PDF(Pubmed)
Abstract：
BACKGROUND: In older patients with progressive neurodegeneration, replacing fixed implant-supported prostheses (FIP) with implant overdentures (IOD) has been proposed to prevent future mucosal injury and create an oral environment that is easier for caregivers to clean. However, there have been no reports on the progress after replacing FIP with IOD. In this report, we present the progress of an older patient with Parkinson\'s disease in whom FIP was replaced with IOD.
METHODS: An 81-year-old male patient with Parkinson\'s disease presented to our outpatient clinic with bruxism and crossbites. FIPs, with five Brånemark system implants, were placed in the bilateral lower molars. The FIP was replaced with an IOD with two locator attachments to create an oral environment that was easier for caregivers to clean and allow easy recovery of masticatory function if residual teeth were fractured in the care environment. As his systemic condition deteriorated, treatment was changed from outpatient to in-home visits. During dental care visits, professional oral cleaning and denture repair were continued, and good nutritional status was maintained. However, the patient developed cholecystitis and was hospitalized. During hospitalization, gastrostomy was performed because he developed aspiration pneumonia. After discharge from the hospital, the patient remained in bed all day and could not wear an IOD, resulting in buccal mucosa ulceration due to abrasion of the locator abutment. We decided to replace the abutment with cover screws; however, not all the implants could sleep submucosally. Although regular oral cleaning was resumed, new ulcers developed even when cover screws were installed. Additionally, swelling and drainage were observed at the peri-implant mucosal site where peri-implantitis had once occurred during an outpatient visit. The patient was readmitted to the hospital for a urinary tract infection, and subsequent visits were abandoned.
CONCLUSIONS: By replacing FIP with IOD in an older patient with Parkinson\'s disease, we addressed a barrier to caregiver-provided oral management. The removable prosthesis facilitated smooth oral care by caregivers and functional recovery in the event of trouble with residual teeth. However, it could not completely avoid the recurrence of buccal mucosal ulcers or peri-implantitis.
METHODS: An 81-year-old male patient with Parkinson\'s disease presented to our outpatient clinic with bruxism and crossbites. FIPs, with five Brånemark system implants, were placed in the bilateral lower molars. The FIP was replaced with an IOD with two locator attachments to create an oral environment that was easier for caregivers to clean and allow easy recovery of masticatory function if residual teeth were fractured in the care environment. As his systemic condition deteriorated, treatment was changed from outpatient to in-home visits. During dental care visits, professional oral cleaning and denture repair were continued, and good nutritional status was maintained. However, the patient developed cholecystitis and was hospitalized. During hospitalization, gastrostomy was performed because he developed aspiration pneumonia. After discharge from the hospital, the patient remained in bed all day and could not wear an IOD, resulting in buccal mucosa ulceration due to abrasion of the locator abutment. We decided to replace the abutment with cover screws; however, not all the implants could sleep submucosally. Although regular oral cleaning was resumed, new ulcers developed even when cover screws were installed. Additionally, swelling and drainage were observed at the peri-implant mucosal site where peri-implantitis had once occurred during an outpatient visit. The patient was readmitted to the hospital for a urinary tract infection, and subsequent visits were abandoned.
CONCLUSIONS: By replacing FIP with IOD in an older patient with Parkinson\'s disease, we addressed a barrier to caregiver-provided oral management. The removable prosthesis facilitated smooth oral care by caregivers and functional recovery in the event of trouble with residual teeth. However, it could not completely avoid the recurrence of buccal mucosal ulcers or peri-implantitis.
摘要：
背景：在进行性神经变性的老年患者中，有人建议用种植体覆盖义齿(IOD)代替固定的种植体支撑假体(FIP),以防止未来的粘膜损伤,并创造更易于护理人员清洁的口腔环境.然而,没有关于用IOD替换FIP后的进展报告。在这份报告中,我们介绍了1例老年帕金森病患者的进展，其中FIP被IOD替代。
方法：一名患有帕金森病的81岁男性患者出现磨牙症和交叉咬伤到我们的门诊诊所就诊。FIPS,有五个布拉纳马克系统植入物，放置在双侧下磨牙中。将FIP替换为带有两个定位器附件的IOD，以创建口腔环境，如果在护理环境中残牙断裂，则护理人员更容易清洁并易于恢复咀嚼功能。随着他全身状况的恶化,治疗从门诊改为家庭访视.在牙科护理访问期间，继续进行专业的口腔清洁和义齿修复，并保持良好的营养状况。然而,患者出现胆囊炎并住院。住院期间,胃造口术是因为他出现了吸入性肺炎。出院后,患者整天躺在床上，无法佩戴IOD，由于定位器基台的磨损而导致颊粘膜溃疡。我们决定用盖螺钉更换基台；然而，不是所有的植入物都能在粘膜下睡觉.尽管恢复了定期的口腔清洁，即使安装了盖螺钉，也会出现新的溃疡。此外,在门诊就诊时曾经发生过种植体周围炎的种植体周围粘膜部位观察到肿胀和引流.病人因尿路感染再次入院,随后的访问被放弃。
结论：在患有帕金森病的老年患者中，通过用IOD代替FIP，我们解决了护理人员提供口腔管理的障碍.可移除的假体有助于护理人员的顺利口腔护理，并在残牙出现问题时促进功能恢复。然而,它不能完全避免口腔黏膜溃疡或种植体周围炎的复发。
方法：一名患有帕金森病的81岁男性患者出现磨牙症和交叉咬伤到我们的门诊诊所就诊。FIPS,有五个布拉纳马克系统植入物，放置在双侧下磨牙中。将FIP替换为带有两个定位器附件的IOD，以创建口腔环境，如果在护理环境中残牙断裂，则护理人员更容易清洁并易于恢复咀嚼功能。随着他全身状况的恶化,治疗从门诊改为家庭访视.在牙科护理访问期间，继续进行专业的口腔清洁和义齿修复，并保持良好的营养状况。然而,患者出现胆囊炎并住院。住院期间,胃造口术是因为他出现了吸入性肺炎。出院后,患者整天躺在床上，无法佩戴IOD，由于定位器基台的磨损而导致颊粘膜溃疡。我们决定用盖螺钉更换基台；然而，不是所有的植入物都能在粘膜下睡觉.尽管恢复了定期的口腔清洁，即使安装了盖螺钉，也会出现新的溃疡。此外,在门诊就诊时曾经发生过种植体周围炎的种植体周围粘膜部位观察到肿胀和引流.病人因尿路感染再次入院,随后的访问被放弃。
结论：在患有帕金森病的老年患者中，通过用IOD代替FIP，我们解决了护理人员提供口腔管理的障碍.可移除的假体有助于护理人员的顺利口腔护理，并在残牙出现问题时促进功能恢复。然而,它不能完全避免口腔黏膜溃疡或种植体周围炎的复发。
