: 623-627.

  30. Peñarrocha-Diago M, Serrano C, Sanchis JM, Silvestre FJ, Bagán JV (2000) Placement of endosseous implants in patients with oral epidermolysis bullosa. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 90: 587-590.

  31. Penarrocha M, Rambla J, Balaguer J, Serrano C, Silvestre J, et al. (2007) Complete fixed prostheses over implants in patients with oral epidermolysis bullosa. J Oral Maxillofac Surg 65: 103-106.

  32. Burket LW (1984) Burket's oral medicine, diagnosis and treatment (7th edn) Philadelphia: JB Lippincott 483-485.

  33. McCord JF, Tyson KW, Blair IS (1989) A sectional complete denture for a patient with microstomia. J Prosthet Dent 61: 645-647.

  34. Langer Y, Cardash HS, Tal H (1992) Use of dental implants in the treatment of patients with scleroderma: a clinical report. J Prosthet Dent 68: 873-875.

International Journal of Anesthetics and Anesthesiology (ISSN: 2377-4630)
International Journal of Blood Research and Disorders   (ISSN: 2469-5696)
International Journal of Brain Disorders and Treatment (ISSN: 2469-5866)
International Journal of Cancer and Clinical Research (ISSN: 2378-3419)
International Journal of Clinical Cardiology (ISSN: 2469-5696)
Journal of Clinical Gastroenterology and Treatment (ISSN: 2469-584X)
Clinical Medical Reviews and Case Reports (ISSN: 2378-3656)
Journal of Dermatology Research and Therapy (ISSN: 2469-5750)
International Journal of Diabetes and Clinical Research (ISSN: 2377-3634)
Journal of Family Medicine and Disease Prevention (ISSN: 2469-5793)
Journal of Genetics and Genome Research (ISSN: 2378-3648)
Journal of Geriatric Medicine and Gerontology (ISSN: 2469-5858)
International Journal of Immunology and Immunotherapy (ISSN: 2378-3672)
International Journal of Medical Nano Research (ISSN: 2378-3664)
International Journal of Neurology and Neurotherapy (ISSN: 2378-3001)
International Archives of Nursing and Health Care (ISSN: 2469-5823)
International Journal of Ophthalmology and Clinical Research (ISSN: 2378-346X)
International Journal of Oral and Dental Health (ISSN: 2469-5734)
International Journal of Pathology and Clinical Research (ISSN: 2469-5807)
International Journal of Pediatric Research (ISSN: 2469-5769)
International Journal of Respiratory and Pulmonary Medicine (ISSN: 2378-3516)
Journal of Rheumatic Diseases and Treatment (ISSN: 2469-5726)
International Journal of Sports and Exercise Medicine (ISSN: 2469-5718)
International Journal of Stem Cell Research & Therapy (ISSN: 2469-570X)
International Journal of Surgery Research and Practice (ISSN: 2378-3397)
Trauma Cases and Reviews (ISSN: 2469-5777)
International Archives of Urology and Complications (ISSN: 2469-5742)
International Journal of Virology and AIDS (ISSN: 2469-567X)
More Journals

Contact Us

ClinMed International Library | Science Resource Online LLC
3511 Silverside Road, Suite 105, Wilmington, DE 19810, USA
Email: contact@clinmedlib.org
 

Feedback

Get Email alerts
 
Creative Commons License
Open Access
by ClinMed International Library is licensed under a Creative Commons Attribution 4.0 International License based on a work at https://clinmedjournals.org/.
Copyright © 2017 ClinMed International Library. All Rights Reserved.