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Generalova AN, Vikhrov AA, Prostyakova AI, Apresyan SV, Stepanov AG, Myasoedov MS, Oleinikov VA. Polymers in 3D printing of external maxillofacial prostheses and in their retention systems. Int J Pharm 2024; 657:124181. [PMID: 38697583 DOI: 10.1016/j.ijpharm.2024.124181] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2023] [Revised: 04/12/2024] [Accepted: 04/28/2024] [Indexed: 05/05/2024]
Abstract
Maxillofacial defects, arising from trauma, oncological disease or congenital abnormalities, detrimentally affect daily life. Prosthetic repair offers the aesthetic and functional reconstruction with the help of materials mimicking natural tissues. 3D polymer printing enables the design of patient-specific prostheses with high structural complexity, as well as rapid and low-cost fabrication on-demand. However, 3D printing for prosthetics is still in the early stage of development and faces various challenges for widespread use. This is because the most suitable polymers for maxillofacial restoration are soft materials that do not have the required printability, mechanical strength of the printed parts, as well as functionality. This review focuses on the challenges and opportunities of 3D printing techniques for production of polymer maxillofacial prostheses using computer-aided design and modeling software. Review discusses the widely used polymers, as well as their blends and composites, which meet the most important assessment criteria, such as the physicochemical, biological, aesthetic properties and processability in 3D printing. In addition, strategies for improving the polymer properties, such as their printability, mechanical strength, and their ability to print multimaterial and architectural structures are highlighted. The current state of the prosthetic retention system is presented with a focus on actively used polymer adhesives and the recently implemented prosthesis-supporting osseointegrated implants, with an emphasis on their creation from 3D-printed polymers. The successful prosthetics is discussed in terms of the specificity of polymer materials at the restoration site. The approaches and technological prospects are also explored through the examples of the nasal, auricle and ocular prostheses, ranging from prototypes to end-use products.
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Affiliation(s)
- Alla N Generalova
- Shemyakin-Ovchinnikov Institute of Bioorganic Chemistry of the Russian Academy of Sciences, Miklukho-Maklaya 16/10, 117997 Moscow, Russia; Federal Scientific Research Center "Crystallography and Photonics" of the Russian Academy of Sciences, 119333 Moscow, Russia.
| | - Alexander A Vikhrov
- Shemyakin-Ovchinnikov Institute of Bioorganic Chemistry of the Russian Academy of Sciences, Miklukho-Maklaya 16/10, 117997 Moscow, Russia
| | - Anna I Prostyakova
- Shemyakin-Ovchinnikov Institute of Bioorganic Chemistry of the Russian Academy of Sciences, Miklukho-Maklaya 16/10, 117997 Moscow, Russia
| | - Samvel V Apresyan
- Institute of Digital Dentistry, Medical Institute, Peoples' Friendship University of Russia (RUDN University), Miklukho-Maklaya 6, 117198 Moscow, Russia
| | - Alexander G Stepanov
- Institute of Digital Dentistry, Medical Institute, Peoples' Friendship University of Russia (RUDN University), Miklukho-Maklaya 6, 117198 Moscow, Russia
| | - Maxim S Myasoedov
- Shemyakin-Ovchinnikov Institute of Bioorganic Chemistry of the Russian Academy of Sciences, Miklukho-Maklaya 16/10, 117997 Moscow, Russia
| | - Vladimir A Oleinikov
- Shemyakin-Ovchinnikov Institute of Bioorganic Chemistry of the Russian Academy of Sciences, Miklukho-Maklaya 16/10, 117997 Moscow, Russia
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Jain R, Ghosh M, Goel R, Gupta R, Golhait P, Ghosh B. A challenging journey of maxillofacial implants placement and rehabilitation in an irradiated exenterated socket. J Oral Biol Craniofac Res 2022; 12:319-323. [DOI: 10.1016/j.jobcr.2022.03.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2021] [Revised: 08/02/2021] [Accepted: 03/18/2022] [Indexed: 10/18/2022] Open
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D'heygere V, Mattheis S, Stähr K, Bastian T, Höing B, Lang S, Hussain T. Epithetic nasal reconstruction after total rhinectomy: Oncologic outcomes, immediate and long-term adverse effects, and quality of life. J Plast Reconstr Aesthet Surg 2020; 74:625-631. [PMID: 33189623 DOI: 10.1016/j.bjps.2020.10.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2020] [Accepted: 10/19/2020] [Indexed: 10/23/2022]
Abstract
INTRODUCTION Total rhinectomy for tumors of the nasal cavity substantially alters patients' appearance and requires local reconstruction. While full nasal epitheses are well-established for this purpose, potential long-term adverse effects and impact on patients' quality of life are not fully understood. METHODS Sixteen patients who underwent total rhinectomy with ensuing nasal reconstruction with a full nasal epithesis were included in the study. Oncologic outcomes were assessed, and adverse effects and quality of life analyses were performed based on a patient-reported outcomes tool. RESULTS In patients with squamous cell carcinomas of the nasal cavity, total rhinectomy led to excellent local tumor control. Immediate and long-term adverse effects of total rhinectomy and placement of a nasal epithesis were predominantly limited to the immediate nasal region. While patients were satisfied with their nasal appearance, they reported a worse assessment of their facial appearance and a measurable long-term effect on their psychological well-being. CONCLUSION Total rhinectomy and reconstruction with a full nasal epithesis is a safe and oncologically sound treatment approach. However, its effects on patients' overall appearance and psychological well-being need to be considered during treatment planning and follow-up.
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Affiliation(s)
- Victoria D'heygere
- Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital Essen, Hufelandstraße 55, 45147 Essen, Germany
| | - Stefan Mattheis
- Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital Essen, Hufelandstraße 55, 45147 Essen, Germany
| | - Kerstin Stähr
- Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital Essen, Hufelandstraße 55, 45147 Essen, Germany
| | - Tobias Bastian
- Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital Essen, Hufelandstraße 55, 45147 Essen, Germany
| | - Benedikt Höing
- Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital Essen, Hufelandstraße 55, 45147 Essen, Germany
| | - Stephan Lang
- Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital Essen, Hufelandstraße 55, 45147 Essen, Germany
| | - Timon Hussain
- Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital Essen, Hufelandstraße 55, 45147 Essen, Germany.
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Subramaniam S, Breik O, Cadd B, Peart G, Wiesenfeld D, Heggie A, Gibbons S, Nastri A. Long-term outcomes of craniofacial implants for the restoration of facial defects. Int J Oral Maxillofac Surg 2018; 47:773-782. [DOI: 10.1016/j.ijom.2018.01.013] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2017] [Revised: 01/14/2018] [Accepted: 01/17/2018] [Indexed: 10/18/2022]
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Conical Modification of Forearm Free Flaps for Single-Stage Reconstruction After Total Orbital Exenteration. J Craniofac Surg 2017; 28:e767-e769. [DOI: 10.1097/scs.0000000000003944] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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Cobein MV, Coto NP, Crivello Junior O, Lemos JBD, Vieira LM, Pimentel ML, Byrne HJ, Dias RB. Retention systems for extraoral maxillofacial prosthetic implants: a critical review. Br J Oral Maxillofac Surg 2017; 55:763-769. [PMID: 28552609 DOI: 10.1016/j.bjoms.2017.04.012] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2016] [Accepted: 04/23/2017] [Indexed: 10/19/2022]
Abstract
We describe the techniques available for retention of implant-supported prostheses: bar-clips, O-rings, and magnets. We present reported preferences and, although this is limited by the heterogeneity of methods used and patients studied, we hope we have identified the best retention systems for maxillofacial prosthetic implants. If practitioners know the advantages and disadvantages of each system, they can choose the most natural and comfortable prosthesis. We searched the PubMed and Scopus databases, and restricted our search to papers published 2001-13. MeSH terms used were Maxillofacial prosthesis and Craniofacial prosthesis OR Craniofacial prostheses. We found a total of 2630 papers, and after duplicates had been removed we analysed the rest and found 25 papers for review. Of these, 12 were excluded because they were case reports or non-systematic reviews. Of the remaining 13, 10 described group analyses and seemed appropriate to find practitioner's choices, as cited in the abstract (n=1611 prostheses). Three papers did not mention the type of prosthetic connection used, so were excluded. The most popular choices for different conditions were analysed, though the sites and retention systems were not specified in all 10 papers. The bar-clip system was the most used in auricular (6/10 papers) and nasal prostheses (4/10). For the orbital region, 6/10 favoured magnets. Non-osseointegrated mechanical or adhesive retention techniques are the least expensive and have no contraindications. When osseointegrated implants are possible, each facial region has a favoured system. The choice of system is influenced by two factors: standard practice and the abilities of the maxillofacial surgeon and maxillofacial prosthetist.
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Affiliation(s)
- M V Cobein
- Oral and Maxillofacial Surgeon, Hospital Regional Sul, São Paulo, Brazil; Department of Maxillofacial Surgery, Prosthetics and Traumatology - Area of Maxillofacial Prosthetics, School of Dentistry of University of São Paulo, São Paulo, Brazil.
| | - N P Coto
- Department of Maxillofacial Surgery, Prosthetics and Traumatology - Area of Maxillofacial Prosthetics, School of Dentistry of University of São Paulo, São Paulo, Brazil.
| | - O Crivello Junior
- Department of Maxillofacial Surgery, Prosthetics and Traumatology - Area of Maxillofacial Traumatology, School of Dentistry of University of São Paulo, São Paulo, Brazil.
| | - J B D Lemos
- Department of Maxillofacial Surgery, Prosthetics and Traumatology - Area of Maxillofacial Traumatology, School of Dentistry of University of São Paulo, São Paulo, Brazil.
| | - L M Vieira
- Department of Maxillofacial Surgery, Prosthetics and Traumatology - Area of Maxillofacial Prosthetics, School of Dentistry of University of São Paulo, São Paulo, Brazil.
| | - M L Pimentel
- Department of Maxillofacial Surgery, Prosthetics and Traumatology - Area of Maxillofacial Prosthetics, School of Dentistry of University of São Paulo, São Paulo, Brazil.
| | - H J Byrne
- FOCAS Research Institute of Dublin Institute of Technology, Dublin, Ireland.
| | - R B Dias
- Department of Maxillofacial Surgery, Prosthetics and Traumatology - Area of Maxillofacial Prosthetics, School of Dentistry of University of São Paulo, São Paulo, Brazil.
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Craniofacial implants at a single centre 2005-2015: retrospective review of 451 implants. Br J Oral Maxillofac Surg 2017; 55:242-245. [DOI: 10.1016/j.bjoms.2016.11.324] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2016] [Accepted: 11/04/2016] [Indexed: 11/23/2022]
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Poort LJ, Kiewiet CC, Cleutjens JPM, Houben R, Hoebers FJP, Kessler PAWH. Osseointegration and implant stability of extraoral implants in Göttingen minipigs after irradiation. J Craniomaxillofac Surg 2016; 44:1842-1848. [PMID: 27697399 DOI: 10.1016/j.jcms.2016.08.019] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2016] [Revised: 07/19/2016] [Accepted: 08/24/2016] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVES The aim of this study was to compare the influence of implant surface treatment and irradiation dose on implant stability and osseointegration of 144 extraoral implants in irradiated frontal bone of minipigs. MATERIAL AND METHODS 144 implants with 3 different surface treatments (machined, etched and HAVD-coated) were implanted in the frontal bone of 16 Göttingen minipigs. Three groups of four pigs received radiation with equivalent doses of 25, 50 and 70 Gy, and one group served as control. Resonance frequency analysis (RFA) was performed recording Implant Stability Quotients (ISQ) at implant placement and 3 months thereafter. Removal torque was measured whilst removing specific implants after 3 months. In addition, the bone-to-implant contact (BIC) was analyzed. RESULTS Evaluation of ISQ, BIC-values showed no significant difference between the different surface treatments in irradiated and non-irradiated bone. Removal torque revealed statistically significant differences between machined and HAVD-coated implants in the irradiated bone. CONCLUSIONS Implant stability and osseointegration, based on Removal Torque showed significant higher results for the HAVD-coated implants. No significant difference was observed between the irradiated and non-irradiated animals. This study shows that HAVD-coated extraoral implants can potentially be used for craniofacial rehabilitation in non-irradiated and irradiated bone.
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Affiliation(s)
- Lucas J Poort
- Department of Cranio-Maxillofacial Surgery and GROW School for Oncology and Developmental Biology, Maastricht University Medical Centre, Maastricht, The Netherlands.
| | - Charlotte C Kiewiet
- Department of Cranio-Maxillofacial Surgery, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Jack P M Cleutjens
- Department of Pathology and CARIM School for Cardiovascular, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Ruud Houben
- Department of Radiation Oncology (Maastro Clinic) and GROW School for Oncology and Developmental Biology, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Frank J P Hoebers
- Department of Radiation Oncology (Maastro Clinic) and GROW School for Oncology and Developmental Biology, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Peter A W H Kessler
- Department of Cranio-Maxillofacial Surgery and GROW School for Oncology and Developmental Biology, Maastricht University Medical Centre, Maastricht, The Netherlands
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Brandão TB, Vechiato Filho AJ, de Souza Batista VE, de Oliveira MCQ, Visser A, de Faria JCM, Júnior GDC, Santos-Silva AR. A systematic comparison of bar-clips versus magnets. J Prosthet Dent 2016; 117:321-326.e2. [PMID: 27666496 DOI: 10.1016/j.prosdent.2016.05.020] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2015] [Revised: 05/04/2016] [Accepted: 05/06/2016] [Indexed: 10/21/2022]
Abstract
STATEMENT OF PROBLEM Currently, which type of suprastructure is preferred when fabricating implant-retained craniofacial prostheses is unknown. PURPOSE The purpose of this systematic review was to identify the best retention system (bar-clips versus magnets) for implant-retained craniofacial prostheses. MATERIAL AND METHODS This systematic review was conducted and reported in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement. A systematic search of Medline/PubMed and Web of Science databases for clinical trials was conducted on implant-retained craniofacial prostheses published between 2005 and 2015. English-language studies that directly compared different types of retention systems or presented information on implant survival, periimplant soft tissue reactions, and prosthetic complications were included. Nonclinical studies were excluded to eliminate bias. RESULTS A total to 173 studies were identified, of which 10 satisfied the inclusion criteria. In total, 492 participants were included in these studies. Four selected studies displayed detailed information with regard to the number of implant failures according to the retention system. As reported, 29 (18.2%) of 159 implants with magnets failed, whereas 25 (31.6%) of 79 implants with bars failed. Overall auricular superstructures showed the highest survival (99.08%). In addition, 55.4% of all participants in the selected studies showed grade 0 of periimplant soft tissue reactions. CONCLUSIONS A systematic search for clinical studies resulted in few studies with a short-term follow-up and small number of participants. The limited data collected indicated that magnets show fewer complications than bar superstructures; however, no hard conclusions could be drawn. Further research, preferably in the form of clinical trials, is needed to validate these findings.
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Affiliation(s)
- Thais Bianca Brandão
- Coordinator, Dental Oncology Service, Instituto do Câncer do Estado de São Paulo (ICESP), Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil.
| | - Aljomar José Vechiato Filho
- Assistant, Dental Oncology Service, Instituto do Câncer do Estado de São Paulo (ICESP), Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - Victor Eduardo de Souza Batista
- Doctoral student, Department of Dental Materials and Prosthodontics, Aracatuba Dental School, Sao Paulo State University, São Paulo, Brazil
| | - Maria Cecília Querido de Oliveira
- Assistant, Dental Oncology Service, Instituto do Câncer do Estado de São Paulo (ICESP), Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - Anita Visser
- Assistant Professor, Department of Oral and Maxillofacial Surgery, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - José Carlos Marques de Faria
- Associate Professor, Plastic Surgery, University of São Paulo, São Paulo, Brazil; and Head, Plastic Surgery, Pontificia Universidade Catolica, Medical School, Campinas, São Paulo, Brazil
| | - Gilberto de Castro Júnior
- Attending Physician, Clinical Oncology, Instituto do Câncer do Estado de São Paulo (ICESP), Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - Alan Roger Santos-Silva
- Professor, Oral Diagnosis Department, Piracicaba Dental School, University of Campinas, Sao Paulo, Brazil
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Zuo KJ, Wilkes GH. Clinical Outcomes of Osseointegrated Prosthetic Auricular Reconstruction in Patients With a Compromised Ipsilateral Temporoparietal Fascial Flap. J Craniofac Surg 2016; 27:44-50. [PMID: 26703031 DOI: 10.1097/scs.0000000000002181] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Patients with major ear deformities and associated compromise of the superficial temporal artery are poor candidates for autogenous ear reconstruction because of a tenuous ipsilateral temporoparietal fascial flap (TPFF). Osseointegrated prosthetic auricular reconstruction (OPAR) is an alternative to contralateral free TPFF microsurgical and autogenous reconstruction, but data on clinical outcomes are limited. The records of patients with ear loss or major deformity and a compromised ipsilateral TPFF who underwent OPAR from 1989 to 2013 were reviewed. Satisfaction was assessed using a questionnaire based on a 5 point Likert scale. Thirty-two patients (8 women, 24 men) with mean age 43.0 years (range, 10-70 years) underwent OPAR. The ipsilateral TPFF was compromised due to major trauma (13 patients), cancer extirpation (9), burn injury (4), previous harvest (4), arteriovenous malformation (1), or infection (1). All but 2 patients had an associated craniofacial defect, such as soft tissue deformity (87.5%), hearing loss (46.9%), or bony deformity (31.3%). The overall implant success rate was 88.6% at mean follow-up time of 7.6 years post-OPAR. Prosthesis wear averaged 12.2 hours/day and 6.6 days/week (80.5 hours/week). All 5 patients who experienced implant failures had received prior head and neck irradiation. With their prosthesis, 76.2% (16 patients) stated that their self-consciousness and self-esteem were "better" or "much better," whereas 85.7% (18 patients) stated that their self-image was "better" or "much better." All patients declared that they would undergo the treatment again. Osseointegrated prosthetic auricular reconstruction is a reliable option in this challenging population with high patient satisfaction. Patients with prior radiotherapy may have a higher chance of implant failure and would benefit from extended annual follow-up.
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Affiliation(s)
- Kevin J Zuo
- *Faculty of Medicine and Dentistry, University of Alberta †Institute for Reconstructive Sciences in Medicine, Misericordia Hospital, Covenant Health Group ‡Division of Plastic and Reconstructive Surgery, University of Alberta, Edmonton, Canada
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Zong C, Cai B, Wen X, Alam S, Chen Y, Guo Y, Liu Y, Tian L. The role of myofibroblasts in the development of osteoradionecrosis in a newly established rabbit model. J Craniomaxillofac Surg 2016; 44:725-33. [PMID: 27150352 DOI: 10.1016/j.jcms.2016.03.002] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2015] [Revised: 03/01/2016] [Accepted: 03/14/2016] [Indexed: 11/29/2022] Open
Abstract
This study aimed to establish a proper animal model of osteoradionecrosis of jaws (ORNJ) and to observe preliminarily the characteristics of myofibroblasts, the key effector cell of fibrosis, in ORNJ. Rabbit mandibles were irradiated at three different doses based on a human equivalent radiation schedule, and examined by gross manifestation, single-photon emission computed tomography (SPECT), micro-computed tomography, sequential fluorochrome labeling, and histology. Immunohistochemistry staining of α-SMA was applied to detect the existence of myofibroblasts. The exposed necrotic bone, which is the main indication of ORNJ, started to be observed at all rabbits at 9 Gy. With the radiation dose increasing, the microarchitecture of the irradiated mandibles was more destroyed, the metabolism and mineralization of the irradiated mandibles diminished, the osteocytes number decreased, and more mature bones were substituted by fibrosis in the irradiated mandibles. In addition, as the radiation dose increased, the myofibroblast number increased and collected around the separated sequestrum, which indicated that myofibroblasts might relate to the pathogenesis of ORNJ. In summary, a clinically translational ORNJ model was successfully established in our study, and the role of myofibroblasts in the pathogenesis of ORNJ is described for the first time.
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Affiliation(s)
- Chunlin Zong
- Department of Cranio-facial Trauma and Orthognathic Surgery, School of Stomatology, Fourth Military Medical University, Xi'an, China; The State Key Laboratory of Military Stomatology, School of Stomatology, Fourth Military Medical University, Xi'an, China
| | - Bolei Cai
- Department of Cranio-facial Trauma and Orthognathic Surgery, School of Stomatology, Fourth Military Medical University, Xi'an, China; The State Key Laboratory of Military Stomatology, School of Stomatology, Fourth Military Medical University, Xi'an, China
| | - Xinxin Wen
- Department of Orthopedics, Xijing Hospital, Fourth Military Medical University, Xi'an, China
| | - Syed Alam
- National Health Service Lothian, West Lothian, United Kingdom
| | - Yuanli Chen
- Department of Cranio-facial Trauma and Orthognathic Surgery, School of Stomatology, Fourth Military Medical University, Xi'an, China; The State Key Laboratory of Military Stomatology, School of Stomatology, Fourth Military Medical University, Xi'an, China
| | - Yuxuan Guo
- Department of Cranio-facial Trauma and Orthognathic Surgery, School of Stomatology, Fourth Military Medical University, Xi'an, China; The State Key Laboratory of Military Stomatology, School of Stomatology, Fourth Military Medical University, Xi'an, China
| | - Yanpu Liu
- Department of Cranio-facial Trauma and Orthognathic Surgery, School of Stomatology, Fourth Military Medical University, Xi'an, China; The State Key Laboratory of Military Stomatology, School of Stomatology, Fourth Military Medical University, Xi'an, China
| | - Lei Tian
- Department of Cranio-facial Trauma and Orthognathic Surgery, School of Stomatology, Fourth Military Medical University, Xi'an, China; The State Key Laboratory of Military Stomatology, School of Stomatology, Fourth Military Medical University, Xi'an, China.
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Balik A, Ozdemir-Karatas M, Peker K, Cifter ED, Sancakli E, Gökcen-Röhlig B. Soft Tissue Response and Survival of Extraoral Implants: A Long-Term Follow-up. J ORAL IMPLANTOL 2016; 42:41-5. [DOI: 10.1563/aaid-joi-d-14-00086] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Maxillofacial defects may be reconstructed by plastic surgery or treated by prosthetic mean rehabilitation. In case of large defects, prosthetic rehabilitation rather than surgical reconstruction is preferred due to the insufficient esthetic results of surgical interventions. However, retention of the craniofacial prosthesis is a great problem despite the satisfactory esthetic results. With the presentation of extraoral implants, the retention of maxillofacial prostheses was improved, and osseointegrated craniofacial implants have become indispensable for retention and stability. However, there are conflicting results regarding the success rates of osseointegrated implants used at the craniofacial region. A total of 24 patients with 64 implants (30 in auricular region of 13 patients, 24 in nasal region of 8 patients, and 10 in orbital region of 3 patients) ranging in age from 16 to 83 years (mean age = 45.45 years) were evaluated. One patient among 13 patients (1/13) has lost his implants in the auricular area, 1 patient among 8 patients (1/8) lost his implants, and 1 patient among 3 patients (1/3) has lost all of her implants. Peri-implant soft tissue response was evaluated for a 60-month period and a total of 654 visits/sites recorded. Grade 0 (no irritation) was present in 72.8% (476/654) of the visits/sites. Grade 1 (slight redness) was observed for 18.8% (123/654). Grade 2 (red and slightly moist tissue) was scored in 6.9% (45/654). Grade 3 (red and slightly moist tissue with granulation) was noted in 1.5% (10/654) and grade 4 (infection) could not be found. Ossseointegrated implants provide reasonable support and show successful results when used with maxillofacial prostheses.
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Affiliation(s)
- Ali Balik
- Department of Maxillofacial Prosthodontics, Faculty of Dentistry, Istanbul University, Istanbul, Capa, Turkey
| | - Meltem Ozdemir-Karatas
- Department of Maxillofacial Prosthodontics, Faculty of Dentistry, Istanbul University, Istanbul, Capa, Turkey
| | - Kadriye Peker
- Department of Dental Public Health, Faculty of Dentistry, Istanbul University, Fatih/Çapa, Istanbul, Turkey
| | - Ebru Demet Cifter
- Department of Maxillofacial Prosthodontics, Faculty of Dentistry, Istanbul University, Istanbul, Capa, Turkey
| | - Erkan Sancakli
- Department of Maxillofacial Prosthodontics, Faculty of Dentistry, Istanbul University, Istanbul, Capa, Turkey
| | - Bilge Gökcen-Röhlig
- Department of Maxillofacial Prosthodontics, Faculty of Dentistry, Istanbul University, Istanbul, Capa, Turkey
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Nader ME, Beadle BM, Roberts DB, Gidley PW. Outcomes and complications of osseointegrated hearing aids in irradiated temporal bones. Laryngoscope 2015; 126:1187-92. [PMID: 26371776 DOI: 10.1002/lary.25592] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/28/2015] [Indexed: 11/12/2022]
Abstract
OBJECTIVES/HYPOTHESIS To compare the complication rate for osseointegrated hearing aids (OIHA) in patients with or without irradiation. STUDY DESIGN Retrospective case review. METHODS We studied patients with OIHAs implanted between January 1, 2005, and July 15, 2013 in a tertiary university center with a referral otology and neurotology practice. Demographics, history of oncologic surgery, follow-up length after OIHA implantation, radiation history and dosage, postoperative complications, and chronologic relationship between oncologic resection, OIHA implantation, and irradiation were reviewed to collect information. Soft tissue complications were graded according to a modified Holgers classification. RESULTS The study included 48 patients. Twenty-nine patients (32 implants) did not undergo radiotherapy and 19 patients (19 implants) did. In the radiotherapy group, six patients had OIHAs implanted before radiotherapy, and 13 had OIHAs implanted in irradiated bone. Of these 13 patients, one had OIHA implanted during primary oncologic surgery; 11 had OIHA implanted during secondary surgery; and one patient did not have oncologic surgery. Patients with both OIHA implantation and radiotherapy had more complications than patients without radiotherapy (31.6% vs. 24.1%, P > 0.05) and more major complications than patients without radiotherapy (26.3% vs. 3.4%, P > 0.05). Patients with OIHAs implanted before radiotherapy did not have any complications. There were significantly fewer and less severe complications in patients with OIHAs implanted during primary oncologic resection than in patients with OIHAs implanted secondarily (0/8 vs. 8/11, P < 0.05). CONCLUSIONS The rate and severity of complications of OIHAs can be minimized by implanting the device before irradiation, ideally at the time of primary oncologic surgery. LEVEL OF EVIDENCE 4. Laryngoscope, 126:1187-1192, 2016.
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Affiliation(s)
- Marc-Elie Nader
- Department of Head and Neck Surgery, The University of Texas MD Anderson Cancer Center, Houston, Texas, U.S.A
| | - Beth M Beadle
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, U.S.A
| | - Diana B Roberts
- Department of Head and Neck Surgery, The University of Texas MD Anderson Cancer Center, Houston, Texas, U.S.A
| | - Paul W Gidley
- Department of Head and Neck Surgery, The University of Texas MD Anderson Cancer Center, Houston, Texas, U.S.A
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15
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Korfage A, Raghoebar GM, Noorda WD, Plaat BE, Vissink A, Visser A. Recommendations for implant-retained nasal prostheses after ablative tumor surgery: Minimal surgical aftercare, high implant survival, and satisfied patients. Head Neck 2015; 38 Suppl 1:E619-24. [PMID: 25784187 DOI: 10.1002/hed.24053] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/05/2015] [Indexed: 11/08/2022] Open
Abstract
BACKGROUND Nasal defects resulting from tumor resection are preferably rehabilitated with implant-retained nasal prostheses. Aftercare, clinical outcome of the implants, and patients' satisfaction with implant-retained nasal prostheses were assessed. METHODS Twenty-eight consecutive patients needing total rhinectomy because of tumor resection between 1998 and 2013 were treated according to a standardized protocol with 2 implants in the nasal floor. Surgical and prosthetic aftercare was scored using patient records. Finally in 2014, skin reaction, peri-implant bone loss, and patients' satisfaction were assessed in all 13 still living patients. RESULTS In total, 56 implants were inserted (median follow-up, 35.1 months; interquartile range [IQR], 8.9-63.3). Implant survival was 96.4%. Implant survival was independent of radiotherapy. Peri-implant skin was healthy and patients' satisfaction high. Longevity of the prostheses was limited. CONCLUSION Rehabilitation of nasal defects resulting from total rhinectomy with implant-retained nasal prostheses, according to our protocol, resulted in high patient satisfaction and favorable treatment outcome. © 2015 Wiley Periodicals, Inc. Head Neck 38: E-E, 2016.
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Affiliation(s)
- Anke Korfage
- Department of Oral and Maxillofacial Surgery, University of Groningen and University Medical Center Groningen, Groningen, The Netherlands
| | - Gerry M Raghoebar
- Department of Oral and Maxillofacial Surgery, University of Groningen and University Medical Center Groningen, Groningen, The Netherlands
| | - Willem D Noorda
- Department of Oral and Maxillofacial Surgery, University of Groningen and University Medical Center Groningen, Groningen, The Netherlands
| | - Boudewijn E Plaat
- Department of Otorhinolaryngology, Head and Neck Surgery, University of Groningen and University Medical Center Groningen, Groningen, The Netherlands
| | - Arjan Vissink
- Department of Oral and Maxillofacial Surgery, University of Groningen and University Medical Center Groningen, Groningen, The Netherlands
| | - Anita Visser
- Department of Oral and Maxillofacial Surgery, University of Groningen and University Medical Center Groningen, Groningen, The Netherlands
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16
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Extraoral implants for orbit rehabilitation: a comparison between one-stage and two-stage surgeries. Int J Oral Maxillofac Surg 2014; 43:341-7. [DOI: 10.1016/j.ijom.2013.09.002] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2012] [Revised: 06/01/2013] [Accepted: 09/02/2013] [Indexed: 11/23/2022]
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17
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Abstract
Extraoral cranial implant-retained prosthetic reconstructions have been proved to be highly successful. Replacement of the eyes, ears, nose, and larger areas including combined midface defects, which frequently have no other option available, has been done successfully. Burn patients and those with congenital defects are good candidates for this type of reconstruction, especially after autogenous attempts have failed. Cranial implant prosthetic reconstruction should be considered as a viable option for difficult craniofacial defects.
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Affiliation(s)
- Douglas P Sinn
- Division of Oral and Maxillofacial Surgery, Department of Surgery, UT Southwestern Medical School at Dallas, 5323 Harry Hines Boulevard, Dallas, TX 75390, USA.
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18
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Abstract
This clinical report describes the treatment of a patient with osseointegrated extraoral implants supporting a framework retainer and acrylic resin mesostructures and a large silicone midfacial prosthesis. A metal framework was used to splint the implants together and provided satisfactory retention for the facial prosthesis. A 2-piece prosthesis that composed of an obturator and facial prosthesis was fabricated. Cosmetic improvements as well as the ability to speak, swallow, and, to a lesser degree, chew, were achieved for this patient.
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19
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Sinn DP, Bedrossian E, Vest AK. Craniofacial implant surgery. Oral Maxillofac Surg Clin North Am 2011; 23:321-35, vi-vii. [PMID: 21492804 DOI: 10.1016/j.coms.2011.01.005] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Extraoral cranial implant-retained prosthetic reconstructions have been proved to be highly successful. Replacement of the eyes, ears, nose, and larger areas including combined midface defects, which frequently have no other option available, has been done successfully. Burn patients and those with congenital defects are good candidates for this type of reconstruction, especially after autogenous attempts have failed. Cranial implant prosthetic reconstruction should be considered as a viable option for difficult craniofacial defects.
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Affiliation(s)
- Douglas P Sinn
- Division of Oral and Maxillofacial Surgery, Department of Surgery, UT Southwestern Medical School at Dallas, 5323 Harry Hines Boulevard, Dallas, TX 75390, USA.
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20
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Dings JPJ, Maal TJ, Muradin MS, Ingels KJ, Klevering BJ, Koole R, Merkx MA, Meijer GJ. Extra-oral implants: insertion per- or post-ablation? Oral Oncol 2011; 47:1074-8. [PMID: 21835682 DOI: 10.1016/j.oraloncology.2011.07.015] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2011] [Revised: 07/14/2011] [Accepted: 07/18/2011] [Indexed: 11/30/2022]
Abstract
Although the benefit of extra-oral implants in the reconstruction of maxillofacial oncological defects is undisputable, some relevant issues need to be clarified. The purpose of this retrospective study was to evaluate the relationship between implants placed during ablation (DA-implants) and after ablation (AA-implants) of the tumor with respect to implant survival. In total, 103 implants were assessed: 44 nasal implants (17 patients) and 59 orbital implants (18 patients). All patients received their implant-retained maxillofacial epithesis between 1997 and 2010, with a mean follow-up of 35 months (range 8-156 months). The survival rate of DA-implants was 90.0% for the orbital region and 93.5% for the nasal region. The survival rate of the AA-implants for the orbital and the nasal region was 82.8% and 61.5%, respectively. This study shows a significant higher survival rate of extra-oral implants placed during ablative surgery compared to implants in a later stage (p=0.044), thereby stressing the importance of installing extra-oral implants during the ablative surgical session.
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Affiliation(s)
- J P J Dings
- Dept. of Oral and Maxillofacial Surgery 590, Radboud University Nijmegen Medical Center, PO Box 9101, NL 6500 HB Nijmegen, The Netherlands.
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21
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Pekkan G, Tuna SH, Oghan F. Extraoral prostheses using extraoral implants. Int J Oral Maxillofac Surg 2011; 40:378-83. [PMID: 21255978 DOI: 10.1016/j.ijom.2010.12.001] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2010] [Revised: 09/20/2010] [Accepted: 12/13/2010] [Indexed: 10/18/2022]
Abstract
The aim of this study was to evaluate extraoral prostheses and the use of extraoral implants in patients with facial defects. 10 cases were treated utilizing maxillofacial prostheses employing extraoral implants in five cases. 16 extraoral implants were installed. Seven implants were placed in irradiated sites in the orbital regions. Six implants were placed in mastoid regions and three in a zygoma region that was irradiated. Two implants failed before initial integration was achieved in irradiated areas. Using 14 extraoral implants as anchors, five extraoral prostheses were set. The other five cases were treated with extraoral prostheses without using extraoral implants due to cost and patient-related factors. The data included age, sex, primary disease, implant length, implant failure, prosthetic attachment, radiation therapy, and peri-implant skin reactions. The use of extraoral implants for the retention of extraoral prostheses has simplified the placement, removal, and cleaning of the prosthesis by the patient. The stability of the prostheses was improved by anchors. Clinical and technical problems are presented with the techniques used for their resolution. Using extraoral implants resulted in a high rate of success in retaining facial prostheses and gave good stability and aesthetic satisfaction.
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Affiliation(s)
- G Pekkan
- Department of Dentistry, Dumlupinar University, Kutahya, Turkey
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22
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Paris M, Chaux-Bodard AG, Gourmet R, Fortin T. Guided implant surgery on oral cancer patients: in vitro study. Int J Comput Assist Radiol Surg 2010; 6:135-42. [PMID: 20661657 DOI: 10.1007/s11548-010-0490-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2010] [Accepted: 05/12/2010] [Indexed: 11/29/2022]
Abstract
PURPOSE Many oral cancer patients (OCPs) are unable to wear conventional prostheses due to the disease and treatment effects, so they are candidates for oral rehabilitation with osseointegrated implants. A guide suitable for OCPs was designed and tested. METHODS Image-guided systems based on a custom template for oral implant placement are now widespread among healthy patients, but this has not been extended to OCPs. The EasyGuideT system (Keystone Dental, Burlington, MA, USA) for template stabilization is used on healthy edentulous patients, achieved by bone screws, mini-implants or stereolithography with a bone support. All these systems are invasive and cannot be used in many oral cancer patients. We adapted the EasyGuideT to OCP rehabilitation. The first stage focused on developing a template-positioning system for use on edentulous mandibles that is non-invasive, repeatable, stable on the oral mucosa, consistent with the operating room asepsis, and comfortable for the patient. This repositioning system consists of a cube fiducial marker and an extra-oral support using a facial thermoplastic mask. The mask is linked to the surgical template through the cube. The second stage consisted of direct evaluation of the repositioning system reproducibility, performed on 5 adult cadaver skulls. RESULTS The translation errors and rotation errors obtained using the modified EasyGuideT system were satisfactory in ex vivo experiments on cadaver skulls. CONCLUSION A non-invasive repositioning system for image-guided implant surgery on oral cancer patients is clinically feasible using a cube fiducial marker and extra-oral support with a facial thermoplastic mask.
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Implant-retained nasal prosthesis for reconstruction of large rhinectomy defects: the Salisbury experience. Int J Oral Maxillofac Surg 2010; 39:343-9. [PMID: 20149598 DOI: 10.1016/j.ijom.2010.01.003] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2008] [Revised: 06/29/2009] [Accepted: 01/12/2010] [Indexed: 11/24/2022]
Abstract
The authors report their experience with 34 patients who had large full thickness nasal defects reconstructed with an implant-retained prosthesis. Their technique of modifying post-rhinectomy defects is described and factors influencing implant success are evaluated. 111 implants were placed to retain a nasal prosthesis. Age, sex and tumour histology did not affect the outcome. Smoking, extent of rhinectomy, use of radiotherapy (pre- and post-implant), hyperbaric oxygen, length and location of the implant and type of retention (bar/magnets) influenced implant success. The overall success rate was 89% (99/111); 94% in patients who did not receive radiotherapy and 86% in those who did. The prosthesis was in place in all patients (100%) at the time of last follow up. Post-rhinectomy defect modification enables adequate access for safe placement of long implants with good primary stability and helps the maintenance of good hygiene (further enhanced by the use of skin grafts). The authors think implant-retained prosthesis is a reliable option for reconstructing large full thickness rhinectomy defects. They suggest their technique of modifying the defect, use of long implants and magnets for retention is responsible for the high success rate of implants used to retain a nasal prosthesis.
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25
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Schrom T, Horenburg L, Holz S, Paschen C. [Evaluation of quality of life following prosthetic replacement of the auricle]. HNO 2009; 58:134-41. [PMID: 19727623 DOI: 10.1007/s00106-009-1989-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
INTRODUCTION The assessment of quality of life (QOL) of patients is becoming increasingly important in the evaluation of the quality of care. Therefore, we examined the quality of life of patients treated with prostheses following loss of an auricle using a questionnaire. PATIENTS AND METHODS Of 18 patients (14 male, 4 female), 10 had lost an auricle due to a neoplasm, 2 traumatically, while 6 patients showed a congenital lack of an auricle. In order to measure the subjective quality of life we used a questionnaire compiled by the WHO (WHOQOL-BREF); we used a self-designed questionnaire for questions relating to the prostheses. RESULTS Analysis of the data of all patients with prostheses in comparison with the age-based general population showed a lower score value for quality of life, indicating a poorer quality of life. However, none of the differences were statistically significant. Patients with neoplasms achieved higher values compared with the age-based standard value; in contrast, the other patients showed lower values in nearly every respect. The gender-related analysis of the results showed a poorer quality of life for females than for males. CONCLUSION The reason for an auricle defect as well as patient gender influenced the subjective quality of life following prosthetic surgery. The overall acceptance of auricular prostheses can be considered good, especially among patients suffering from neoplasms. In order to be able to evaluate the results and compare the different working groups more sufficiently it would be desirable to use standardized test procedures and a larger patient collective.
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Affiliation(s)
- T Schrom
- Klinik für Hals-Nasen-Ohren-Heilkunde, Kopf- und Halschirurgie, Plastische Operationen, Helios-Klinikum Bad Saarow, Bad Saarow, Deutschland.
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26
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Karakoca S, Aydin C, Yilmaz H, Bal BT. Survival rates and periimplant soft tissue evaluation of extraoral implants over a mean follow-up period of three years. J Prosthet Dent 2009; 100:458-64. [PMID: 19033030 DOI: 10.1016/s0022-3913(08)60265-6] [Citation(s) in RCA: 52] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
STATEMENT OF PROBLEM The use of implants with extraoral prostheses provides excellent support, stability, and retention, thereby offering the potential for improving a patient's appearance and quality of life. However, few studies have examined cumulative survival rates of extraoral implants, nor have these reports documented long-term aspects of treatment, such as soft tissue health around abutments. PURPOSE The purpose of this study was to evaluate the survival rates and the periimplant soft tissue responses of extraoral implants used to retain facial prostheses. MATERIAL AND METHODS Thirty-three patients with auricular, nasal, and orbital anatomical compromise were treated with 98 craniofacial and dental implants. Of the 33 patients, 14 had auricular, 9 had nasal, and 10 had orbital defects. After a 3-month osseointegration period, implant-retained prostheses were fabricated. Following completion of treatment, each patient was seen at 6-month intervals. These examinations were recorded for this patient cohort from 25 to 50 months. Data were analyzed using Kaplan-Meier survival analysis. A 5-point scale was used to record the health of periimplant soft tissues. The unit of measure as a visit/site unit was assigned for each instance and implant site. Periimplant soft tissue reactions were assessed for auricular, nasal, and orbital defects, for each implant site used for these patients' treatments. RESULTS The overall cumulative survival rates were 100% for auricular, 83.3% for nasal, and 77.4% for orbital implants, respectively. The survival rates of the implants were 72.7% for those placed in irradiated sites treated without adjunctive HBO therapy, and 93.4% for implants placed in nonirradiated sites. To evaluate the response of the periimplant soft tissues to the implants, a total of 524 visits/sites were recorded. Absence of inflammation (grade 0) of the periabutment soft tissues was observed in 73.3% of the visits/sites. CONCLUSIONS The anatomical site into which the implant is placed has an effect on success rate. The auricular site is the most predictable implant site. Survival rates of nasal and orbital implants were found to offer promising results in achieving reliable implant prognoses in these regions. Regardless of the implant site, a decreased survival rate was observed in the irradiated sites. Periimplant soft tissue reactions were most commonly associated with lapses in hygiene.
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Affiliation(s)
- Secil Karakoca
- Department of Prosthodontics, Faculty of Dentistry, Gazi University, Ankara, Turkey
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Gevorgyan A, La Scala GC, Neligan PC, Pang CY, Forrest CR. Radiation-induced craniofacial bone growth disturbances. J Craniofac Surg 2007; 18:1001-7. [PMID: 17912072 DOI: 10.1097/scs.0b013e31812f7584] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Multimodality treatment, including radiotherapy, chemotherapy, and surgery, is required for the management of head and neck cancer in pediatric patients. Despite the modern advances in radiation dosing and targeting techniques, the radiation damage to the growing craniofacial skeleton in children remains a significant clinical problem. The first part of this review summarizes the clinical effects of radiotherapy on craniofacial bone growth in children. Experimental evidence on therapeutic radiation effects on bone growth in in vivo and in vitro models is reviewed. The second part of this review focuses on prevention of radiation-induced craniofacial bone growth inhibition using radioprotective agents.
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Affiliation(s)
- Artur Gevorgyan
- Division of Plastic Surgery, Hospital for Sick Children, University of Geneva Children's Hospital, Geneva, Switzerland
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28
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Abstract
Reconstruction of acquired or congenitally absent facial structures is a challenging task for the reconstructive surgeon. Often inadequate soft tissue, cartilaginous, or osseous support exists for a reconstruction which is functional, aesthetic, and achieved with a reasonable effort on the part of the surgeon and patient. Prosthetic reconstruction of these structures utilizing cranial implants is a viable option which offers several advantages when compared to traditional reconstructive techniques. We present our experience with 114 cranial implants in 32 patients for craniofacial reconstruction. One hundred fourteen cranial implants were placed in a total of 32 patients for reconstruction of facial structures. Indications for cranial implants with prosthetic reconstruction were lack of adequate tissue for reconstruction, failed reconstructive attempts, and selection of the technique by the patient. Seventy-two implants were placed in the mastoid region, 31 within the orbit, 7 within the nasal cavity, with four additional implants for the reconstruction of eyebrows. Cranial implants were followed by clinical and radiographic examination at intervals ranging from 3-46 months (mean 15.3 months). Patient records were retrospectively reviewed for surgical complications, soft tissue reactions, infections, and implant failures. The total success rate of cranial implantation in the study group was 92.9% (106/114). Surgical complications occurred in three of the 32 patients (9.3%). All cranial implants were successfully reconstructed after integration. Seven percent of the implants failed after initial integration was successful. The rate of significant soft tissue reactions or frank infection observed among the implanted patients was 6.1%. Titanium cranial implants coupled with custom prosthetic reconstruction offer an excellent alternative to traditional surgical techniques in the reconstruction of acquired or congenitally absent facial structures. Predictability, prosthetic adaptability, as well as superior aesthetics are major advantages to this technique when compared to traditional surgical reconstructive techniques.
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Affiliation(s)
- Brett A Miles
- Department of Otolaryngology, Head and Neck Surgey, UT Southwestern Medical Center, Dallas, Texas 75093, USA
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29
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Donoff RB. Treatment of the Irradiated Patient With Dental Implants: The Case Against Hyperbaric Oxygen Treatment. J Oral Maxillofac Surg 2006; 64:819-22. [PMID: 16631491 DOI: 10.1016/j.joms.2006.01.011] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2005] [Indexed: 11/19/2022]
Affiliation(s)
- R Bruce Donoff
- Harvard School of Dental Medicine, Massachusetts General Hospital, Boston, 02115, USA.
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