Dr. P. asks:
I have a patient with SLE [Systemic Lupus Erythematosus] . She was treated with steroids for about 2 years and has been off of steroids for 6 months now. She has several retained primary teeth and wants to have them extracted and replaced with implants. She is 30 years old. Her rheumatologist has advised not to have implants in view of her systemic connective tissue disorder. Please share your experience and advice. Money and time are not an issue with this patient. She would like to improve her aesthetics and function. I feel that her rheumatologist is being overly cautious. What are your thoughts? Does anyone have experience in placing implants in this type of situation?
Implants for Patient with Lupus and Treated with Steriods?
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I have to agree with the rheumatologist. I have tried doing this and it was a complete failure and can be problem.
To my knowledge, (limited to be sure) there is little literature on this specific subject.
I have performed successful dental implants on SLE patients….
Two patients …. three implants… all well integrated over conservative two stage technique.
Relatively young patients 46 & 50 with good looking type II and III bone that had excellent vascularity.
It is possible with a proper patient relationship and informed consent in my opinion.
Be very careful here, if you are going to go against the advice of her rheumatologist you are walking on medico-legal thin ice. I have done many cases on lupus patients. atraumatic, clean implant surgery can be tolerated by just about anyone. osseointegration does not seem to be a problem. however, your expert advised against it. i would discuss it with the rheumatologist. you really don’t want to be on the wrong side of a case like this if something goes wrong. it is an elective procedure with non-surgical alternatives. i would try to co-educate with her rheumatologist. I have found that many MD’s have misconceptions about implant dentistry.
additionally, i would let a surgical specialist (i don’t know if you are one) do the surgical part of the case. it will be easier for him/her to manage the medical aspect of the patinet.
keep us posted.