Lupus erythematodes und dentale Implantate?

Implants in patients with oral manifestations of autoimmune or muco-cutaneous diseases – A systematic review.
Med Oral Patol Oral Cir Bucal.2019 Mar 1;24(2):e217-e230. doi: 10.4317/medoral.22786.
Implants in patients with oral manifestations of autoimmune or muco-cutaneous diseases – A systematic review.
Strietzel FP, Schmidt-Westhausen AM, Neumann K, Reichart PA, Jackowski J.
BACKGROUND:
To give an overview on implant survival rates in patients with oral manifestations of systemic autoimmune (oral Lichen planus (oLp), Pemphigus (Pe)), muco-cutaneous (Epidermolysis bullosa (EB)), autoimmune multisystemic rheumatic diseases (Sjögren’s syndrome (SjS), systemic Lupus erythematosus (sLE), or systemic Sclerosis (sSc)).
MATERIAL AND METHODS:
Systematic literature review (PubMed/Medline, Embase) using MESH and search term combinations, published between 1980 and August 2018 in English language reporting on dental implant-prosthetic rehabilitation of patients with oLp, Pe, EB, SjS, sLE, sSc, study design, age, gender, follow-up period (≥ 12 months), implant survival rate. Implant-related weighed mean values of implant survival rate (wmSR) were calculated.
RESULTS:
After a mean follow-up period (mfp) of 44.6 months, a wmSR of 98.3 % was calculated from data published for patients with oLp (100 patients with 302 implants). Data of 27 patients (152 implants) with EB revealed wmSR of 98.7 % following mfp of 32.6 months. For 71 patients (272 implants) with SjS, wmSR was 94.2 % following a mfp of 45.2 months, and for 6 patients (44 implants) with sSc, wmSR was 97.7 % after mfp of 37.5 months. One case report on one patient each with Pe (two implants) as well as sLE (6 implants) showed 100 % SR following at least 24 months.
CONCLUSIONS:
Guidelines regarding implant treatment of patients with oLp, Pe, EB, SjS, sLE or sSc do not exist nor are contraindicating conditions defined. Implant survival rates of patients affected are comparable to those of healthy patients. For implant-prosthetic rehabilitation of patients with Pe and sLE no conclusions can be drawn due to lack of sufficient clinical data. Implant-prosthetic treatment guidelines regarding healthy patients should be strictly followed, but frequent recall is recommended in patients affected with oLp, SjS, EB, SSc, Pe or sLE.
Zusammenfassung
Es gibt aktuell keine Leitlinien zur Implantatbehandlung von Patienten mit oLP, Pe, SjS, sLE oder sSc und es sind auch keine Kontraindikationen definiert. Die Implantat-Überlebensraten der betroffenen Patienten sind mit denen gesunder vergleichbar. Für implantat-prothetische Versorgungen können für Patienten mit Pe oder sLE aufgrund der mangelnden Datenlage keine Schlüsse gezogen werden. Die allgemeinen Leitlinien für implantatprothetische Versorgungen sollten strikt eingehalten werden, und es wird für von oLp, SjS, EB, SSc, Pe oder sLE betroffene Patienten ein engmaschiger Recall empfohlen.

Prosthetically Driven Therapy for a Patient With Systemic Lupus Erythematosus and Common Variable Immunodeficiency: A Case Report.
J Oral Implantol.2018 Dec;44(6):447-455. doi: 10.1563/aaid-joi-D-18-00046. Epub 2018 Jul 23.
Prosthetically Driven Therapy for a Patient With Systemic Lupus Erythematosus and Common Variable Immunodeficiency: A Case Report.
Drew A, Bittner N, Florin W, Koch A.
Patients who have systemic diseases in conjunction with severely resorbed maxillary and mandibular bone present challenges for dental implant therapy and rehabilitation. This case report describes the interdisciplinary comprehensive treatment completed on a patient with systemic lupus erythematosus (SLE) and common variable immunodeficiency (CVID). Patients with these systemic conditions present a multifactorial challenge for dental treatment due to advanced carious lesions, missing teeth, lack of adequate bone quality and quantity, as well as secondary effects of their medications. The sequence of treatment presented allowed for the necessary case control to ensure successful, predictable reconstruction of the edentulous patient with limited bone available for implant placement. For this patient, we used a combination of autogenous iliac bone graft, bilateral maxillary sinus lifts with BMP-2, transitional implants, and dental endosseous root form implants. Digital dentistry aided in designing the final implant supported fixed restorations. Transitional implants eliminated the need for tissue-borne prostheses, avoiding pressure to the graft and implants. Digital dentistry allowed for prosthetically driven implant placement and a functional, esthetic result. The techniques and staging presented for implant placement and rehabilitation can be used for other patients presenting with similar challenging conditions.
Zusammenfassung
Die Autoren sehen Patienten mit SLE oder Autoimmunerkrankungen als schwer kompromittierte und als Risikopatienten und empfehlen eine digital gestützte, prothetisch orientierte Planung und den Einsatz einer provisorischen Implantatversorgung (Mini-Implantate) um den Druck einer Übergangsprothese auf Augmentate, Implantate, aber auch Weichgewebe zu vermeiden.

Implant-supported oral rehabilitation of a patient with systemic lupus erythematosus: case report and review of the literature.
Quintessence Int.2010 Nov-Dec;41(10):863-7.
Implant-supported oral rehabilitation of a patient with systemic lupus erythematosus: case report and review of the literature.
Ergun S, Katz J, Cifter ED, Koray M, Esen BA, Tanyeri H.
Systemic lupus erythematosus (SLE) is a chronic inflammatory autoimmune disease with multisystemic involvement. Immune-suppressive drugs used in the treatment of the disease can increase the risk of infection and delay healing, which are of concern in dental-treatment procedures. Because of the involvement of the salivary glands, the composition and amount of saliva released are usually altered in patients with SLE. Significantly lowered salivary flow rate causes difficulties during dental procedures and makes it difficult to maintain oral hygiene and conserve both fixed and removable prostheses. This case report presents a patient who had an extremely dry mouth and oral lesions due to SLE and describes how oral rehabilitation was achieved with implant-supported fixed dentures. To the best of our knowledge, this is the first report of the use of oral implants in a patient with SLE. Dental practitioners should consider dental implants as a preferred treatment choice in the oral rehabilitation of patients with SLE.
Zusammenfassung
Der Einsatz von Immunsuppressiva bei Patienten mit SLE erhöht das Infektionsrisiko und verzögert die Heilung. Meist besteht auch erhöhte Mundtrockenheit mit den bekannten Nebenwirkungen bzw. Erschwernissen einer funktionalen Mundhygiene. In diesem Fall wurde ein Patient mit SLE und extremer Mundtrockenheit und dadurch bedingten oralen Läsionen mit einer implantatgestützten festsitzenden Prothese versorgt. Der Autor der aus 2010 stammenden Arbeit sieht in einer Implantatversorgung sogar die Behandlung der Wahl für Patienten mit SLE.