实体器官移植患者的口腔种植治疗研究进展

doi:10.12337/zgkqzzxzz.2024.04.015

摘要/Abstract

摘要： 随着实体器官移植治疗技术的发展,患者的生存期逐渐延长,对恢复缺失牙的需求也逐渐增加。在长期的临床实践中,种植治疗可作为恢复患者口颌功能的一种安全、有效方案。然而,许多原发疾病及移植后终身的免疫抑制治疗对骨代谢的影响,增加了骨质疏松、骨折等疾病的风险,同时也为骨与种植体的结合带来了潜在危害。因此,移植后全身情况的稳定、种植围手术期口腔内感染的控制、种植体负荷时间以及定期随访检查在此类患者的种植治疗中尤为重要。本文将就实体器官移植对骨及种植体骨结合的影响、口腔种植治疗进展及注意事项等方面进行阐述,以期为临床医生提供参考。

关键词: 实体器官移植, 免疫抑制剂, 种植

Abstract: With the development of solid organ transplantation treatment technology, the survival period of patients is gradually extended, and the demand to restore missing teeth is increasing. In long-term clinical practice, implant therapy can be used as a safe and effective program to restore stomatognathic function. However, the impacts of primary disease and lifelong immunosuppressive therapy after transplantation on bone metabolism increase the risk of osteoporosis, fracture, and other diseases, and bring potential hazards to implant osseointegration. Therefore, stability of condition after transplantation, control of oral infection during the perioperative period of implantation, implant loading time, and regular follow-up examination are particularly important in the implantation treatment of such patients. In this review, we discuss the effects of solid organ transplantation on bone and implant osteoporosis, the progress and precautions of oral implant treatment, so as to provide guidance for dentists.

Key words: Solid organ transplantation, Immunosuppressor, Dental implant

赵克,等朱洁莹,等顾新华. 实体器官移植患者的口腔种植治疗研究进展[J]. 中国口腔种植学杂志, 2024, 29(2): 190-194. DOI: 10.12337/zgkqzzxzz.2024.04.015

Zhao Ke, Zhu Jieying, Gu Xinhua. Research progress of dental implants in patients with solid organ transplantation[J].Chinese Journal of Oral Implantology, 2024, 29(2): 190-194.DOI: 10.12337/zgkqzzxzz.2024.04.015.

参考文献

[1] Dolgos S, Hartmann A, Isaksen GA, et al.Osteoporosis is a prevalent finding in patients with solid organ failure awaiting transplantation - a population based study[J]. Clin Transplant, 2010,24(5):e145-e152. DOI: 10.1111/j.1399-0012.2010.01231.x.
[2] Anastasilakis AD, Tsourdi E, Makras P, et al.Bone disease following solid organ transplantation: a narrative review and recommendations for management from The European Calcified Tissue Society[J]. Bone, 2019,127:401-418. DOI: 10.1016/j.bone.2019.07.006.
[3] Rodríguez-Aguilar EF, Pérez-Escobar J, Sánchez Herrera D, et al.Bone disease and liver transplantation: a review[J]. Transplant Proc, 2021,53(7):2346-2353. DOI: 10.1016/j.transproceed.2021.07.049.
[4] Hruska KA, Sugatani T, Agapova O, et al.The chronic kidney disease-mineral bone disorder (CKD-MBD): advances in pathophysiology[J]. Bone, 2017,100:80-86. DOI: 10.1016/j.bone.2017.01.023.
[5] Loncar G, Cvetinovic N, Lainscak M, et al.Bone in heart failure[J]. J Cachexia Sarcopenia Muscle, 2020,11(2):381-393. DOI: 10.1002/jcsm.12516.
[6] Muschitz C, Zwick RH, Haschka J, et al.Osteoporosis in pneumological diseases : joint guideline of the Austrian Society for Bone and Mineral Research (ÖGKM) and the Austrian Society for Pneumology (ÖGP)[J]. Wien Klin Wochenschr, 2021,133(Suppl 4):155-173. DOI: 10.1007/s00508-021-01896-x.
[7] Black CK, Termanini KM, Aguirre O, et al.Solid organ transplantation in the 21(st) century[J]. Ann Transl Med, 2018,6(20):409. DOI: 10.21037/atm.2018.09.68.
[8] Paredes V, López-Pintor RM, Torres J, et al.Implant treatment in pharmacologically immunosuppressed liver transplant patients: a prospective-controlled study[J]. Clin Oral Implants Res, 2018,29(1):28-35. DOI: 10.1111/clr.13035.
[9] Wu Z, Bucher NL, Farmer SR.Induction of peroxisome proliferator-activated receptor gamma during the conversion of 3T3 fibroblasts into adipocytes is mediated by C/EBPbeta, C/EBPdelta, and glucocorticoids[J]. Mol Cell Biol, 1996,16(8):4128-4136. DOI: 10.1128/MCB.16.8.4128.
[10] Ohnaka K, Tanabe M, Kawate H, et al.Glucocorticoid suppresses the canonical wnt signal in cultured human osteoblasts[J]. Biochem Biophys Res Commun, 2005,329(1):177-181. DOI: 10.1016/j.bbrc.2005.01.117.
[11] Mazziotti G, Formenti AM, Adler RA, et al.Glucocorticoid-induced osteoporosis: pathophysiological role of GH/IGF-I and PTH/VITAMIN D axes, treatment options and guidelines[J]. Endocrine, 2016,54(3):603-611. DOI: 10.1007/s12020-016-1146-8.
[12] Humphrey EL, Williams JH, Davie MW, et al.Effects of dissociated glucocorticoids on OPG and RANKL in osteoblastic cells[J]. Bone, 2006,38(5):652-661. DOI: 10.1016/j.bone.2005.10.004.
[13] Torregrosa JV, Ferreira AC, Cucchiari D, et al.Bone mineral disease after kidney transplantation[J]. Calcif Tissue Int, 2021,108(4):551-560. DOI: 10.1007/s00223-021-00837-0.
[14] Bouquegneau A, Salam S, Delanaye P, et al.Bone disease after kidney transplantation[J]. Clin J Am Soc Nephrol, 2016,11(7):1282-1296. DOI: 10.2215/CJN.11371015.
[15] Schepper JD, Collins F, Rios-Arce ND, et al.Involvement of the gut microbiota and barrier function in glucocorticoid-induced osteoporosis[J]. J Bone Miner Res, 2020,35(4):801-820. DOI: 10.1002/jbmr.3947.
[16] Schilperoort M, Kroon J, Kooijman S, et al.Loss of glucocorticoid rhythm induces an osteoporotic phenotype in female mice[J]. Aging Cell, 2021,20(10):e13474. DOI: 10.1111/acel.13474.
[17] Carvas JS, Pereira RM, Caparbo VF, et al.A single dose of zoledronic acid reverses the deleterious effects of glucocorticoids on titanium implant osseointegration[J]. Osteoporos Int, 2010,21(10):1723-1729. DOI: 10.1007/s00198-009-1125-5.
[18] Fujimoto T, Niimi A, Sawai T, et al.Effects of steroid-induced osteoporosis on osseointegration of titanium implants[J]. Int J Oral Maxillofac Implants, 1998,13(2):183-189.
[19] Petsinis V, Kamperos G, Alexandridi F, et al.The impact of glucocorticosteroids administered for systemic diseases on the osseointegration and survival of dental implants placed without bone grafting-a retrospective study in 31 patients[J]. J Craniomaxillofac Surg, 2017,45(8):1197-1200. DOI: 10.1016/j.jcms.2017.05.023.
[20] van Sandwijk MS, Bemelman FJ, Ten Berge IJ. Immunosuppressive drugs after solid organ transplantation[J]. Neth J Med, 2013,71(6):281-289.
[21] Gratreak B, Swanson EA, Lazelle RA, et al.Tacrolimus-induced hypomagnesemia and hypercalciuria requires FKBP12 suggesting a role for calcineurin[J]. Physiol Rep, 2020,8(1):e14316. DOI: 10.14814/phy2.14316.
[22] Epstein S.Post-transplantation bone disease: the role of immunosuppressive agents and the skeleton[J]. J Bone Miner Res, 1996,11(1):1-7. DOI: 10.1002/jbmr.5650110102.
[23] Zheng X, Mo A, Wang Y, et al.Effect of FK-506 (tacrolimus) therapy on bone healing of titanium implants: a histometric and biomechanical study in mice[J]. Eur J Oral Sci, 2017,125(1):28-33. DOI: 10.1111/eos.12320.
[24] Cvetkovic M, Mann GN, Romero DF, et al.The deleterious effects of long-term cyclosporine A, cyclosporine G, and FK506 on bone mineral metabolism in vivo[J]. Transplantation, 1994,57(8):1231-1237. DOI: 10.1097/00007890-199404270-00016.
[25] Sakakura CE, Margonar R, Sartori R, et al.The influence of cyclosporin a on mechanical retention of dental implants previously integrated to the bone: a study in rabbits[J]. J Periodontol, 2006,77(12):2059-2062. DOI: 10.1902/jop.2006.050290.
[26] Duarte PM, Nogueira Filho GR, Sallum EA, et al.The effect of an immunosuppressive therapy and its withdrawal on bone healing around titanium implants. A histometric study in rabbits[J]. J Periodontol, 2001,72(10):1391-1397. DOI: 10.1902/jop.2001.72.10.1391.
[27] Duarte PM, Nogueira Filho GR, Sallum EA, et al.Short-term immunosuppressive therapy does not affect the density of the pre-existing bone around titanium implants placed in rabbits[J]. Pesqui Odontol Bras, 2003,17(4):362-366. DOI: 10.1590/s1517-74912003000400012.
[28] de Molon RS, Sakakura CE, Faeda RS, et al. Effect of the long-term administration of cyclosporine A on bone healing around osseointegrated titanium implants: a histomorphometric study in the rabbit tibia[J]. Microsc Res Tech, 2017,80(9):1000-1008. DOI: 10.1002/jemt.22894.
[29] Sakakura CE, Margonar R, Holzhausen M, et al.Influence of cyclosporin A therapy on bone healing around titanium implants: a histometric and biomechanic study in rabbits[J]. J Periodontol, 2003,74(7):976-981. DOI: 10.1902/jop.2003.74.7.976.
[30] Westenfeld R, Schlieper G, Wöltje M, et al.Impact of sirolimus, tacrolimus and mycophenolate mofetil on osteoclastogenesis--implications for post-transplantation bone disease[J]. Nephrol Dial Transplant, 2011,26(12):4115-4123. DOI: 10.1093/ndt/gfr214.
[31] Romero DF, Buchinsky FJ, Rucinski B, et al.Rapamycin: a bone sparing immunosuppressant?[J]. J Bone Miner Res, 1995,10(5):760-768. DOI: 10.1002/jbmr.5650100513.
[32] Kneissel M, Luong-Nguyen NH, Baptist M, et al.Everolimus suppresses cancellous bone loss, bone resorption, and cathepsin K expression by osteoclasts[J]. Bone, 2004,35(5):1144-1156. DOI: 10.1016/j.bone.2004.07.013.
[33] Gregorini M, Sileno G, Pattonieri EF, et al.Understanding bone damage after kidney transplantation: a retrospective monocentric cross sectional analysis[J]. Transplant Proc, 2017,49(4):650-657. DOI: 10.1016/j.transproceed.2017.02.023.
[34] Dissanayake IR, Goodman GR, Bowman AR, et al.Mycophenolate mofetil: a promising new immunosuppressant that does not cause bone loss in the rat[J]. Transplantation, 1998,65(2):275-278. DOI: 10.1097/00007890-199801270-00025.
[35] Radzewski R, Osmola K.Osseointegration of dental implants in organ transplant patients undergoing chronic immunosuppressive therapy[J]. Implant Dent, 2019,28(5):447-454. DOI: 10.1097/ID.0000000000000916.
[36] Heckmann SM, Heckmann JG, Linke JJ, et al.Implant therapy following liver transplantation: clinical and microbiological results after 10 years[J]. J Periodontol, 2004,75(6):909-913. DOI: 10.1902/jop.2004.75.6.909.
[37] Montebugnoli L, Venturi M, Cervellati F, et al.Peri-implant response and microflora in organ transplant patients 1 year after prosthetic loading: a prospective controlled study[J]. Clin Implant Dent Relat Res, 2015,17(5):972-982. DOI: 10.1111/cid.12207.
[38] Paredes V, López-Pintor RM, Torres J, et al.Implant treatment in pharmacologically immunosuppressed liver transplant patients: a prospective-controlled study[J]. Clin Oral Implants Res, 2018,29(1):28-35. DOI: 10.1111/clr.13035.
[39] Gu L, Wang Q, Yu YC.Eleven dental implants placed in a liver transplantation patient: a case report and 5-year clinical evaluation[J]. Chin Med J (Engl), 2011,124(3):472-475.
[40] Gu L, Yu YC.Clinical outcome of dental implants placed in liver transplant recipients after 3 years: a case series[J]. Transplant Proc, 2011,43(7):2678-2682. DOI: 10.1016/j.transproceed.2011.06.037.
[41] Hernández G, Paredes V, López-Pintor RM, et al.Implant treatment in immunosuppressed renal transplant patients: a prospective case-controlled study[J]. Clin Oral Implants Res, 2019,30(6):524-530. DOI: 10.1111/clr.13437.
[42] Dalla Torre D, Burtscher D.Ridge augmentation in an organ transplant patient[J]. Int J Oral Maxillofac Surg, 2016,45(5):658-661. DOI: 10.1016/j.ijom.2015.11.002.
[43] Kwak EJ, Kim DJ, Choi Y, et al.Importance of oral health and dental treatment in organ transplant recipients[J]. Int Dent J, 2020,70(6):477-481. DOI: 10.1111/idj.12585.
[44] Mougeot FK, Saunders SE, Brennan MT, et al.Associations between bacteremia from oral sources and distant-site infections: tooth brushing versus single tooth extraction[J]. Oral Surg Oral Med Oral Pathol Oral Radiol, 2015,119(4):430-435. DOI: 10.1016/j.oooo.2015.01.009.
[45] Burtscher D, Dalla Torre D.Dental implant procedures in immunosuppressed organ transplant patients: a systematic review[J]. Int J Oral Maxillofac Surg, 2022,51(3):380-387. DOI: 10.1016/j.ijom.2021.06.008.