国际口腔医学杂志 ›› 2021, Vol. 48 ›› Issue (2): 147-155.doi: 10.7518/gjkq.2021020

• 口腔黏膜病专栏 • 上一篇    下一篇

常见口腔黏膜疾病患者行种植修复相关问题的研究进展

冯璐1,2(),孟文霞1()   

  1. 1.南方医科大学口腔医院黏膜科 广州 510008
    2.北海市人民医院口腔科 北海 536000
  • 收稿日期:2020-06-15 修回日期:2020-11-10 出版日期:2021-03-01 发布日期:2021-03-17
  • 通讯作者: 孟文霞
  • 作者简介:冯璐,医师,硕士,Email: 350343180@qq.com
  • 基金资助:
    国家自然科学基金(81500850)

Research progress on the problems of dental implant treatment in patients with common oral mucosal disease

Feng Lu1,2(),Meng Wenxia1()   

  1. 1. Dept. of Oral Medicine, Stomatological Hospital, Southern Medical University, Guangzhou 510008, China
    2. Dept. of Stomatology, Beihai People ,s Hospital, Beihai 536000, China
  • Received:2020-06-15 Revised:2020-11-10 Online:2021-03-01 Published:2021-03-17
  • Contact: Wenxia Meng
  • Supported by:
    National Natural Science Foundation of China(81500850)

摘要:

随着修复技术的发展及人们对生活质量要求的提高,伴有缺牙的口腔黏膜病患者行种植修复的需求越来越高。受口腔黏膜病困扰的缺牙患者行种植修复是否可行,效果如何目前并无定论,亦无针对口腔黏膜病患者行种植修复的相关治疗指南。本文就常见的口腔黏膜病(如口腔扁平苔藓、自身免疫性大疱性疾病和舍格伦综合征等)患者行种植修复的相关研究进展进行综述,以期为种植医生提供一定的临床帮助。

关键词: 口腔扁平苔藓, 自身免疫性大疱性疾病, 舍格伦综合征, 种植修复

Abstract:

Given advancements in prosthodontics as well as increasing demands for a high quality of life, dental implants for patients with dentition defects and suffering from oral mucosal diseases (OMDs) have received increased attention. However, whether implant treatment is feasible and effective for these patients, as well as the related guidelines, is unknown. This paper reviews the implant-prosthetic rehabilitation progress of patients with common OMDs, such as oral lichen planus, autoimmune bullous disease, and Sjögren,s syndrome. The results of this work serve as a reference for future research on stomatology.

Key words: oral lichen planus, autoimmune bullous disease, Sjögren's syndrome, dental implant

中图分类号: 

  • R781.5

表1

常见口腔黏膜病患者行种植修复的评估"

疾病 系统分析 病例报道例数/例 随访时间 可能的风险因素 风险因素的应对措施 总结
OLP[8] 成功率
98%
100 平均
44.6个月
1)糖皮质激素;
2)其他免疫抑制剂,如他克莫司、环孢素的应用
1)糖皮质激素的使用可能导致骨质疏松,但骨质疏松对种植体长期骨结合的维持无影响;
2)其他免疫抑制剂对骨结合的影响未明确
疾病控制,口内无糜烂溃疡时可行种植修复
LE[21] 1 24个月 1)糖皮质激素的应用;
2)羟氯喹的应用;
3)口腔感染;
4)全身器官损害
1)糖皮质激素的使用可能导致骨质疏松,但骨质疏松对种植体长期骨结合的维持无影响;
2)羟氯喹对骨结合的影响未明确;
3)注意预防口腔念珠菌的感染,教会患者自我保持口腔卫生;
4)术前谨慎评估全身损害,必要时请内科医生会诊
疾病控制,口内无糜烂溃疡时,可考虑行种植修复
寻常型天疱疮[27] 1 32个月 糖皮质激素的应用 糖皮质激素的使用可能导致骨质疏松,但骨质疏松对种植体长期骨结合的维持无影响 疾病控制,口内无糜烂、溃疡、起疱时,可考虑行种植修复
黏膜良性类
天疱疮[27]
1 15年 糖皮质激素的应用 糖皮质激素的使用可能导致骨质疏松,但骨质疏松对种植体长期骨结合的维持无影响 疾病控制,口内无糜烂、溃疡、起疱时,可考虑行种植修复
SS[31] 失败率
4.1%
186 平均
72.5个月
1)唾液分泌功能下降;
2)糖皮质激素的应用;
3)其他药物的应用;
4)继发性SS伴糖尿病
1)SS唾液分泌功能下降,需对症治疗,教会患者保持良好的口腔卫生;
2)糖皮质激素的使用可能导致骨质疏松,但骨质疏松对种植体长期骨结合的维持无影响;
3)甲氨喋呤的应用增加骨折风险,应谨慎对待;
4)伴全身性疾病的SS患者种植修复需谨慎对待
推荐适当条件下在SS患者中行种植修复,但是需要重视术前全身状态的评估,教会患者自我口腔维护,定期 随访
AIDS[47] 成功率
94.76%
169 平均
47.9个月
1)CD4淋巴细胞百分数≤20%,种植体放置于上颌,吸烟及抗逆转录病毒治疗4项因素;
2)骨密度低,骨质疏松风险高
1)术前全身状态评估,CD4淋巴细胞的百分数>20%;
2)口腔内黏膜完整,无黏膜病损;
3)术前、术后抗生素应用控制感染风险必不可少
全身条件许可,口腔黏膜完整,感染风险可控的情况下,可以行种植 修复

图1

口腔黏膜病患者行种植修复的诊疗流程图"

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