Regression of oral lichenoid lesions after replacement of dental restorations

Oral Lichenoid Lesion following Dental Implant Placement and Successful Management with Free Gingival Graft: A Case Report with 10-Year Follow-Up

Titanium and metal alloys are widely used in implants, crowns, and bridges in implant dentistry owing to their biocompatibility. In this case report of a 45-year-old female patient, multiple implants were placed in five different sextants at different time points. Notably, oral lichenoid lesions (OLL) occurred in three sextants following implant placement, strongly suggesting that the dental implants or prostheses were the causative factors for OLL. The lesion was of the reticular type with erythematous surroundings and was symptomatic. Although several conservative treatments, including repeated topical application of corticosteroids, were repeatedly continued, no discernible improvement or alleviation of symptoms was observed. Consequently, surgical excision and replacement of the lesion with a free gingival graft (FGG) harvested from the palatal soft tissue were performed. No clinical symptoms or recurrence of lesions were observed during 10 years of follow-up post-FGG.

Lymphocyte and CD62E expression in lichen planus and lichenoid reaction

Background

It is difficult to distinguish the clinical and histopathological aspects of oral lichen planus lesions from those of oral lichenoid reaction. Some criteria were proposed to distinguish them, mainly because they have different biological behaviors. The aim of the present study was to compare the lymphocyte population and the expression of E-selectin between these lesions.

Methods

Participants with a clinical diagnosis of oral lichen planus (GOLP) and oral lichenoid reaction (GOLR) who needed to perform a biopsy were selected. The tissue was frozen and immunostaining was performed for CD3/CD4, CD3/CD8, CD4/CLA, CD8/CLA, and CD62E. The analysis of each immunostaining was accomplished using the ImageJ program.

Results

In total, 25 participants with oral lichen planus and 11 with oral lichenoid reaction were seen. In the evaluation of CD3 + CD4+/CD3 + and CD3 + CD8+/CD3 + proportions, there was a higher percentage of these cells in the oral lichen planus group when compared with the oral lichenoid reaction group (p = 0.027 and p = 0.038 respectively). The average number of CLA + lymphocytes for CD4+/CLA + and CD8+/CLA + in both groups was not statistically significant (p = 0.840; d = 0.363). In GOLP, the number of CD4 + CLA+/E-selectin and CD8 + CLA+/E-selectin was not statistically significant (p = 0.951 and p = 0.454 respectively); neither in GOLR (p = 0.454 and p = 0.989 respectively).

Conclusion

Our results indicate that CD3 + CD4+, CD3 + CD8+, CD4 + CLA+, CD8 + CLA + lymphocytes and E-selectin are present in both lesions. However, the proportion of CD3 + CD4+/CD3 + and CD3 + CD8/CD3 + cells is higher in the oral lichen planus group when compared with the oral lichenoid reaction group, suggesting that these cells may be important for the etiopathogenic mechanism of these lesions.

French guidelines for the management of oral lichen planus (excluding pharmacological therapy)

INTRODUCTION

Oral lichen is a chronic inflammatory disease for which diagnostic management and follow-up are heterogeneous given the absence of specific guidelines in France. Our objective was to develop French multidisciplinary guidelines for the management of oral lichen.

MATERIALS AND METHODS

Working groups from the Groupe d'Etude de la Muqueuse Buccale (GEMUB) formulated a list of research questions and the corresponding recommendations according to the "formal consensus" method for developing practice guidelines. These recommendations were submitted to a group of experts and the degree of agreement for each recommendation was assessed by a scoring group.

RESULTS

Twenty-two research questions, divided into 3 themes (nosological classification and initial assessment, induced oral lichenoid lesions, and follow-up) resulted in 22 recommendations. Initial biopsy for histology is recommended in the absence of reticulated lesions. Biopsy for direct immunofluorescence is recommended for ulcerated, erosive, bullous types and for diffuse erythematous gingivitis. Management should include a periodontal and dental check-up, and investigation for extra-oral lesions. Hepatitis C testing is recommended only if risk factors are present. Definitions, triggering factors and the management of "induced oral lichenoid lesions" were clarified. Oral lichen must be monitored by a practitioner familiar with the disease at least once a year, using objective tools.

CONCLUSION

This formalised consensus of multidisciplinary experts provides clinical practice guidelines on the management and monitoring of oral lichen.

Can We Separate Oral Lichen Planus from Allergic Contact Dermatitis and Should We Patch Test? A Systematic Review of Chronic Oral Lichenoid Lesions

This systematic review summarizes characteristics and treatment outcomes of dental amalgam-associated oral lichenoid lesions (OLLs) and oral lichen planus (OLP). Embase and MEDLINE were searched for original studies on OLLs or OLP associated with dental amalgam. Data extraction was completed from 44 studies representing 1855 patients. Removal of amalgam restorations led to complete resolution in 54.2% (n = 423/781), partial resolution in 34.8% (n = 272/781), and no resolution in 11.0% (n = 86/781) of the patients with OLLs, whereas complete resolution occurred in 37.1% (n = 72/194), partial resolution in 26.3% (n = 51/194), and no resolution in 36.6% (n = 71/194) of the patients with OLP. For patients with OLLs, 91.6% of the patients with positive patch tests and 82.9% with negative patch tests had improvement with removal of amalgam, whereas for patients with OLP, 89.2% of the patients with positive patch tests and 78.9% with negative patch tests had improvement with removal of amalgam. Our results suggest improvement occurs, regardless of patch testing status.

Reverse Koebnerization in a linear oral lichenoid lesion: A case report

The spectacle of Koebner’s phenomenon (KP) is interesting in that trauma precipitates a subset of pathologically distinct conditions, indicating the subtle interplay between sensitization and dermato-mucosal integrity. KP is interesting because, if factors initiating it are controlled, then it may be possible to prevent these debilitating conditions through induction of reverse Koebnerization. Herein, we present a report of a patient with an erosive lesion, localized to the occlusal plane on buccal and lingual mucosa, that interestingly subsided following 1 week after a dental scaling procedure. This report analytically describes the role of dental calculus and cuspal trauma as important triggers surrounding the genesis of oral lichenoid lesion and oral lichen planus. An engaging discussion on these closely related enigmatic entities forms the central theme of this report.

Healing of Oral Lichenoid Lesions following Replacement of Dental Amalgam Restorations with Feldspathic Ceramic Inlay-Onlay Restorations: Clinical Results of a Follow-Up Period Varied from Three Months up to Five Years

Objective

Previous studies have shown the effect of amalgam removal on the healing of oral lichenoid lesions (OLLs); however, no specific replacement materials have been suggested. The present series evaluated long-term results following the complete replacement of amalgam restorations with feldspathic ceramic inlay-onlay restorations for a group of patients with OLLs whose lesions were suspected to be related to amalgam restorations.

Materials and Methods

Twenty-four patients who had OLLs suspected to be related to their amalgam restorations were initially recruited. The patients underwent patch tests for a series of dental materials, in addition to clinical and histopathological examination. Sixteen (67%) of the 24 patients had their amalgam replaced with feldspathic ceramic inlay-onlay restorations and were examined within a follow-up period of 3 months to 5 years.

Results

After 3 months of clinical follow-up, complete healing (63%) was noted in all patients with OLLs whose lesions were in only close contact with their amalgam restorations. Healing was significantly related to the combination of lesions with close contact with the amalgam restoration and a diagnosis of OLL (x² test, P=0.02).

Conclusion

Feldspathic ceramic can be safely used as a replacement material for patients with OLLs to diminish adverse reactions to amalgam restorations.

Oral Lichenoid Lesion Manifesting as Desquamative Gingivitis: Unlikely Association? Case Report

Introduction:

The aim of this report is to present a clinical case of oral lichenoid lesions associated with amalgam restorations with the presence of desquamative gingivitis for a nine months follow up period.

Case Report:

The histopathologic characteristics and direct immunofluorescence were compatible with Oral Lichenoid Lesion (LLO). Diagnosis was based on a synthesis of all available information, including medical history, clinical examination, histopathology and the results of specific tests, such as the patch test, which confirmed allergy to thimerosal, an organic compound of mercury.

Discussion:

The replacement of amalgam restorations has brought improvements to the instrument, as evidenced by the disappearance of desquamative gingivitis, aspect erythematosus and erosive lesions. The fading does not complete the same, however, indicates the need to continue has been under continuous observation, the patient, having in view the possibility of the existence of an underlying lichen planus.

Management of Oral Lichen Planus by 980 nm Diode Laser

Introduction: Oral lichen planus (OLP) is a mucocutaneous disease with uncertain etiology. As the etiology is unknown standard treatment modalities are not available. The traditional and common treatment relies on corticosteroids whether topical or systemic. In recent years, development of lasers made a proper path to use this instrument for treatment of the diseases which are refractory to conventional treatments. Previous studies in this field used CO2, ND:YAG, Excimer and some wavelength of diode lasers for the treatment of different types of lichen planus. Case Report: In this study, we present an OLP case which is treated using 980 nm diode laser. The result was measured by visual analogue scale (VAS) and clinical assessment; as a result, symptoms including pain and soreness started to decrease within a week, and by the end of a month completely subsided; the lesion disappeared totally as well. No recurrence was observed after a month and no side-effect was reported. Conclusion: 980 nm diode laser can be successfully used for treatment of patients with OLP.