Oral Lichen Planus and a failing dental implant: approach?
I have a 72 year old white female patient with a long history of Lichen Planus. She had an implant that was placed 16 years ago. There is a 6 mm facial pocket with suppuration. Is an implant patient with Lichen Planus treated with a different approach?
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7 Comments on Oral Lichen Planus and a failing dental implant: approach?
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CRS
3/21/2014
I would treat it as a surgical perimplantitis, no promises. I think sixteen years is great.
CRS
3/25/2014
Six mm is a large defect conservative non surgical treatments are not of much use with a Periimplantitis it needs to be treated. When this implant does fail it will cause additional bone loss. LAPIP is a conservative option vs an open technique which is what I would use. The time for water pick and super floss has past get her to someone who can treat this or you'll just be watching this fail. Sixteen years is great, but intervention is needed no promises there is a 50% success rate with this, then removal grafting and/or replacement vs bridge but the defect needs to be fixed. Super floss and hygiene are great options for a soft tissue problem not a bony defect since there is no PDL, this is treated like an isolated osteomyelitis , good luck.
ttmillerjr
3/23/2014
Is there gingiva on the facial? 6mm isn't too bad. Get her using a Waterpik and Superfloss, often times these can be stabilized. If no or minimal gingiva consider recommending an FGG.
Kaz
3/25/2014
This is not going to heal just with a water pic. She needs to either do Lapip or a surgical procedure. The recent article by Froum in the 2012 Int J of Perio and Rest seems very promising and effective.
JockularDocSez
4/1/2014
If she is asyptomatic, what you have is a successful implant with a 6 mm supportive facial defect which if kept clean (WaterPik) etc will probably be around till she passes. Would consider a surgical procedure if she's willing to possibly become symptomatic and possibly loose the implant prematurely. Don't think LP changes anything, hope it is Bx proven and not visually Diagnosed.
CRS
4/2/2014
You have a point " benign neglect" if you wait a few years it will be easy to remove hopefully she won't live long sounds pessimistic. Sixteen years is getting to the end of this implants shelf life. I think I would be honest with the patient. Salvaging these implants as a suggested has about a 50% success rate and since it is a minimally invasive procedure I feel it is worth a try unless this patient has a terminal illness or is debilitated. Remember allowing an active inflammation to be untreated has a oral systemic connection. I would treat because I have a protocol the patient could always be referred for care.
Jaw doc
7/7/2014
The only appreciable link between LP & implants will be that of immunosuppression ( if she's on drugs like azathioprine etc) that increases susceptibility to perio diseases. Even then, a rigorous OH regime helps a lot. This is probably a case of oral hygiene neglect.
