金属烤瓷冠替换牙科银汞合金对口腔苔藓样反应的影响

Effect of Replacement of Dental Amalgam with Metal Crown on Oral Lichenoid Reactions.

目的了解替换银汞充填体后,口腔苔藓样反应(OLR)的愈合情况,在治疗效果上的差异。方法参与实验的病人:10例苔藓样反应(OLR)病人,病损局限在与银汞充填体频繁接触的口腔粘膜区域(OLR组,n=10)。20例扁平苔藓(OLP)病人,病损累及口腔粘膜各个部位,包括与银汞充填体接触的区域(OLP组,n=20)。5例OLR病和8例OLP病人不做银汞充填体替换的,作为对照组。初诊时,测量记录病人的口腔症状,各病损的范围及临床表现特征,取活检,然后去除银汞充填体,用金属烤瓷冠修复。在6个月后随访评价疗效。结果在OLR组,替换银汞充填体后,90％病人的病损获得明显的好转或病损全部消失;症状基本消失。10％病人无缓解。在OLP组,替换银汞后,45％的病人,其与银汞有接触的糜烂和萎缩病损有改善,不与银汞接触的病损是无改变。55％的OLP病人的体征在替换银汞后无好转。对照组中,5例OLR及8例OLP与银汞接触的病损无缓解,症状同前。结论以上结果可看到,在金属烤瓷冠替换银汞充填体后,OLR病损绝大部分消退,为临床提供了一种有效的治疗方式。

Objective The objectives of this study were to investigate (1) healing of oral lichenoid reactions (OLR) following the selective replacement of restorations of dental amalgam, (2) whether there were differences in healing between lichenoid reactions (OLR) and oral lichen planus (OLP) .Methods Patients included in the study presented with OLR confined to areas of the oral mucosa in close contact with amalgam restorations (OLR; n=10), or with which involved other parts of the oral mucosa as well (OLP; n = 20) .After examination, restorations of dental amalgam which were in contact with OLR or OLP in both patient groups were replaced.The effect of replacement was evaluated at a follw -up after 6 months. Results In the OLR group, the lesions showed a considerable improvement or had totally disappeared in 95% of the patients after replacement of the restorations of dental amalgam.This effect was paralleled by a disappearance of symptoms, in contrast to patients with persisting (5%) who did not report any significant improvement. In the OLP group (n=20), 45% of the patients with amalgam- associated erosive and atrophic lesions showed an improvement following selective replacement. OLP lesions in sites not in contact with amalgams were not affected. Conclusions From these data it can be concluded that the vast majority of resolve following selective replacement of restorations of dental a-malgam, provided that a correct clinical diagnosis is established.