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Dental Implants Placement in Paranoid Squizofrenic Patient with Obsessive-Compulsive Disorder: a Case Report

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Dental Implants Placement in Paranoid Squizofrenic Patient with Obsessive-Compulsive Disorder: a Case Report J Clin Exp Dent. 2017;9(11):e1371-4. Dental implants in squizofrenic patient Journal section: Oral Surgery doi:10.4317/jced.54356 Publication Types: Case Report http://dx.doi.org/10.4317/jced.54356 Dental implants placement in paranoid squizofrenic patient with obsessive-compulsive disorder: A case report Lizett Castellanos-Cosano 1, José-Ramón Corcuera-Flores 1, María Mesa-Cabrera 2, José Cabrera-Domínguez 1, Daniel Torres-Lagares 3, Guillermo Machuca-Portillo 4 1 Associate Professor, Department of Stomatology, School of Dentistry, University of Seville, Seville, Spain 2 Master Special Care Dentistry, Department of Stomatology, School of Dentistry, University of Seville, Seville, Spain 3 Professor and Chairman, Oral Surgery, Department of Stomatology, School of Dentistry, University of Seville, Seville, Spain 4 Professor and Chairman, Special Care Dentistry, Department of Stomatology, School of Dentistry, University of Seville, Seville, Spain Correspondence: School of Dentistry University of Sevilla C/Avicena s/n 41009 Sevilla, Spain Castellanos-Cosano L, Corcuera-Flores JR, Mesa-Cabrera M, Cabrera- [email protected] Domínguez J, Torres-Lagares D, Machuca-Portillo G. Dental implants placement in paranoid squizofrenic patient with obsessive-compulsive disorder: A case report. J Clin Exp Dent. 2017;9(11):e1371-4. Received: 24/09/2017 http://www.medicinaoral.com/odo/volumenes/v9i11/jcedv9i11p1371.pdf Accepted: 23/10/2017 Article Number: 54356 http://www.medicinaoral.com/odo/indice.htm © Medicina Oral S. L. C.I.F. B 96689336 - eISSN: 1989-5488 eMail: [email protected] Indexed in: Pubmed Pubmed Central® (PMC) Scopus DOI® System Abstract Background: Paranoid schizophrenia is a mental illness that involves no observable anatomical alteration. Main characteristic affects the personality of the individual, as well as areas of his own psychology. Case Report: A 33-year-old man with paranoid schizophrenia and obsessive-compulsive disorder in treatment with Haloperidol, Oxcarbazepine, Olanzapine and Seroquel is presented. Dental exploration showed widespread decay mostly cervical with numerous root fragments, agenesis of lateral incisors, impacted wisdom teeth, missing teeth and malocclusion. Treatment plan included restoration of teeth decay, extractions of root fragments and implant- supported prostheses in bilateral upper lateral incisors for aesthetics reason. A previous consultation with a psy- chiatric specialist was performed and no contraindication were observed. A preliminary radiological examination was performed previous dental treatment and implant placement. Due to patient refusal to replace dental abscenses with implants, inform consent was signed up from his parents. After local anesthesia, first implant was placed at upper right lateral positions (Straumann Bone Level Ø 3.3 mm, length 10 mm). Two weeks later a second implant was placed at upper left lateral position (Straumann Bone Level Ø 3.3 mm, length 12 mm). The patient showed no postoperative complications. After implant placement, the patient attended scheduled review appointments. The prosthesis was placed after a 3-month period of osseointegration. Conclusions: Implant placement can be considered a suitable option for people with mental disorders. A previous consultation with psychiatric specialists for conducting a good patient management is necessaire. Key words: Paranoid schizophrenia, obsessive-compulsive disorder, dental implants. e1371 J Clin Exp Dent. 2017;9(11):e1371-4. Dental implants in squizofrenic patient Introduction incisors, widespread decay mostly cervical, numerous Schizophrenia is considered to be a brain disorder cha- root fragments, impacted wisdom teeth, missing teeth racterized by diverse symptoms that might include hallu- and malocclusion. A preliminary radiological examina- cinations, delusions, lack of organized communication, tion was performed and agenesis of permanent lateral a reduce capacity for planning, diminished motivation, incisors was observed (Fig. 1). and blunted affect (1). The incidence and prevalence of -Protocol Design schizophrenia does not show a prominent location. Ma- A previous consultation with his psychiatric specialist les are considered more risky to develop schizophrenia was performed and no contraindication were observed. than females (2). Due to patient refusal to replace dental abscenses with Schizophrenia and bipolar affective disorder are consi- implants, inform consent was signed up from his parents. dered the most common disorders associated with severe Treatment plan included restoration of teeth decay, ex- mental illness. These conditions have proved to have a tractions of root fragments and implant-supported pros- worse physical health with a life expectancy diminished theses in bilateral upper lateral incisors for aesthetics when you compare to general population (3,4). First reasons. A computarized axial tomography was realized and second generations of antipsychotics drugs are fre- previous implant placement with a radiological guide quently used in the treatment of these disorders. Both splint once a complete oral health state was achieve. generation of drugs block brain dopamine receptors -Surgical Treatment and can cause a negative effect on the patient’s ability Surgical treatment was performed under local infiltrative to effectively brush their teeth and perform oral hygie- anesthesia with vasoconstrictor (articaine plus 1:100,000 ne activities (5). These drugs have anticholinergic side epinephrine) by periapical injection. A mucoperiosteal effects as xerostomia, considered a major risk factor of flap was made along the crestal bone of the edentulous dental caries. In addition, patients with dry mouth drink space. First implant was placed at upper right lateral po- carbonated drinks more frequently, increasing the risk sition (Straumann Bone Level Ø 3.3 mm, length 10 mm) for caries (6). (Fig. 2). Two weeks later a second implant was placed Psychiatrists are not sufficiently alert to the risk and ex- at upper left lateral position (Straumann Bone Level Ø tent of dental pathology among their patients or to its ps- 3.3 mm, length 12 mm) following the same protocol as ychological impact. In 1982, the World Health Organi- upper right lateral implant placement. Implant closure zation published its recommendations for improving the screws were immersed in the flap in both implants surge- socio-psychological aspects of oral health (7). Although ries to avoid self-injuries of the patient to a foreign body. oral health has improved throughout the global popu- Antibiotic and anti-inflammatory drugs were prescribed. lation, however psychiatric patients continue belonging The patient showed no postoperative complications. Af- to a minority group that have not reach this oral health ter implant placement, the patient attended scheduled state (8). review appointments. Dentists are generally unwilling to invest in complex -Prosthetic Treatment conservative or rehabilitative treatments owing to the After a 3-month period of osseointegration a second sur- difficulty in treating patients with psychiatric disease (9). gery was perform in order to expose both implant where Advanced treatments such as dental implants placement healing abutments were placed. A week later implant in patients with mental disorders have not been descri- impression were performed with an impression post bed in the scientific literature. This is the first case report screw-retained, with integral guide screw height of 10 that describes a successful integrated oral treatment with mm in both implants. implant placement in a patient with schizophrenia and The prosthesis was placed and both patient and family obsessive-compulsive disorder. were fully satisfied with the results. Follow up appo- intments were performed at 6 months and 1 year after Case Report coronal prosthesis implant placement (Fig. 3). A 33-year-old man with paranoid schizophrenia and ob- sessive-compulsive disorder was attended at the Faculty Discussion of Dentistry at the University of Seville. The patient was Our patient was under antipsychotics (Haloperidol, on treatment with Haloperidol, Oxcarbazepine, Olan- Olanzapine and Quetiapine) and antiepilectical (Oxcar- zapine and Quetiapine (Seroquel®). Extraoral frontal bazepine) medications. The xerostomia consequently of exploration showed no proportional thirds, with a slight antipsychotic drugs is often increased by the concomi- augmentation of the inferior facial third. The patient did tant use of anticholinergic drugs, which are prescribed not show teeth while was smiling due to a serious com- with high-potency antipsychotics in order to alleviate the plex regard to his oral state. Sagital exploration showed Parkinsonian side effects of these psychiatric drugs (10). a mandibular retrognatia. Clinical oral exploration showed numerous root frag- Dental exploration showed presence of temporary lateral ments result of advance caries lesion without treatment. e1372 J Clin Exp Dent. 2017;9(11):e1371-4. Dental implants in squizofrenic patient Fig. 1: Initial oral state. (1) Right lateral intraoral photography, (2) Frontal intraoral photography, (3) Left lateral intraoral photography, (4) Upper occlusal intraoral photography and (5) Orthopantomography. Fig. 2: Surgical implant placement in upper right lateral incisor. Fig. 3: Follow up after 1 year. (1) Right lateral intraoral photography, (2) Frontal intraoral photography, (3) Left lateral intraoral photog- raphy and (4) Orthopantomography. e1373 J Clin Exp Dent. 2017;9(11):e1371-4.
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