Preliminary impressions in microstomia patients: an innovative technique

Frequency and type of digital procedures used for the intraoral prosthetic rehabilitation of patients with head and neck cancer: A systematic review

STATEMENT OF PROBLEM

In spite of a digital workflow playing an important role in the intraoral prosthetic rehabilitation of patients with head and neck cancer, information about how it has been implemented and its clinical implications is sparse.

PURPOSE

The purpose of this systematic review was to evaluate the use of a digital workflow in the intraoral prosthetic rehabilitation of patients with head and neck cancer by analyzing the frequency and type of the digital procedures used.

MATERIAL AND METHODS

Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were followed. The following terms were applied for the search conducted in the MEDLINE-PubMed, Cochrane, and SciELO databases: (prosthesis OR dental OR rehabilitation) AND (digital OR CAD-CAM OR intraoral scanner) AND (Cancer OR head neck). Articles that specified data on intraoral prosthetic treatment and analyzed the use of a digital workflow in the different prosthetic phases such as digital scanning and computer-aided design and computer-aided manufacturing (CAD-CAM) in patients with head and neck cancer were included. Data from the frequency and type of digital procedures were analyzed.

RESULTS

Thirteen articles were included, and all had incorporated CAD-CAM techniques in at least 1 of the prosthetic treatment stages (scanning, design, and/or fabrication). Only 1 patient was rehabilitated by using a completely digital workflow. The most frequent prosthetic treatment was an obturator (82.6%). Regarding the image capture method, the most used method was cone beam computed tomography (CBCT) (60.9%).

CONCLUSIONS

Most reports described the partial use of a digital workflow in the intraoral prosthetic rehabilitation of patients treated for head and neck cancer. A digital workflow is used for specific stages but not for the entire process. More studies are needed to evaluate digital systems, ideally comparing parameters with the conventional method, and to determine whether this technique has more relevant clinical implications.

Rehabilitation of a maxillectomy patient using intraoral scanning impression technology and a computer-aided design/computer-aided manufacturing fabricated obturator prosthesis: A clinical report

Rehabilitation of a partially dentate postmaxillectomy patient using a novel approach is presented in this report. The patient was referred to our practice by the oral and maxillofacial surgery department of the local general hospital for the evaluation and prosthetic treatment planning. He had undergone biopsy for a lesion located in the right quadrant of his maxilla and was scheduled for a hemimaxillectomy for removal of a squamous cell carcinoma. A surgical obturator was prepared for placement at the time of ablative surgery. Following completion of adjuvant radiotherapy and chemotherapy, a digital intraoral impression of the remaining maxilla and mandible was obtained, and a computer-aided design/computer-aided manufacturing obturator removable partial denture utilizing a selective laser melting -produced metal framework was fabricated and delivered to the patient to restore function and esthetics. The need for conventional impression was eliminated leading to a reduction of necessary appointments and more comfort to the patient.

Preliminary impression techniques for microstomia patients

The Prosthetic rehabilitation of microstomia patients presents difficulties at all the stages. The difficulty starts with the preliminary impression making. This is due to the tongue rigidity and the decreased oral opening. A maximum oral opening which is smaller than the size of the tray can make prosthetic treatment challenging. Due to the restricted mouth opening, insertion and removal of the impression trays is extremely cumbersome and various modifications of the trays have been used in the past. Among these are the flexible trays and the sectional trays used with different modes of reassembling the segments extra orally after the impression is made. This article reviews the literature published from 1971 to 2015 concerning preliminary impression techniques used in making impressions for patients with microstomia based on various tray designs. An electronic search was performed across three databases (PubMed, Science Direct and Google Scolar) for relevant citations. The keywords/combinations used for the search were microstomia, limited/constricted/restricted mouth opening/oral access, trismus, sectional trays, impressions and prosthetic/prosthodontic rehabilitation. The search was limited to papers written in English which resulted in a total of 45 related articles of which 17 articles were included for discussion of this review.