Clinical Management Protocol for Dental Implants Inserted in Patients with Active Lichen Planus

Purpose: To propose a treatment protocol for management of implant candidates suffering from active lichen planus.

Materials and methods: Twenty-three patients who were diagnosed with active lichen planus were referred to a dental practice seeking dental implants. Patients received dental implants using open flap technique and sequential osteotomy. After a healing time of 6 weeks, implants were put into occlusal contact using interim prostheses. Of the 55 inserted implants, 42 failed after a short clinical service time (7 to 11 weeks). Failed implants were surgically removed, and osteotomy sites were carefully cleaned using manual curettes and scrubbing of osteotomy walls. CD4/CD8 cell count and gingival biopsies were collected from the surgical sites. Patients were put on an ascending dose (5 mg/10 days) of oral corticosteroids until a daily dose of 20 mg/day was achieved and maintained for 2 weeks. All patients received ten sessions of low-energy soft tissue laser irradiation at the implant insertion sites to assess soft tissue healing through improving blood circulation, reduction of inflammation, and sterilization of the osteotomy region. After approximately 8 weeks, a new set of 42 implants was placed, and definitive restorations were cemented using early loading technique. Marginal bone levels around inserted implants were periodically evaluated every 3 months using digital periapical radiographs (α = 0.05).

Results: Primary blood tests revealed a high CD8 cell count, while soft tissue biopsies revealed infiltration of inflammatory cells at the epithelium soft tissue interface of the examined tissue. Repetition of immunological investigations after administration of the oral corticosteroids and soft tissue laser irradiation revealed reduction of CD8 cell counts and disappearance of inflammatory cell infiltration of the examined soft tissue biopsy. Patients reported marked improvement of the oral mucosa after treatment. All implants (n = 42) were functional after 3 years of clinical observation. There was an initial reduction in marginal bone level after 3 months from insertion time, after which it remained constant during the following observation periods.

Conclusion: Active lichen planus should be managed with oral corticosteroids and soft tissue laser irradiation before insertion of dental implants.