journal of prosthodontic research 58 (2014) 127–131
Available online at www.sciencedirect.com
ScienceDirect journal homepage: www.elsevier.com/locate/jpor
Case Report
Implant treatment followed by living donor lung transplant: A follow-up case report Akinari Nakagawa DDS, PhDa, Naoki Shitara DDSb, Yasunori Ayukawa DDS, PhDc,*, Kiyoshi Koyano DDS, PhDc, Kenji Nishimura DDSb a
Nakagawa Dental Clinic, 2377 Sonezaki, Tosu, Saga 841-0025, Japan Nishimura Dental Clinic, 104-1 Morodomitsu, Morodomi, Saga 840-2105, Japan c Section of Implant and Rehabilitative Dentistry, Division of Oral Rehabilitation, Faculty of Dental Science, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka 812-8582, Japan b
article info
abstract
Article history:
Patients: Dental implant treatment in patients with complicated systemic disease has been
Received 20 August 2013
discussed, especially in the context of achieving osseointegration. However, some patients
Received in revised form
with no pre-existing systemic disease develop it later, during their implant maintenance
8 November 2013
periods. Organ transplants, and the lifelong administration of immunosuppressants that
Accepted 21 November 2013
follows, are also of relevance to post-implant oral health. Thus, strategies to maintain the
Available online 3 January 2014
health of peri-implant tissue in these patients should be considered. Here, we present the
Keywords:
period. The condition of the lung is affected by that of the oral cavity, so the maintenance is
case of a patient receiving a living-donor lung transplant during her implant follow-up Maintenance
of utmost importance. Throughout the follow-up period, we provided periodical profes-
Pulmonary alveolar proteinosis
sional maintenance care.
Immunosuppressant
Discussion and conclusion: The patient experienced no complications, alterations in her
Immune compromise
radiographic findings, or worsening of periodontal indices, despite being extensively medicated with immunosuppressants, steroids and bisphosphonate. # 2013 Japan Prosthodontic Society. Published by Elsevier Ireland. All rights reserved.
1.
Introduction
Since its inception over forty years ago, implant treatment is rapidly becoming the most important treatment modality for edentulous patients. Several attempts being made to expand this field such as immediate loading, immediate implant placement after extraction and implant-related bone regeneration/expansion [1–3] are gaining momentum as promising evidence-based treatment protocols.
As the field of implant dentistry widens, it is more likely to encounter patients with severe systemic disease. However, the predictability of implant characteristics and, ultimately, success in patients experiencing systemic disease has not yet been fully discussed. Organ transplant therapy, an extreme therapeutic response to irreversible systemic disease, is necessarily accompanied by a lifelong regimen of immunosuppressant medication. Because there is a strong interplay between immunosuppressants and oral and systemic health, the effects of this therapy on oral hygiene
* Corresponding author. Tel.: +81 92 642 6441; fax: +81 92 642 6380. E-mail addresses: [email protected] (A. Nakagawa), [email protected] (N. Shitara, K. Nishimura), [email protected] (Y. Ayukawa), [email protected] (K. Koyano) 1883-1958/$ – see front matter # 2013 Japan Prosthodontic Society. Published by Elsevier Ireland. All rights reserved. http://dx.doi.org/10.1016/j.jpor.2013.11.001
128
journal of prosthodontic research 58 (2014) 127–131
Table 1 – Medications (and function) at the time of lung transplantation. Prednisolone (steroid hormone) Tacrolimus (immunosuppressant) Mycophenolate mofetil (immunosuppressant) Famotidine (histamine H2-receptor antagonist for peptic ulcer) Alprazolam (benzodiazepine anxiolytic) Trimethoprim/sulfamethoxazole (anti-infective) Aciclovir (antiviral) Itraconazole (antifungal) Insulin (hypoglycemic)
Table 2 – Current medications (and function), as at September 14, 2011.
Fig. 1 – At the time of superstructure delivery. (a) Occlusal view and (b) panoramic radiograph.
indices and radiographic findings of the implant may demand attention. The relationship between implants and immunosuppressive therapy has been discussed previously, and controversial results were reported [4–8]. Many studies conducted in animals have described how osseointegration is achieved. Extrapolation of this evidence to humans requires further study and discussion. In the present case report, we described the 10-year followup of a female patient (45 years old at the initial visit) who received a living-donor lung transplant during the follow-up period after dental implant placement. We focus on the status of the implant (i.e. radiographic findings and periodontal indices) in this patient, who was receiving polymedication including immunosuppressants and steroids for transplant therapy.
2.
Outline of the case
A 45-year-old Japanese woman was referred to our clinic in October 1999 for comprehensive evaluation. She complained of discomfort in the upper right first molar (#3). The surrounding gingivae were swollen and radiographic findings revealed evidence of bone resorption around the palatal root. At the initial visit, no significant family or personal medical history was reported. The situation showed negligible improvement after routine treatment for periodontal disease such as scaling, root planing and local/systemic administration of antibiotics. In March 2000, the tooth was extracted, followed by a healing period of 5 months before placement of a titanium implant (Straumann Standard SLA1 Implant: 4.8 mm diameter, 10 mm length) (Institut Straumann AG1, Waldenburg, Switzerland), combined with an osteotome vertical sinus floor elevation
Prednisolone (steroid hormone) Tacrolimus (immunosuppressant) Amphotericin B (antifungal) Trimethoprim/sulfamethoxazole (anti-infective) Aciclovir (antiviral) Alendronate (bisphosphonate for osteoporosis) Insulin (hypoglycemic) Rabeprazole sodium (proton-pump inhibitor for peptic ulcer) Entecavir monohydrate (antiviral for hepatitis B) Sodium ferrous citrate (iron preparation for anemia)
procedure. In December 2000, a screw-retained composite resin-facing crown as a superstructure was delivered (Fig. 1). From the date of delivery of this superstructure to February 2007, the patient visited the clinic a further five times for maintenance treatment. We checked for the presence of any periodontal and occlusal complications, or other implantspecific problems such as screw loosening, or detachment of the access hole filling. No such complications were detected. In 2001, the patient was diagnosed with pulmonary alveolar proteinosis at Nagasaki University Hospital in Nagasaki Prefecture, Japan. She received bronchoalveolar lavage seven times under general anesthesia, which was unsuccessful. She then received a bilateral living-donor lung transplant at Nagasaki University in April 2008, the first time such procedure for a patient with pulmonary alveolar proteinosis had been performed in Japan. Administration of the steroid and immunosuppressant medication regime was initiated immediately after the transplant surgery (Table 1). During hospitalization, oral care including tooth brushing and rinsing with povidone–iodine solution (3 times/day), and local application of the antifungal agent, amphotericin B (4 times/ day), was provided for two months after surgery. Recurrent laryngeal nerve palsy and steroid diabetes were recognized as postoperative complications, the former being resolved within one month of surgery. The patient resumed oral ingestion of food one month after surgery, and was discharged from hospital in June 2008. Her latest medication is listed in Table 2. Six months after the surgery, the patient was affected by pulmonary aspergillosis, from which she also recovered. Two months after transplantation, the patient visited our clinic for professional maintenance care, which she has been receiving every two months since. Care includes mechanical cleaning using a toothbrush, tuft brush and interdental brush; irrigation with chlorhexidine; and oral hygiene instruction (i.e. toothbrushing technique, etc.). We also performed X-ray
journal of prosthodontic research 58 (2014) 127–131
129
Fig. 2 – Periapical radiographs during the maintenance period. (a) 1 year after implant placement; (b) 3.5 month after lung transplant (8 years after implant placement); (c) 13 months after lung transplant (8 years 9 months after implant placement); and (d) 20 months after lung transplant (9 years 3 months after the implant placement).
Fig. 3 – Distance from the implant shoulder to the alveolar bone level (DIB) measured using periapical radiographs. Standardization among radiographs was done using following formula. (DIB measured on radiograph) T (distance between first and fifth threads on radiograph)/(actual distance between first and fifth threads).
130
journal of prosthodontic research 58 (2014) 127–131
Fig. 4 – Periodontal indices.
Fig. 5 – Occlusal views during the maintenance period. (a) At the date of superstructure delivery; (b) 3.5 months after lung transplant (8 years after implant placement); (c) 13 months after lung transplant (8 years 9 months after implant placement); and (d) 20 months after lung transplant (9 years 3 months after implant placement).
journal of prosthodontic research 58 (2014) 127–131
examination (Figs. 2 and 3) and examination of periodontal indices (Fig. 4) at every visit. Despite the intensive medication regime of immunosuppressants, steroids and bisphosphonate, the appearance of the peri-implant tissue, radiography and periodontal indices, all of which were measured by one dentist (KN), remain stable (Figs. 2–5).
3.
Discussion and conclusion
After organ transplantation, the patient must receive lifelong medication with immunosuppressants. Given the increasing prevalence of both transplant surgery and dental implants, there is an increased likelihood that the implant recovery period will be coincident with a regime of immunosuppressive therapy. In such cases, the suppression of neutrophils, macrophages and inferior humoral immunity increases the risk of opportunistic infection, which may manifest in the oral cavity. According to the published literature, immunosuppressants have no negative effect on peri-implant bone quality [5,6], although other reports contain contrary results showing that immunosuppressants do negatively affect peri-implant bone healing [4,7] and/or the mechanical properties of the bone integrated with the implant [8]. All of these results were obtained in animal experiments and evidence of similar effects of immunosuppressants on the peri-implant bone in human subjects is awaited. Above all, as described above, this was the first living-donor lung transplant for a patient with pulmonary alveolar proteinosis in Japan, so an effective and evidence-based maintenance protocol has yet to be developed. In comparison with other transplant tissues, the lung seems to be exquisitely vulnerable to the health of the oral cavity. Hence, the maintenance of a healthy oral environment in patients undergoing immunosuppressant/steroid therapy is paramount. An evidence-based treatment protocol is warranted. In the present study, radiography and periodontal indices were not affected by the transplant surgery and subsequent medication. Professional oral care and toothbrushing instruction may contribute in part to the conservation of peri-implant health. Notably, in order to prevent osteoporosis, bisphosphonate is administered perorally in addition to steroids and immunosuppressants. This drug is reported to induce or exacerbate osteonecrosis of the jaw [9], especially in case of intravenous administration. Dentists should thus be familiar with transplantation and its subsequent medication regime, including bisphosphonate, and their relevance to oral health. This understanding is important both for successful implant integration and for general maintenance of oral health. In parallel, the development of new procedures which can facilitate both bone and soft tissue healing are expected to obtain promising outcome [10]. According to some previous reports, immunocompromised patients could also successfully receive implant treatment [11–13]. Based on this, although no data supported the opinion, the use of chlorhexidine and the consideration of the benefit from antibiotic prophylaxis were indicated to be prudent [12]. In addition, shortened intervals between examinations may also help the maintenance of oral health in case of immunocompromised patient. Oral health is strongly believed
131
to play a strong role in the health and longevity [14], and especially in this case deteriorated oral health may directly affect transplanted lung health.
Conflicts of interest All authors have no conflicts of interest.
references
[1] Atieh MA, Payne AGT, Duncan WJ, de Silva RK, Cullinan MP. Immediate placement or immediate restoration/loading of single implants for molar tooth replacement: a systematic review and meta-analysis. Int J Oral Maxillofac Implants 2010;25:401–15. [2] Chiapasco M, Casentini P, Zaniboni M. Bone augmentation procedures in implant dentistry. Int J Oral Maxillofac Implants 2009;24(Suppl.):237–59. [3] Malo P, Rangert B, Nobre M. All-on-4 immediate-function concept with Branemark System implants for completely edentulous maxillae: a 1-year retrospective clinical study. Clin Implant Dent Relat Res 2005;7(Suppl. 1):S88–94. [4] Duarte PM, Nogueira Filho GR, Sallum EA, de Toledo S, Sallum AW, Nociti Ju´nior FH. The effect of an immunosuppressive therapy and its withdrawal on bone healing around titanium implants. A histometric study in rabbits. J Periodontol 2001;72:1391–7. [5] Duarte PM, Nogueira Filho GR, Sallum EA, Sallum AW, Nociti Ju´nior FH. Short-term immunosuppressive therapy does not affect the density of the pre-existing bone around titanium implants placed in rabbits. Pesqui Odontol Bras 2003;17:362–6. [6] Sakakura CE, Marcantonio Jr E, Wenzel A, Scaf G. Influence of cyclosporin A on quality of bone around integrated dental implants: a radiographic study in rabbits. Clin Oral Implants Res 2007;18:34–9. [7] Sakakura CE, Margonar R, Holzhausen M, Nociti Jr FH, Alba Jr RC, Marcantonio Jr E. Influence of cyclosporin A therapy on bone healing around titanium implants: a histometric and biomechanic study in rabbits. J Periodontol 2003;74:976–81. [8] Sakakura CE, Margonar R, Sartori R, Morais JA, Marcantonio Jr E. The influence of cyclosporin a on mechanical retention of dental implants previously integrated to the bone: a study in rabbits. J Periodontol 2006;77:2059–62. [9] Filleul O, Crompot E, Saussez S. Bisphosphonate-induced osteonecrosis of the jaw: a review of 2400 patient cases. J Cancer Res Clin Oncol 2010;136:1117–24. [10] Maeda T, Masaki C, Kanao M, Kondo Y, Ohta A, Nakamoto T, et al. Low-intensity pulsed ultrasound enhances palatal mucosa wound healing in rats. J Prosthodont Res 2013;57:93–8. [11] Heckmann SM, Heckmann JG, Linke JJ, Hohenberger W, Mombelli A. Implant therapy following liver transplantation: clinical and microbiological results after 10 years. J Periodontol 2004;75:909–13. [12] Scurry C, Hobkirk J, Dios PD. Dental endosseous implants in the medically compromised patient. J Oral Rehabil 2007;34:590–9. [13] Gu L, Wang Q, Yu YC. Eleven dental implants placed in a liver transplantation patient: a case report and 5-year clinical evaluation. Chin Med J (Engl) 2011;124:472–5. [14] Yatani H. Inaugural address by the new president of the Japan Prosthodontic Society—promoting prosthetic dental practice as a contributor to society. J Prosthodont Res 2013;57:233–5.
Available online at www.sciencedirect.com
ScienceDirect journal homepage: www.elsevier.com/locate/jpor
Case Report
Implant treatment followed by living donor lung transplant: A follow-up case report Akinari Nakagawa DDS, PhDa, Naoki Shitara DDSb, Yasunori Ayukawa DDS, PhDc,*, Kiyoshi Koyano DDS, PhDc, Kenji Nishimura DDSb a
Nakagawa Dental Clinic, 2377 Sonezaki, Tosu, Saga 841-0025, Japan Nishimura Dental Clinic, 104-1 Morodomitsu, Morodomi, Saga 840-2105, Japan c Section of Implant and Rehabilitative Dentistry, Division of Oral Rehabilitation, Faculty of Dental Science, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka 812-8582, Japan b
article info
abstract
Article history:
Patients: Dental implant treatment in patients with complicated systemic disease has been
Received 20 August 2013
discussed, especially in the context of achieving osseointegration. However, some patients
Received in revised form
with no pre-existing systemic disease develop it later, during their implant maintenance
8 November 2013
periods. Organ transplants, and the lifelong administration of immunosuppressants that
Accepted 21 November 2013
follows, are also of relevance to post-implant oral health. Thus, strategies to maintain the
Available online 3 January 2014
health of peri-implant tissue in these patients should be considered. Here, we present the
Keywords:
period. The condition of the lung is affected by that of the oral cavity, so the maintenance is
case of a patient receiving a living-donor lung transplant during her implant follow-up Maintenance
of utmost importance. Throughout the follow-up period, we provided periodical profes-
Pulmonary alveolar proteinosis
sional maintenance care.
Immunosuppressant
Discussion and conclusion: The patient experienced no complications, alterations in her
Immune compromise
radiographic findings, or worsening of periodontal indices, despite being extensively medicated with immunosuppressants, steroids and bisphosphonate. # 2013 Japan Prosthodontic Society. Published by Elsevier Ireland. All rights reserved.
1.
Introduction
Since its inception over forty years ago, implant treatment is rapidly becoming the most important treatment modality for edentulous patients. Several attempts being made to expand this field such as immediate loading, immediate implant placement after extraction and implant-related bone regeneration/expansion [1–3] are gaining momentum as promising evidence-based treatment protocols.
As the field of implant dentistry widens, it is more likely to encounter patients with severe systemic disease. However, the predictability of implant characteristics and, ultimately, success in patients experiencing systemic disease has not yet been fully discussed. Organ transplant therapy, an extreme therapeutic response to irreversible systemic disease, is necessarily accompanied by a lifelong regimen of immunosuppressant medication. Because there is a strong interplay between immunosuppressants and oral and systemic health, the effects of this therapy on oral hygiene
* Corresponding author. Tel.: +81 92 642 6441; fax: +81 92 642 6380. E-mail addresses: [email protected] (A. Nakagawa), [email protected] (N. Shitara, K. Nishimura), [email protected] (Y. Ayukawa), [email protected] (K. Koyano) 1883-1958/$ – see front matter # 2013 Japan Prosthodontic Society. Published by Elsevier Ireland. All rights reserved. http://dx.doi.org/10.1016/j.jpor.2013.11.001
128
journal of prosthodontic research 58 (2014) 127–131
Table 1 – Medications (and function) at the time of lung transplantation. Prednisolone (steroid hormone) Tacrolimus (immunosuppressant) Mycophenolate mofetil (immunosuppressant) Famotidine (histamine H2-receptor antagonist for peptic ulcer) Alprazolam (benzodiazepine anxiolytic) Trimethoprim/sulfamethoxazole (anti-infective) Aciclovir (antiviral) Itraconazole (antifungal) Insulin (hypoglycemic)
Table 2 – Current medications (and function), as at September 14, 2011.
Fig. 1 – At the time of superstructure delivery. (a) Occlusal view and (b) panoramic radiograph.
indices and radiographic findings of the implant may demand attention. The relationship between implants and immunosuppressive therapy has been discussed previously, and controversial results were reported [4–8]. Many studies conducted in animals have described how osseointegration is achieved. Extrapolation of this evidence to humans requires further study and discussion. In the present case report, we described the 10-year followup of a female patient (45 years old at the initial visit) who received a living-donor lung transplant during the follow-up period after dental implant placement. We focus on the status of the implant (i.e. radiographic findings and periodontal indices) in this patient, who was receiving polymedication including immunosuppressants and steroids for transplant therapy.
2.
Outline of the case
A 45-year-old Japanese woman was referred to our clinic in October 1999 for comprehensive evaluation. She complained of discomfort in the upper right first molar (#3). The surrounding gingivae were swollen and radiographic findings revealed evidence of bone resorption around the palatal root. At the initial visit, no significant family or personal medical history was reported. The situation showed negligible improvement after routine treatment for periodontal disease such as scaling, root planing and local/systemic administration of antibiotics. In March 2000, the tooth was extracted, followed by a healing period of 5 months before placement of a titanium implant (Straumann Standard SLA1 Implant: 4.8 mm diameter, 10 mm length) (Institut Straumann AG1, Waldenburg, Switzerland), combined with an osteotome vertical sinus floor elevation
Prednisolone (steroid hormone) Tacrolimus (immunosuppressant) Amphotericin B (antifungal) Trimethoprim/sulfamethoxazole (anti-infective) Aciclovir (antiviral) Alendronate (bisphosphonate for osteoporosis) Insulin (hypoglycemic) Rabeprazole sodium (proton-pump inhibitor for peptic ulcer) Entecavir monohydrate (antiviral for hepatitis B) Sodium ferrous citrate (iron preparation for anemia)
procedure. In December 2000, a screw-retained composite resin-facing crown as a superstructure was delivered (Fig. 1). From the date of delivery of this superstructure to February 2007, the patient visited the clinic a further five times for maintenance treatment. We checked for the presence of any periodontal and occlusal complications, or other implantspecific problems such as screw loosening, or detachment of the access hole filling. No such complications were detected. In 2001, the patient was diagnosed with pulmonary alveolar proteinosis at Nagasaki University Hospital in Nagasaki Prefecture, Japan. She received bronchoalveolar lavage seven times under general anesthesia, which was unsuccessful. She then received a bilateral living-donor lung transplant at Nagasaki University in April 2008, the first time such procedure for a patient with pulmonary alveolar proteinosis had been performed in Japan. Administration of the steroid and immunosuppressant medication regime was initiated immediately after the transplant surgery (Table 1). During hospitalization, oral care including tooth brushing and rinsing with povidone–iodine solution (3 times/day), and local application of the antifungal agent, amphotericin B (4 times/ day), was provided for two months after surgery. Recurrent laryngeal nerve palsy and steroid diabetes were recognized as postoperative complications, the former being resolved within one month of surgery. The patient resumed oral ingestion of food one month after surgery, and was discharged from hospital in June 2008. Her latest medication is listed in Table 2. Six months after the surgery, the patient was affected by pulmonary aspergillosis, from which she also recovered. Two months after transplantation, the patient visited our clinic for professional maintenance care, which she has been receiving every two months since. Care includes mechanical cleaning using a toothbrush, tuft brush and interdental brush; irrigation with chlorhexidine; and oral hygiene instruction (i.e. toothbrushing technique, etc.). We also performed X-ray
journal of prosthodontic research 58 (2014) 127–131
129
Fig. 2 – Periapical radiographs during the maintenance period. (a) 1 year after implant placement; (b) 3.5 month after lung transplant (8 years after implant placement); (c) 13 months after lung transplant (8 years 9 months after implant placement); and (d) 20 months after lung transplant (9 years 3 months after the implant placement).
Fig. 3 – Distance from the implant shoulder to the alveolar bone level (DIB) measured using periapical radiographs. Standardization among radiographs was done using following formula. (DIB measured on radiograph) T (distance between first and fifth threads on radiograph)/(actual distance between first and fifth threads).
130
journal of prosthodontic research 58 (2014) 127–131
Fig. 4 – Periodontal indices.
Fig. 5 – Occlusal views during the maintenance period. (a) At the date of superstructure delivery; (b) 3.5 months after lung transplant (8 years after implant placement); (c) 13 months after lung transplant (8 years 9 months after implant placement); and (d) 20 months after lung transplant (9 years 3 months after implant placement).
journal of prosthodontic research 58 (2014) 127–131
examination (Figs. 2 and 3) and examination of periodontal indices (Fig. 4) at every visit. Despite the intensive medication regime of immunosuppressants, steroids and bisphosphonate, the appearance of the peri-implant tissue, radiography and periodontal indices, all of which were measured by one dentist (KN), remain stable (Figs. 2–5).
3.
Discussion and conclusion
After organ transplantation, the patient must receive lifelong medication with immunosuppressants. Given the increasing prevalence of both transplant surgery and dental implants, there is an increased likelihood that the implant recovery period will be coincident with a regime of immunosuppressive therapy. In such cases, the suppression of neutrophils, macrophages and inferior humoral immunity increases the risk of opportunistic infection, which may manifest in the oral cavity. According to the published literature, immunosuppressants have no negative effect on peri-implant bone quality [5,6], although other reports contain contrary results showing that immunosuppressants do negatively affect peri-implant bone healing [4,7] and/or the mechanical properties of the bone integrated with the implant [8]. All of these results were obtained in animal experiments and evidence of similar effects of immunosuppressants on the peri-implant bone in human subjects is awaited. Above all, as described above, this was the first living-donor lung transplant for a patient with pulmonary alveolar proteinosis in Japan, so an effective and evidence-based maintenance protocol has yet to be developed. In comparison with other transplant tissues, the lung seems to be exquisitely vulnerable to the health of the oral cavity. Hence, the maintenance of a healthy oral environment in patients undergoing immunosuppressant/steroid therapy is paramount. An evidence-based treatment protocol is warranted. In the present study, radiography and periodontal indices were not affected by the transplant surgery and subsequent medication. Professional oral care and toothbrushing instruction may contribute in part to the conservation of peri-implant health. Notably, in order to prevent osteoporosis, bisphosphonate is administered perorally in addition to steroids and immunosuppressants. This drug is reported to induce or exacerbate osteonecrosis of the jaw [9], especially in case of intravenous administration. Dentists should thus be familiar with transplantation and its subsequent medication regime, including bisphosphonate, and their relevance to oral health. This understanding is important both for successful implant integration and for general maintenance of oral health. In parallel, the development of new procedures which can facilitate both bone and soft tissue healing are expected to obtain promising outcome [10]. According to some previous reports, immunocompromised patients could also successfully receive implant treatment [11–13]. Based on this, although no data supported the opinion, the use of chlorhexidine and the consideration of the benefit from antibiotic prophylaxis were indicated to be prudent [12]. In addition, shortened intervals between examinations may also help the maintenance of oral health in case of immunocompromised patient. Oral health is strongly believed
131
to play a strong role in the health and longevity [14], and especially in this case deteriorated oral health may directly affect transplanted lung health.
Conflicts of interest All authors have no conflicts of interest.
references
[1] Atieh MA, Payne AGT, Duncan WJ, de Silva RK, Cullinan MP. Immediate placement or immediate restoration/loading of single implants for molar tooth replacement: a systematic review and meta-analysis. Int J Oral Maxillofac Implants 2010;25:401–15. [2] Chiapasco M, Casentini P, Zaniboni M. Bone augmentation procedures in implant dentistry. Int J Oral Maxillofac Implants 2009;24(Suppl.):237–59. [3] Malo P, Rangert B, Nobre M. All-on-4 immediate-function concept with Branemark System implants for completely edentulous maxillae: a 1-year retrospective clinical study. Clin Implant Dent Relat Res 2005;7(Suppl. 1):S88–94. [4] Duarte PM, Nogueira Filho GR, Sallum EA, de Toledo S, Sallum AW, Nociti Ju´nior FH. The effect of an immunosuppressive therapy and its withdrawal on bone healing around titanium implants. A histometric study in rabbits. J Periodontol 2001;72:1391–7. [5] Duarte PM, Nogueira Filho GR, Sallum EA, Sallum AW, Nociti Ju´nior FH. Short-term immunosuppressive therapy does not affect the density of the pre-existing bone around titanium implants placed in rabbits. Pesqui Odontol Bras 2003;17:362–6. [6] Sakakura CE, Marcantonio Jr E, Wenzel A, Scaf G. Influence of cyclosporin A on quality of bone around integrated dental implants: a radiographic study in rabbits. Clin Oral Implants Res 2007;18:34–9. [7] Sakakura CE, Margonar R, Holzhausen M, Nociti Jr FH, Alba Jr RC, Marcantonio Jr E. Influence of cyclosporin A therapy on bone healing around titanium implants: a histometric and biomechanic study in rabbits. J Periodontol 2003;74:976–81. [8] Sakakura CE, Margonar R, Sartori R, Morais JA, Marcantonio Jr E. The influence of cyclosporin a on mechanical retention of dental implants previously integrated to the bone: a study in rabbits. J Periodontol 2006;77:2059–62. [9] Filleul O, Crompot E, Saussez S. Bisphosphonate-induced osteonecrosis of the jaw: a review of 2400 patient cases. J Cancer Res Clin Oncol 2010;136:1117–24. [10] Maeda T, Masaki C, Kanao M, Kondo Y, Ohta A, Nakamoto T, et al. Low-intensity pulsed ultrasound enhances palatal mucosa wound healing in rats. J Prosthodont Res 2013;57:93–8. [11] Heckmann SM, Heckmann JG, Linke JJ, Hohenberger W, Mombelli A. Implant therapy following liver transplantation: clinical and microbiological results after 10 years. J Periodontol 2004;75:909–13. [12] Scurry C, Hobkirk J, Dios PD. Dental endosseous implants in the medically compromised patient. J Oral Rehabil 2007;34:590–9. [13] Gu L, Wang Q, Yu YC. Eleven dental implants placed in a liver transplantation patient: a case report and 5-year clinical evaluation. Chin Med J (Engl) 2011;124:472–5. [14] Yatani H. Inaugural address by the new president of the Japan Prosthodontic Society—promoting prosthetic dental practice as a contributor to society. J Prosthodont Res 2013;57:233–5.
