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Clinical Case Report

Oral Lichen Planus Associated with the Peri-implant Mucosa

Agnieszka Frydrych

This case describes the ongoing management of a 64-year-old healthy, non-smoking female patient with erosive oral lichen planus (OLP) affecting the gingivae and the buccal and lingual mucosa. The peri-implant mucosa was also affected subsequent to implant placement. The patient had osseointegrated implants (four in the maxilla, four in the mandible) placed following extraction of hopeless teeth and a healing period. The patient had a history of OLP prior to implant placement and had been referred to an oral-medicine specialist for definitive diagnosis and treatment. She exhibited generalized oral mucosal involvement. Following a clinical assessment, biopsy, and blood tests, she was treated with topical corticosteroids. Systemic prednisolone was reserved for severe flare-ups. Amphotericin lozenges were used in combination with corticosteroid treatment to prevent the development of oral candidiasis.
Surgical SAC classification
Complex
Prosthodontic SAC classification
Complex
Source
Treatment Guide 8
Purchase price
10 Academy Coins
CPD/CME
0.15 hours

Recommended content

General information

Case Type Edentulous Maxilla
Jaw Maxilla and Mandible
Area Full-Arch|Posterior
# of Teeth All
# of Implants 8
Type of Implants Two-Piece
Attachment Two-Piece
Bone Augmentation No
Augmentation Materials -
Guided Surgery No
Soft Tissue Grafting None
Abutment Type Standard
Prosthesis Type FDP

Esthetic Risk Assessment

Esthetic Risk Factors Low Medium High
Medical Status Healthy Compromised
Smoking Habit Non-smoker Light smoker (< 10 cigarettes per day) Heavy smoker (≥ 10 cigarettes per day)
Patient's Esthetic Expectations Low Medium High
Lip Line No exposure of papillae Exposure of papillae Full exposure of mucosa margin
Periodontal Phenotype Low-scalloped, thick Medium-scalloped, medium-thick High-scalloped, thin
Shape of Tooth Crowns Rectangular Triangular
Infection at Implant Site None Chronic Acute
Bone Level at Adjacent Teeth ≤ 5 mm to contact point 5.5 to 6.5 mm to contact point > 7 mm to contact point
Prosthodontic Status of Neighboring Teeth Virgin Restored
Width of Edentulous Span 1 tooth (≥ 7 mm) 1 tooth (< 7 mm) 2 teeth or more
Soft Tissue Anatomy Intact Defective
Bone Volume Horizontally and vertically sufficient Horizontally deficient Deficient vertically or deficient vertically AND horizontally

  • * General SAC assessment modifiers that are also part of the ERA. To avoid redundancy they are listed in this section even if no complete ERA has been made.

  • ** Not applicable to the ERA of immediate placement cases and replaced by "Socket Integrity" listed below under "Surgical SAC Classification". For all other placement types this value is a classification determinant and listed here even if no complete ERA has been made.

Surgical SAC classification

SAC Level Complex
Defining Characteristics Fully edentulous upper jaw to be rehabilitated with four or more implants
Modality Fixed hybrid bridge on 5+ implants
Placement Protocol -
Tooth Site -
Socket Morphology -
Socket Integrity -
Bone Volume Deficient vertically or deficient vertically AND horizontally
Anatomic Risk High
Esthetic Risk Medium
Complexity High
Risk of Complications High

Prosthodontic SAC classification

SAC Level Complex
Defining Characteristics Fully edentulous upper jaw to be rehabilitated with an implant-borne fixed dental prosthesis
Loading Protocol Conventional or early
Retention Screw-retained, with 4 or more splinted implants Screw-retained, with 4 or more splinted implants
Maxillomandibular Relationship -
Mesio-Distal Space -
Inter-Arch Distance Average
Bruxism Absent
Esthetic Risk Medium
Provisional Implant-Supported Prosthesis Prosthodontic margin < 3 mm apical to mucosal crest Prosthodontic margin < 3 mm apical to mucosal crest
Interim Prosthesis during Healing Removable Removable
Occlusion/Articulation -
Occlusal Scheme/Issues Anterior guidance

Surgical SAC Modifiers

Periodontal Status History of periodontitis or genetic predisposition

Prosthodontic SAC Modifiers

Soft Tissue Contour and Volume Significantly deficient

General SAC Modifiers

Oral Hygiene and Compliance Sufficient
Access Adequate
Craniofacial/Skeletal Growth Completed
Publication date: Mar 29, 2016 Last review date: Mar 24, 2021 Next review date: Mar 24, 2024

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