Title Implant Rehabilitation Is a Successful and Long-term Treatment Option for Patients with Oral Lichen Planus (OLP)
Clinical Question In patients diagnosed with oral lichen planus (OLP), can implant rehabilitation be a successful and long-term treatment option?
Clinical Bottom Line Implant rehabilitation is a successful and long-term treatment option for patients with oral lichen planus. This is supported by systematic reviews with between 259 – 615 implants showing high success and low failure rates with follow-up times between 6 months and 13 years. OLP has been considered as a condition leading to a higher risk of developing peri-implantitis, but patients with OLP can still benefit from implant rehabilitation. Overall, authors recommend implants as a rehabilitative option for patients with OLP but also call for more research to be done; more well-designed studies should be conducted to improve available information on the topic.
Best Evidence  
PubMed ID Author / Year Patient Group Study type
(level of evidence)
33371347Terrejon-Moya/202114 articles with 97 patients and 334 implantsMeta-Analysis
Key resultsImplant survival rates in patients with OLP is similar to patients without OLP. Meta-analysis of 48 patients with OLP and 48 without OLP showed an odds ratio of 2.48 (95% CI 0.34-18.1) with follow-up times ranging between 6 and 108 months.
32012782Chrcanovic/202022 publications with 230 patients and 615 implantsSystematic review of non-randomized trials
Key resultsFailure rates of dental implants in patients with OLP were very low at 2.7% with a follow-up time of approximately 5 years. One study presented very high rates of failure in patients with “active Lichen Planus” which conflicted with the findings of the other articles included in the review. Patients who developed oral squamous cell carcinoma (OSCC) were also excluded due to high rates of implant loss; implants were removed with the tumor and not from implant failure. When findings of the paper with very high failure rates and patients with OSCC were excluded, failure rates were very low. For failed implants, the time between implant placement and implant failure was 25.4 +/- 32.6 months.
30176217Fu/201913 publications with 86 patients and 259 implantsCase Report & Systematic review of non-randomized trials
Key resultsThe case report follows a patient with severe OLP who underwent successful implant rehabilitation with a 3 year follow-up. Dental implants have a high survival rate of 95.8% with a follow period of 1 – 13 years. Patients who developed OSCC were excluded from the study as the implants were removed with the tumor.
Evidence Search Oral Lichen Planus, Oral mucosa disease AND Implant rehabilitation
Comments on
The Evidence		 Strict inclusion and exclusion criteria were provided in these papers, but there lacked uniformity on the methods used to diagnose OLP; there was also variation as to what kind of OLP was included in the studies. For example, Terrejon-Moya et al / 2021 mentioned that up to 46.6% of patients included in their review may not have been correctly diagnosed with OLP. Of the three papers cited, one had no language exclusions, one looked at papers in English and Spanish and one looked at only papers in the English language, which reduced the numbers of excluded non-English results in this CAT. In the three papers included in this review, when looking at what kinds of studies were included by the authors from their searches, a wide range in study quality is seen. Meta-analysis, systematic reviews, clinical studies to case reports were reviewed and both prospective and retrospective studies were included in the reviews across all three papers. Quality assessment of the individual included studies was either not performed or not reported in all three papers cited. Looking at the three papers, there were higher quantities of low-level evidence (case reports) included in the reviews by the authors. This produces an overall lower quality of evidence, and results should be interpreted with caution. It was not clearly stated how other confounding factors that may lead to implant failure were accounted for. For example, Chrcanovic et al/2020 mention that it is not clear if OLP plays the most significant role in implant failure when included with other confounding conditions which may influence implant failure. The reviews all provided similar results and recommend that patients with OLP can be treated successfully with implants, but more research needs to be done to strengthen the available evidence.
Applicability Oral Lichen planus is an autoimmune and inflammatory disease that affects 1-2% of the population, with a higher prevalence in older women. A small percentage of patients with OLP develop OSCC. Implant rehabilitation is a well recommended and successful treatment option for patients. It has been suggested that OLP should be considered a risk factor for implant failure due to inflammatory properties of the mucosa reducing successful mucosa to implant attachment and leading to a higher risk of developing peri-implantitis. The evidence provided acts as a guideline for clinicians treating patients with OLP. This evidence suggests that patients with OLP in need of implant rehabilitation can be treated successfully. OLP is not a contraindication for implant placement and patients can have long-term success with implant rehabilitation.
Specialty (Oral Medicine/Pathology/Radiology) (General Dentistry) (Oral Surgery) (Periodontics) (Prosthodontics) (Restorative Dentistry) (Interprofessional CATs)
Keywords Oral Lichen Planus, OLP, Oral mucosal disease, implant success, implant rehabilitation.
ID# 3488
Date of submission 12/09/2021
E-mail udeh@uthscsa.edu
Author Cynthia Udeh, DDS
Co-author(s) Kellen McWhorter, DMD
Co-author(s) e-mail mcwhorterr1@uthscsa.edu
Faculty mentor Dr. Panagiotis Gakis, DDS, MS, FACP
Faculty mentor e-mail gakis@uthscsa.edu
   
Basic Science Rationale
(Mechanisms that may account for and/or explain the clinical question, i.e. is the answer to the clinical question consistent with basic biological, physical and/or behavioral science principles, laws and research?)
None available
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Comments and Evidence-Based Updates on the CAT
(FOR PRACTICING DENTISTS', FACULTY, RESIDENTS and/or STUDENTS COMMENTS ON PUBLISHED CATs)
None available