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Mosaddad SA, Talebi S, Keyhan SO, Fallahi HR, Darvishi M, Aghili SS, Tavahodi N, Namanloo RA, Heboyan A, Fathi A. Dental implant considerations in patients with systemic diseases: An updated comprehensive review. J Oral Rehabil 2024; 51:1250-1302. [PMID: 38570927 DOI: 10.1111/joor.13683] [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: 03/30/2023] [Revised: 10/27/2023] [Accepted: 03/02/2024] [Indexed: 04/05/2024]
Abstract
BACKGROUND Various medical conditions and the drugs used to treat them have been shown to impede or complicate dental implant surgery. It is crucial to carefully monitor the medical status and potential post-operative complications of patients with systemic diseases, particularly elderly patients, to minimize the risk of health complications that may arise. AIM The purpose of this study was to review the existing evidence on the viability of dental implants in patients with systemic diseases and to provide practical recommendations to achieve the best possible results in the corresponding patient population. METHODS The information for our study was compiled using data from PubMed, Scopus, Web of Science and Google Scholar databases and searched separately for each systemic disease included in our work until October 2023. An additional manual search was also performed to increase the search sensitivity. Only English-language publications were included and assessed according to titles, abstracts and full texts. RESULTS In total, 6784 studies were found. After checking for duplicates and full-text availability, screening for the inclusion criteria and manually searching reference lists, 570 articles remained to be considered in this study. CONCLUSION In treating patients with systemic conditions, the cost-benefit analysis should consider the patient's quality of life and expected lifespan. The success of dental implants depends heavily on ensuring appropriate maintenance therapy, ideal oral hygiene standards, no smoking and avoiding other risk factors. Indications and contraindications for dental implants in cases of systemic diseases are yet to be more understood; broader and hardcore research needs to be done for a guideline foundation.
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Affiliation(s)
- Seyed Ali Mosaddad
- Department of Research Analytics, Saveetha Dental College and Hospitals, Saveetha Institute of Medical and Technical Sciences, Saveetha University, Chennai, Tamil Nadu, India
- Department of Conservative Dentistry and Bucofacial Prosthesis, Faculty of Odontology, Complutense University of Madrid, Madrid, Spain
- Student Research Committee, School of Dentistry, Shiraz University of Medical Sciences, Shiraz, Iran
- Maxillofacial Surgery & Implantology & Biomaterial Research Foundation, Tehran, Iran
| | - Sahar Talebi
- Research Committee, School of Dentistry, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Seied Omid Keyhan
- Maxillofacial Surgery & Implantology & Biomaterial Research Foundation, Tehran, Iran
- Department of Oral & Maxillofacial Surgery, Gangneung-Wonju National University, Gangneung, South Korea
- Department of Oral & Maxillofacial Surgery, College of Medicine, University of Florida, Jacksonville, FL, USA
- Iface Academy, Istanbul, Turkey
| | - Hamid Reza Fallahi
- Maxillofacial Surgery & Implantology & Biomaterial Research Foundation, Tehran, Iran
- Department of Oral & Maxillofacial Surgery, Gangneung-Wonju National University, Gangneung, South Korea
- Department of Oral & Maxillofacial Surgery, College of Medicine, University of Florida, Jacksonville, FL, USA
- Iface Academy, Istanbul, Turkey
| | - Mohammad Darvishi
- Faculty of Dentistry, Isfahan (Khorasgan) Branch, Islamic Azad University, Isfahan, Iran
| | - Seyedeh Sara Aghili
- Student Research Committee, School of Dentistry, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Narges Tavahodi
- Student Research Committee, Faculty of Dentistry, Mazandaran University of Medical Sciences, Sari, Iran
| | | | - Artak Heboyan
- Department of Research Analytics, Saveetha Dental College and Hospitals, Saveetha Institute of Medical and Technical Sciences, Saveetha University, Chennai, Tamil Nadu, India
- Department of Prosthodontics, Faculty of Stomatology, Yerevan State Medical University after Mkhitar Heratsi, Yerevan, Armenia
- Department of Prosthodontics, School of Dentistry, Tehran University of Medical Sciences, Tehran, Iran
| | - Amirhossein Fathi
- Department of Prosthodontics, Dental Materials Research Center, Dental Research Institute, School of Dentistry, Isfahan University of Medical Sciences, Isfahan, Iran
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Sriram S, Njoroge MW, Lopez CD, Zhu L, Heron MJ, Zhu KJ, Yusuf CT, Yang R. Optimal Treatment Order With Fibula-Free Flap Reconstruction, Oncologic Treatment, and Dental Implants: A Systematic Review and Meta-Analysis. J Craniofac Surg 2024; 35:1065-1073. [PMID: 38666786 DOI: 10.1097/scs.0000000000010127] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2023] [Accepted: 02/05/2024] [Indexed: 06/04/2024] Open
Abstract
Head and neck cancer (HNC) patients benefit from craniofacial reconstruction, but no clear guidance exists for rehabilitation timing. This meta-analysis aims to clarify the impact of oncologic treatment order on implant survival. An algorithm to guide placement sequence is also proposed in this paper. PubMed, Embase, and Web of Science were searched for studies on HNC patients with ablative and fibula-free flap (FFF) reconstruction surgeries and radiotherapy (RTX). Primary outcomes included treatment sequence, implant survival rates, and RTX dose. Of 661 studies, 20 studies (617 implants, 199 patients) were included. Pooled survival rates for implants receiving >60 Gy RTX were significantly lower than implants receiving < 60 Gy (82.8% versus 90.1%, P =0.035). Placement >1 year after RTX completion improved implant survival rates (96.8% versus 82.5%, P =0.001). Implants receiving pre-placement RTX had increased survival with RTX postablation versus before (91.2% versus 74.8%, P <0.001). One hundred seventy-seven implants were placed only in FFF with higher survival than implants placed in FFF or native bone (90.4% versus 83.5%, P =0.035). Radiotherapy is detrimental to implant survival rates when administered too soon, in high doses, and before tumor resection. A novel evidence-based clinical decision-making algorithm was presented for utilization when determining the optimal treatment order for HNC patients. The overall survival of dental prostheses is acceptable, reaffirming their role as a key component in rehabilitating HNC patients. Considerations must be made regarding RTX dosage, timing, and implant location to optimize survival rates and patient outcomes for improved functionality, aesthetics, and comfort.
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Affiliation(s)
- Shreya Sriram
- Department of Plastic and Reconstructive Surgery, Johns Hopkins Hospital, Baltimore, MD
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Hocková B, Slávik R, Azar B, Stebel J, Poruban D, Bonfante EA, Ewers R, Cheng YC, Stebel A. Short and Extra Short Dental Implants in Osseous Microvascular Free Flaps: A Retrospective Case Series. J Pers Med 2024; 14:384. [PMID: 38673010 PMCID: PMC11050822 DOI: 10.3390/jpm14040384] [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: 02/25/2024] [Revised: 03/22/2024] [Accepted: 03/26/2024] [Indexed: 04/28/2024] Open
Abstract
There is limited information regarding implant and prosthetic survival after osseous microvascular free flap (OMFF). This case series aims to describe the placement of short and extra short implants in osseous microvascular free flaps to support prostheses, and present an up to 40-month retrospective follow-up. Short and extra short dental implants were placed in six fibula free flaps (FFF) and in two microvascular deep circumflex iliac artery (DCIA) flaps. In total, 27 short and extra short dental implants have been placed into two different types of free flaps. Kaplan-Meyer (K-M) survival analyses were performed to evaluate the survival and success outcomes of implants and prostheses. Out of the eight patients reconstructed with free flap, five were rehabilitated with prostheses, one patient has a temporary prosthesis, and two patients are in the process of prosthetic rehabilitation. Twenty-seven implants were followed up for up to 40 months, and K-M analyses showed 100% implant survival probability (95% confidence interval: 100%), while the implant success probability was 91.0% (95% confidence interval: 68.6-97.7%). Short and extra short dental implants placed in OMFF presented high survival and success rates in a retrospective case series after up to 40 months.
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Affiliation(s)
- Barbora Hocková
- Department of Maxillofacial Surgery, F. D. Roosevelt University Hospital of Banská Bystrica, 974 01 Banská Bystrica, Slovakia; (B.H.); (R.S.); (D.P.); (A.S.)
| | - Rastislav Slávik
- Department of Maxillofacial Surgery, F. D. Roosevelt University Hospital of Banská Bystrica, 974 01 Banská Bystrica, Slovakia; (B.H.); (R.S.); (D.P.); (A.S.)
| | - Basel Azar
- Department of Prosthodontics, Faculty of Medicine and Dentistry, Palacky University, 779 00 Olomouc, Czech Republic;
- Dentaris Praha Dental Clinic, Olšanská 7, 130 00 Prague, Czech Republic
| | - Jakub Stebel
- 3S DENT Dental Clinic, Šancová Street, 831 04 Bratislava, Slovakia;
| | - Dušan Poruban
- Department of Maxillofacial Surgery, F. D. Roosevelt University Hospital of Banská Bystrica, 974 01 Banská Bystrica, Slovakia; (B.H.); (R.S.); (D.P.); (A.S.)
| | - Estevam A. Bonfante
- Department of Prosthodontics and Periodontology, Bauru School of Dentistry, University of Sao Paulo, Bauru 17012, SP, Brazil
| | - Rolf Ewers
- The University Hospital for Cranio-Maxillofacial and Oral Surgery, Waehringer Guertel 18-20, 1090 Vienna, Austria;
- CMF Institute Vienna, Schumanngasse 15, 1180 Vienna, Austria
| | - Yu-Chi Cheng
- Harvard School of Dental Medicine, 188 Longwood Ave, Boston, MA 02115, USA;
| | - Adam Stebel
- Department of Maxillofacial Surgery, F. D. Roosevelt University Hospital of Banská Bystrica, 974 01 Banská Bystrica, Slovakia; (B.H.); (R.S.); (D.P.); (A.S.)
- 3S DENT Dental Clinic, Šancová Street, 831 04 Bratislava, Slovakia;
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Kaiser M, Burg S, Speth U, Cotter ML, Smeets R, Gosau M, König D. Outcomes and influencing factors of dental implants in fibula, iliac crest, and scapula free flaps: a retrospective case-control study. Int J Implant Dent 2024; 10:8. [PMID: 38334913 PMCID: PMC10858007 DOI: 10.1186/s40729-024-00522-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2023] [Accepted: 01/11/2024] [Indexed: 02/10/2024] Open
Abstract
PURPOSE Reconstruction with vascularized bone grafts after ablative surgery and subsequent dental rehabilitation with implants is often challenging; however, it helps improve the patient's quality of life. This retrospective case-control study aimed to determine the implant survival/success rates in different vascularized bone grafts and potential risk factors. METHODS Only patients who received implants in free vascularized bone grafts between 2012 and 2020 were included. The free flap donor sites were the fibula, iliac crest, and scapula. The prosthetic restoration had to be completed, and the observation period had to be over one year after implantation. Implant success was defined according to the Health Scale for Dental Implants criteria. RESULTS Sixty-two patients with 227 implants were included. The implant survival rate was 86.3% after an average of 48.7 months. The causes of implant loss were peri-implantitis (n = 24), insufficient osseointegration (n = 1), removal due to tumor recurrence (n = 1), and osteoradionecrosis (n = 5). Of all implants, 52.4% were classified as successful, 19.8% as compromised, and 27.8% as failed. Removal of osteosynthesis material prior to or concurrent with implant placement resulted in significantly better implant success than material not removed (p = 0.035). Localization of the graft in the mandibular region was associated with a significantly better implant survival (p = 0.034) and success (p = 0.002), also a higher Karnofsky Performance Status Scale score with better implant survival (p = 0.014). CONCLUSION Implants placed in vascularized grafts showed acceptable survival rates despite the potential risk factors often present in these patient groups. However, peri-implantitis remains a challenge.
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Affiliation(s)
- Marina Kaiser
- Department of Oral and Maxillofacial Surgery, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246, Hamburg, Germany
| | - Simon Burg
- Department of Oral and Maxillofacial Surgery, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246, Hamburg, Germany
| | - Ulrike Speth
- Department of Oral and Maxillofacial Surgery, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246, Hamburg, Germany
| | - Marie-Luise Cotter
- Department of Oral and Maxillofacial Surgery, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246, Hamburg, Germany
| | - Ralf Smeets
- Department of Oral and Maxillofacial Surgery, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246, Hamburg, Germany
| | - Martin Gosau
- Department of Oral and Maxillofacial Surgery, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246, Hamburg, Germany
| | - Daniela König
- Department of Oral and Maxillofacial Surgery, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246, Hamburg, Germany.
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Liu YB, Wu D, Wang JY, Lun XH, Dai W. Meta-analysis of the survival rate and postoperative infection rate of primary and secondary implants after vascularized fibula transplantation for reconstruction of jaw defects. Int J Implant Dent 2023; 9:51. [PMID: 38108942 PMCID: PMC10728391 DOI: 10.1186/s40729-023-00514-x] [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: 08/13/2023] [Accepted: 11/18/2023] [Indexed: 12/19/2023] Open
Abstract
OBJECTIVES Vascularized fibula flap transplantation is the most effective and common method to repair the jaw defects. In addition, implantation is the first choice to restore dentition on the graft fibula. Implants are usually implanted at least 6 months after fibula transplantation. Primary implantation of implants during surgery can restore the dentition earlier, but whether this method can achieve the same restorative effect as secondary implantation is still uncertain. This article aims to compare the survival rate and complications between primary and secondary implantation through meta-analysis. METHODS This meta-analysis was conducted according to PRISMA protocol and the Cochrane Handbook of Systematic Reviews of Interventions. According to the inclusion and exclusion criteria, we selected the PubMed, Embase, Web of Science, Cochrane Library, Chinese National Knowledge Infrastructure (CNKI), Chinese BioMedical Literature Database (CBM) according to established inclusion and exclusion criteria. The Newcastle-Ottawa Scale (NOS) was used to assess the quality of the included studies. Meta-analysis was conducted to compare the survival rate and postoperative infection rate of primary and secondary implantation. RESULTS Seven studies were involved in our research, involving 186 patients. Five of the studies detailed implant success in 106 patients (primary implantation 50, secondary implantation 56), and four studies documented infection after implantation in 117 patients (primary implantation 52, secondary implantation 65); the survival rate of the primary implantation was 93.3%, and the incidence of postoperative infection was 17.3%. The survival rate of the secondary implantation was 93.4%, and 23.1% had postoperative infection. Meta-analysis showed that there was no significant difference in the survival rate between primary implantation and secondary implantation, OR = 0.813 (95% CI 0.383-1.725, P = 0.589 > 0.05), and there was no significant difference in the incidence of postoperative infection, OR = 0.614 (95% CI 0.239-1.581, P = 0.312 > 0.05). CONCLUSIONS Based on the results of this study, the research found no significant difference in the survival rate or infection rates between primary and secondary implantation. After appropriate indications selection, primary implantation can be used to reconstruct the dentition with less waiting time, reduce the impact of radiotherapy, and bring a higher quality of life for patients.
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Affiliation(s)
- Yi-Bo Liu
- Department of Oral and Maxillofacial-Head and Neck Surgery, School of Stomatology, Tianjin Medical University, Tianjin, China
| | - Di Wu
- Department of Oral and Maxillofacial-Head and Neck Surgery, School of Stomatology, China Medical University, Nanjing North Street No.117, Shenyang, 110000, Liaoning, China
| | - Jun-Yi Wang
- Department of Oral and Maxillofacial-Head and Neck Surgery, School of Stomatology, China Medical University, Nanjing North Street No.117, Shenyang, 110000, Liaoning, China
| | - Xiao-Han Lun
- Department of Oral and Maxillofacial-Head and Neck Surgery, School of Stomatology, China Medical University, Nanjing North Street No.117, Shenyang, 110000, Liaoning, China
| | - Wei Dai
- Department of Oral and Maxillofacial-Head and Neck Surgery, School of Stomatology, China Medical University, Nanjing North Street No.117, Shenyang, 110000, Liaoning, China.
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Alfenas E, Silva I, Oliveira D, Tanner P, Jardilino F, Bhering C, Moreno A. Intraoral and facial rehabilitation retained with zygomatic implants and magnets after complete resection of the maxilla, lip and nose: A clinical report. J Clin Exp Dent 2023; 15:e695-e699. [PMID: 37674606 PMCID: PMC10478200 DOI: 10.4317/jced.60659] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2023] [Accepted: 05/22/2023] [Indexed: 09/08/2023] Open
Abstract
Prosthetic rehabilitation is an option available for patients with extensive maxillofacial defects with the ability to restore esthetics and function. The surgical procedure can result in anatomical and functional sequelae leading to functional, psychological and aesthetic disorders. This clinical case report describes the unique and highly-specialized fabrication method of an oral and facial prosthesis for a patient with a near total maxillectomy, excision of upper lip, rhinectomy and radiotherapy for treatment of an extensive malignant neoplasm. Four carefully placed zygomatic implants were used to retain an oral obturator and an external mid-facial prosthesis. A well-functioning maxillofacial prosthesis is essential for improving quality of life, psychological adjustment to cancer and cancer related disabilities, and a positive coping response. The prosthetic rehabilitation allowed the patient's reintegration into society accompanying the satisfactory restoration of aesthetics, phonetics, mastication, and deglutition. Key words:Maxillectomy, rhinectomy, maxillofacial prosthesis, zygomatic implants, head and neck neoplasm.
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Affiliation(s)
- Elizabeth Alfenas
- Adjunct Professor, Department of Oral Surgery, Pathology, and Clinical Dentistry; School of Dentistry, Federal University of Minas Gerais (UFMG), Belo Horizonte, MG, Brazil
| | - Isadora Silva
- Postgraduate student, Department of Oral Surgery, Pathology, and Clinical Dentistry; School of Dentistry, Federal University of Minas Gerais (UFMG), Belo Horizonte, MG, Brazil
| | - Davidson Oliveira
- Maxillofacial surgeon, Private Dental Clinic, Belo Horizonte, Brazil
| | - Paul Tanner
- Adjunct Professor, Prosthetics Services, Huntsman Cancer Institute, University of Utah, Salt Lake City, UT, United States
| | - Francisca Jardilino
- Adjunct Professor, Department of Oral Surgery, Pathology, and Clinical Dentistry; School of Dentistry, Federal University of Minas Gerais (UFMG), Belo Horizonte, MG, Brazil
| | - Cláudia Bhering
- Adjunct Professor, Department of Restorative Dentistry; School of Dentistry, Federal University of Minas Gerais (UFMG), Belo Horizonte, MG, Brazil
| | - Amália Moreno
- Adjunct Professor, Department of Oral Surgery, Pathology, and Clinical Dentistry; School of Dentistry, Federal University of Minas Gerais (UFMG), Belo Horizonte, MG, Brazil
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Wüster J, Sachse C, Sachse C, Rendenbach C, Wagendorf O, Vach K, Preissner S, Heiland M, Nelson K, Nahles S. Vestibuloplasty and its impact on the long-term survival and success of dental implants in irradiated and non-irradiated patients after head and neck tumor therapy: a retrospective study. Clin Oral Investig 2023; 27:4695-4703. [PMID: 37330421 PMCID: PMC10415447 DOI: 10.1007/s00784-023-05096-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2023] [Accepted: 05/24/2023] [Indexed: 06/19/2023]
Abstract
OBJECTIVES This study aimed to evaluate the influence of vestibuloplasty on the clinical success and survival of dental implants in head and neck tumor patients. MATERIALS AND METHODS A retrospective single-center study was conducted. All patients received surgical therapy of a tumor in the head or neck and underwent surgical therapy and, if necessary, radiotherapy/radiochemotherapy. Patients with compromised soft tissue conditions received vestibuloplasty using a split thickness skin graft and an implant-retained splint. Implant survival and success and the influence of vestibuloplasty, gender, radiotherapy, and localizations were evaluated. RESULTS A total of 247 dental implants in 49 patients (18 women and 31 men; mean age of 63.6 years) were evaluated. During the observation period, 6 implants were lost. The cumulative survival rate was 99.1% after 1 year and 3 years and 93.1% after 5 years for patients without vestibuloplasty, compared to a survival and success rate of 100% after 5 years in patients with vestibuloplasty. Additionally, patients with vestibuloplasty showed significantly lower peri-implant bone resorption rates after 5 years (mesial: p = 0.003; distal: p = 0.001). CONCLUSION This study demonstrates a high cumulative survival and success rate of dental implants after 5 years in head and neck tumor patients, irrespective of irradiation. Patients with vestibuloplasty showed a significantly higher rate of implant survival and significantly lower peri-implant bone resorption after 5 years. CLINICAL RELEVANCE Vestibuloplasty should always be considered and applied if required by the anatomical situations to achieve high implant survival/success rates in head and neck tumor patients.
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Affiliation(s)
- Jonas Wüster
- Department of Oral and Maxillofacial Surgery, Campus Virchow-Klinikum, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität Zu Berlin, and Berlin Institute of Health, Campus Benjamin Franklin Hindenburgdamm 30, 12203, Berlin, Germany.
| | - Claudia Sachse
- Department of Oral and Maxillofacial Surgery, Campus Virchow-Klinikum, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität Zu Berlin, and Berlin Institute of Health, Campus Benjamin Franklin Hindenburgdamm 30, 12203, Berlin, Germany
| | - Christian Sachse
- Department of Oral and Maxillofacial Surgery, Campus Virchow-Klinikum, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität Zu Berlin, and Berlin Institute of Health, Campus Benjamin Franklin Hindenburgdamm 30, 12203, Berlin, Germany
| | - Carsten Rendenbach
- Department of Oral and Maxillofacial Surgery, Campus Virchow-Klinikum, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität Zu Berlin, and Berlin Institute of Health, Campus Benjamin Franklin Hindenburgdamm 30, 12203, Berlin, Germany
| | - Oliver Wagendorf
- Department of Oral and Maxillofacial Surgery, Campus Virchow-Klinikum, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität Zu Berlin, and Berlin Institute of Health, Campus Benjamin Franklin Hindenburgdamm 30, 12203, Berlin, Germany
| | - Kirstin Vach
- Institute of Medical Biometry and Statistics, Faculty of Medicine, University of Freiburg, Freiburg Im Breisgau , Baden-Württemberg, Germany
| | - Saskia Preissner
- Department of Oral and Maxillofacial Surgery, Campus Virchow-Klinikum, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität Zu Berlin, and Berlin Institute of Health, Campus Benjamin Franklin Hindenburgdamm 30, 12203, Berlin, Germany
| | - Max Heiland
- Department of Oral and Maxillofacial Surgery, Campus Virchow-Klinikum, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität Zu Berlin, and Berlin Institute of Health, Campus Benjamin Franklin Hindenburgdamm 30, 12203, Berlin, Germany
| | - Katja Nelson
- Department of Oral and Maxillofacial Surgery, Faculty of Medicine, University Medical Center Freiburg, Albert Ludwig University of Freiburg, Freiburg Im Breisgau, Baden-Württemberg, Germany
| | - Susanne Nahles
- Department of Oral and Maxillofacial Surgery, Campus Virchow-Klinikum, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität Zu Berlin, and Berlin Institute of Health, Campus Benjamin Franklin Hindenburgdamm 30, 12203, Berlin, Germany
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Tahmasebi E, Keykha E, Hajisadeghi S, Moslemi H, Shafiei S, Motamedi MHK, Torabizadeh A, Tabrizi R, Alam M. Outcomes and influential factors in functional and dental rehabilitation following microvascular fibula flap reconstruction in the maxillomandibular region: a systematic review and meta-analysis. Maxillofac Plast Reconstr Surg 2023; 45:24. [PMID: 37418121 DOI: 10.1186/s40902-023-00392-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2023] [Accepted: 06/23/2023] [Indexed: 07/08/2023] Open
Abstract
BACKGROUND This systematic review and meta-analysis aimed to evaluate the factors influencing and success rates of dental implants for functional and dental rehabilitation following microvascular fibula flap reconstruction in the maxillomandibular region. MAIN TEXT We conducted a comprehensive search of electronic databases, including MEDLINE, Web of Science, Embase, Scopus, and Cochrane's CENTRAL, as well as gray literature sources and manual searches of notable journals. The search was performed from inception until February 2023. Studies were included if they examined functional and dental rehabilitation outcomes in patients receiving maxillofacial reconstruction using microvascular fibula flaps and were retrospective or prospective cohort studies involving human subjects. Case-control studies, research involving other reconstruction methods, and animal-based studies were excluded. Data was extracted and confirmed by two independent researchers, and risk of bias was assessed using the Newcastle-Ottawa Scale. Meta-analyses were conducted for dental implant and graft success rate, with separate analyses for different factors affecting the outcome. Heterogeneity was evaluated using Cochran's Q test and the I2 test. The pooled success rate for implants was 92% and for grafts, 95%, with significant heterogeneity. Implants in fibular grafts had a 2.91 times higher failure rate than those in natural bones. Radiated bone and smoking were identified as factors influencing implant failure, with radiated bone having a 2.29 times higher risk and smokers having a 3.16 times higher risk compared to their respective counterparts. Patient-reported outcomes showed improvements in key areas such as dietary intake, mastication, speech, and esthetics. The success rates declined over time, emphasizing the importance of long-term follow-up. CONCLUSIONS Dental implants in free fibula grafts generally have favorable success rates, with minimal bone resorption, manageable probing depths, and limited bleeding on probing. Implant success is influenced by factors such as smoking and radiated bone.
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Affiliation(s)
- Elahe Tahmasebi
- Research Center for Prevention of Oral and Dental Diseases, Baqiyatallah University of Medical Sciences, Tehran, Iran
- School of Dentistry, Baqiyatallah University of Medical Sciences, Tehran, Iran
| | - Elham Keykha
- Research Center for Prevention of Oral and Dental Diseases, Baqiyatallah University of Medical Sciences, Tehran, Iran.
- School of Dentistry, Baqiyatallah University of Medical Sciences, Tehran, Iran.
| | - Samira Hajisadeghi
- Research Center for Prevention of Oral and Dental Diseases, Baqiyatallah University of Medical Sciences, Tehran, Iran
- School of Dentistry, Baqiyatallah University of Medical Sciences, Tehran, Iran
| | - Hamidreza Moslemi
- Department of Oral and Maxillofacial Surgery, School of Dentistry, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Shervin Shafiei
- Department of Oral and Maxillofacial Surgery, School of Dentistry, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Mohammad Hosein Kalantar Motamedi
- Research Center for Prevention of Oral and Dental Diseases, Baqiyatallah University of Medical Sciences, Tehran, Iran.
- Trauma Research Center, Baqiyatallah University of Medical Sciences, Tehran, Iran.
| | | | - Reza Tabrizi
- Department of Oral and Maxillofacial Surgery, School of Dentistry, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Mostafa Alam
- Department of Oral and Maxillofacial Surgery, School of Dentistry, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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Laverty DP, Addison O, Newsum D, Bateman G. Prosthodontic complications during implant-based oral rehabilitation of patients with head and neck cancer. J Prosthet Dent 2023; 129:366-372. [PMID: 34311947 DOI: 10.1016/j.prosdent.2021.06.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2020] [Revised: 06/23/2021] [Accepted: 06/24/2021] [Indexed: 10/20/2022]
Abstract
STATEMENT OF PROBLEM Implant-retained prosthodontic rehabilitation of patients with head and neck cancer is complex. However, the extent of prosthodontic complications has been sparsely reported within the literature. PURPOSE The purpose of this retrospective study was to describe the range of complications and issues that affected the oral rehabilitation treatment of patients with head and neck cancer who had completed implant-retained prosthodontic rehabilitation in a tertiary treatment center. MATERIAL AND METHODS A retrospective analysis of complications and their consequences in patients treated in a regional unit from 2012 to 2017 was performed. Descriptive analysis was carried out on the type and frequency of complications and their consequences for the patients' treatment. Complications were grouped into the following complication types: local and systemic, implant, peri-implant soft tissue, and clinical prosthodontic complications. Implant success and implant survival were also reported. RESULTS The sample was composed of 163 patients with head and neck cancer who had completed implant-retained prosthodontic rehabilitation. Local and systemic complications affected 8.6% of patients, and peri-implant soft-tissue complications affected 9.8% of patients. Clinical prosthodontic complications leading to repeated clinical or laboratory stages occurred on 48 occasions in 45 patients (27.6% of patients). A total of 763 implants were placed. Implant survival was 95.8% and implant success 94.5%, with a mean follow-up of 42.1 months. CONCLUSIONS This retrospective evaluation indicated that complications arising during the process of implant-retained prosthetic rehabilitation in this patient group were variable and common. Such complications can delay the process of treatment and lead to repeating or restarting clinical and laboratory stages of treatment.
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Affiliation(s)
- Dominic P Laverty
- Consultant in Restorative Dentistry, Restorative Department, University of Birmingham School of Dentistry, Birmingham Dental Hospital, Birmingham, UK.
| | - Owen Addison
- Professor of Oral Rehabilitation, Centre for Clinical, Oral and Translational Sciences, King's College London, London, UK
| | - David Newsum
- Consultant in Restorative Dentistry, Restorative Department, University of Birmingham School of Dentistry, Birmingham Dental Hospital, Birmingham, UK
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10
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Garner SJ, Patel S, Pollard AJ, Jerreat MP. Post-treatment evaluation of oral health-related quality of life in head and neck cancer patients after dental implant rehabilitation. Br Dent J 2023:10.1038/s41415-023-5460-2. [PMID: 36693964 DOI: 10.1038/s41415-023-5460-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2022] [Accepted: 10/10/2022] [Indexed: 01/25/2023]
Abstract
Objectives To assess oral health-related quality of life (OHRQoL) following oral rehabilitation using dental implants in patients treated for head and neck cancer (HNC).Materials and methods Service evaluation: patients who had received dental implants during their oral rehabilitation were invited to take part (n = 81). In total, 37 patients completed questionnaires and underwent a structured interview regarding OHRQoL after rehabilitation. Analysis was by descriptive statistics for questionnaire and thematic analysis of interview.Results Rehabilitation types were 17 fixed implant prostheses, 12 removable implant prostheses and 8 combination. Functional problems relating to HNC treatment had a significant effect on OHRQoL and persisted after rehabilitation. Removable implant prostheses had more problems associated than fixed. At interview, patients described: functional and emotional benefits of oral rehabilitation involving implants; ease of keeping implants clean; variations in ability of primary care dentists to maintain rehabilitation; thankfulness to have received treatment; long duration of rehabilitation; and problems encountered while undergoing rehabilitation.Conclusions HNC treatment results in functional and emotional difficulties, which has a significant impact on OHRQoL. Use of dental implants in fixed or removable oral rehabilitation can result in good OHRQoL as assessed by patients at treatment completion, although some functional difficulties often remain.
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Affiliation(s)
- Sarah J Garner
- Specialty Registrar, Restorative Dentistry, Musgrove Park Hospital, Taunton, UK; Musgrove Park Hospital, Taunton, UK.
| | - Sapna Patel
- Specialty Training Registrar, Restorative Dentistry, Croydon University Hospital and Guy´s Hospital, London, UK
| | - Alexander J Pollard
- Specialty Registrar, Restorative Dentistry, Musgrove Park Hospital, Taunton, UK; Musgrove Park Hospital, Taunton, UK
| | - Matthew P Jerreat
- Consultant in Restorative Dentistry, Musgrove Park Hospital, Taunton, UK; Associate Professor, Restorative Dentistry, Plymouth University Peninsula School of Dentistry, Plymouth, UK
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11
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Schiegnitz E, Reinicke K, Sagheb K, König J, Al-Nawas B, Grötz KA. Dental implants in patients with head and neck cancer-A systematic review and meta-analysis of the influence of radiotherapy on implant survival. Clin Oral Implants Res 2022; 33:967-999. [PMID: 35841367 DOI: 10.1111/clr.13976] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2022] [Revised: 05/23/2022] [Accepted: 06/12/2022] [Indexed: 11/27/2022]
Abstract
PURPOSE The purpose of this meta-analysis was to compare implant survival in irradiated and non-irradiated bone and to investigate potential risk factors for implant therapy in oral cancer patients. MATERIAL AND METHODS An extensive search in the electronic databases of the National Library of Medicine was performed. Systematic review and meta-analysis were conducted according to PRISMA statement. The meta-analysis was performed for studies with a mean follow-up of at least three and five years, respectively. RESULTS The systematic review resulted in a mean overall implant survival of 87.8% (34%-100%). The meta-analysis revealed a significantly higher rate of implant failure in irradiated bone compared to non-irradiated bone (p < .00001, OR 1.97, CI [1.63, 2.37]). The studies also showed that implants placed into irradiated grafted bone were more likely to fail than those in irradiated native bone (p < .0001, OR 2.26, CI [1.50, 3.40]). CONCLUSION Even though overall implant survival was high, radiotherapy proves to be a significant risk factor for implant loss. Augmentation procedures may also increase the risk of an adverse outcome, especially in combination with radiotherapy. CLINICAL RELEVANCE The treatment of patients receiving radiotherapy of any form requires precise individual planning and a close aftercare. Implants should be placed in local bone rather than in bone grafts, if possible.
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Affiliation(s)
- Eik Schiegnitz
- Department of Oral and Maxillofacial Surgery, Plastic Surgery, University Medical Centre, Johannes Gutenberg-University, Mainz, Germany
| | - Katrin Reinicke
- Department of Oral and Maxillofacial Surgery, Plastic Surgery, University Medical Centre, Johannes Gutenberg-University, Mainz, Germany
| | - Keyvan Sagheb
- Department of Oral and Maxillofacial Surgery, Plastic Surgery, University Medical Centre, Johannes Gutenberg-University, Mainz, Germany
| | - Jochem König
- Institute of Medical Biometry, Epidemiology and Informatics, Johannes Gutenberg-University, Mainz, Germany
| | - Bilal Al-Nawas
- Department of Oral and Maxillofacial Surgery, Plastic Surgery, University Medical Centre, Johannes Gutenberg-University, Mainz, Germany
| | - Knut A Grötz
- Department of Oral and Maxillofacial Surgery, Dr. Horst Schmidt Clinic Wiesbaden, Wiesbaden, Germany
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12
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Clinical performance of different types of dental prosthesis in patients with head and neck tumors-a retrospective cohort study. Clin Oral Investig 2022; 26:7121-7133. [PMID: 35976496 DOI: 10.1007/s00784-022-04673-w] [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: 12/15/2021] [Accepted: 08/09/2022] [Indexed: 11/03/2022]
Abstract
OBJECTIVES To investigate how different types of dental prosthesis perform in patients with head and neck tumors. MATERIALS AND METHODS In this retrospective clinical cohort study, the impact of different patient-related factors was analyzed as influencing factors on the survival probability of dental prosthesis using Kaplan-Meier estimate. For analysis, the dental prosthesis was divided into groups: group 1 (fixed dental prosthesis), group 2 (removable dental prosthesis), group 3 (implant-supported dental prosthesis), and group 4 (prostheses anchored using wrought wire clasps and obturators). The incidental aftercare measures were also evaluated. RESULTS Two hundred seventy-nine restorations were observed (mean observation: 2.7 ± 3.0 years, max.14.8 years) out of which 49 (17.6%) had to be replaced during the observation. After 5 years, 100% of group 1 restorations, 79.9% of group 2 restorations, 91.4% of group 3 restorations, and 30% of group 4 restorations were still functional. Four hundred eighty-eight dental implants were observed, of which 77 (15.8%) failed. CONCLUSIONS Groups 1, 2, and 3 restorations showed good survival times after 5 years in function, whereas group 4 presented the worst survival times. Group 2 restorations showed the highest amount of necessary aftercare measures. CLINICAL RELEVANCE The current investigation shows that groups 1, 2, and 3 restorations should be preferred in the prosthetic treatment planning of patients with head and neck tumors. A treatment with group 4 restorations should only be considered if no other prosthetic treatment is possible or as temporary treatment.
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Laverty DP, Addison O, Sharma P, Newsum D, Bateman G. Survival rate and complication-free survival rate of implant-retained prostheses in the oral rehabilitation of patients with head and neck cancer: A retrospective evaluation of a cohort from a regional service. J Prosthet Dent 2022:S0022-3913(22)00417-6. [PMID: 35931573 DOI: 10.1016/j.prosdent.2022.06.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2021] [Revised: 06/10/2022] [Accepted: 06/13/2022] [Indexed: 11/29/2022]
Abstract
STATEMENT OF PROBLEM Literature reporting on the prosthetic survival and complications of implant-retained prostheses in patients with head and neck cancer is sparse. PURPOSE The purpose of this retrospective study was to present the survival rates and complication-free survival rates of both fixed and removable implant-retained oral prostheses in patients with head and neck cancer while also reporting on the frequency and causes of failure and complications for each prosthesis type. MATERIAL AND METHODS A retrospective analysis of the prosthetic survival rates and complication-free survival rates of implant-retained oral prostheses and the frequency and causes of failure and complications in patients with head and neck cancer treated in a regional unit from 2012 to 2017 was performed. Differences in categorical and continuous data were assessed for statistical significance by using the Pearson chi-square test, Fisher exact test, t test, and analysis of variance as appropriate. Cox proportional hazard regression models were fitted to evaluate the association between prostheses type, clinical and medical factors, and the outcomes of survival and complication-free survival. Descriptive statistics were used to analyze the frequency and type of prosthetic complications. RESULTS The sample was composed of 153 patients diagnosed with head and neck cancer who had completed implant-retained prosthodontic rehabilitation and had been provided with 221 prostheses. The 5-year survival rate was 87% for maxillary fixed prostheses, 79% for mandibular fixed, 66% for maxillary removable, and 50% for mandibular removable. Hazard ratios were calculated showing that the 5-year survival rate of a mandibular removable prosthesis (HR=5.1; 95% CI 1.60-16.25) (P=.006) was greater than that of a maxillary fixed prosthesis (HR=1.0). The 5-year complication-free survival rate was highest for mandibular fixed prostheses (62%), followed by maxillary fixed (58%), maxillary removable (36%), and mandibular removable prostheses (29%). Hazard ratios showed that the 5-year survival rate of maxillary removable (HR=1.91; 95% CI 1.01-3.66) (P=.048) and mandibular removable prosthesis (HR=2.29; 95% CI 1.23-4.25) (P=.009) was greater than that of a maxillary fixed prosthesis (HR=1.0). Variables of radiotherapy, grafting, age, and sex and their influence on the survival rate and complication-free survival rate were assessed but were not statistically significant. CONCLUSIONS This evaluation indicated that fixed implant-retained prostheses had a higher 5-year survival rate and 5-year complication-free survival rate than removable implant-retained prostheses in patients with head and neck cancer.
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Affiliation(s)
- Dominic P Laverty
- Consultant in Restorative Dentistry, Restorative Department, University of Birmingham School of Dentistry, Birmingham Dental Hospital, Birmingham, UK.
| | - Owen Addison
- Professor of Oral Rehabilitation, Centre for Clinical, Oral and Translational Sciences, King's College London, London, UK
| | - Praveen Sharma
- Associate Professor and Honorary Consultant in Restorative Dentistry, University of Birmingham School of Dentistry, Birmingham Dental Hospital, Birmingham, UK
| | - David Newsum
- Consultant in Restorative Dentistry, Restorative Department, University of Birmingham School of Dentistry, Birmingham Dental Hospital, Birmingham, UK
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14
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Glover S, McGoldrick D, Parmar S, Laverty D. Re: “Outcomes of osseointegrated implants in patients with benign and malignant pathologies of the head and neck: a 10-year single-centre study”. Int J Oral Maxillofac Surg 2022; 51:1370-1371. [DOI: 10.1016/j.ijom.2022.04.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2022] [Accepted: 04/28/2022] [Indexed: 10/18/2022]
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Mashrah MA, Aldhohrah T, Abdelrehem A, Sakran KA, Ahmad H, Mahran H, Abu-lohom F, Su H, Fang Y, Wang L. Survival of vascularized osseous flaps in mandibular reconstruction: A network meta-analysis. PLoS One 2021; 16:e0257457. [PMID: 34679077 PMCID: PMC8535428 DOI: 10.1371/journal.pone.0257457] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2021] [Accepted: 09/01/2021] [Indexed: 02/05/2023] Open
Abstract
Objective An evidence regarding which bony flap for reconstruction of mandibular defects following tumour resection is associated with the highest survival rate is still lacking. This network meta-analysis (NMA) aimed to guide surgeons selecting which vascularized osseous flap is associated with the highest survival rate for mandibular reconstruction. Methods From inception to March 2021, PubMed, Embase, Scopus, and Cochrane library were searched to identify the eligible studies. The outcome variable was the flap survival rate. The Bayesian NMA accompanied by a random effect model and 95% credible intervals (CrI) was calculated. Results Twenty-two studies with a total of 1513 patients, comparing four osseous flaps namely fibula free flap (FFF), deep circumferential iliac artery flap (DCIA), scapula flap, and osteocutaneous radial forearm flap (ORFF) were included. The respective survival rates of FFF, DCIA, Scapula, and ORFF were 94.50%, 93.12%, 97%, and 95.95%. The NMA failed to show a statistically significant difference between all comparators (FFF versus DCIA (Odd ratio, 1.8; CrI, 0.58,5.0); FFF versus ORFF (Odd ratio, 0.57; CrI, 0.077; 2.9); FFF versus scapula flap (Odd ratio, 0.25; CrI, 0.026; 1.5); DCIA versus ORFF (Odd ratio, 0.32; CrI, 0.037; 2.1); DCIA versus scapula flap (Odd ratio, 0.14; CrI, 0.015; 1.1) and ORFF versus scapula flap (Odd ratio, 2.3; CrI, 0.16; 34)). Conclusion Within the limitations of the current NMA, FFF, DCIA, Scapula, and ORFF showed a comparable survival rate for mandibular reconstruction. Although the scapula flap reported the highest survival rate compared to other osseous flaps for mandibular reconstruction; however, the decision making when choosing an osseous flap should be based on many factors rather than simply flap survival rate.
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Affiliation(s)
- Mubarak Ahmed Mashrah
- Key Laboratory of Oral Medicine, Guangzhou Institute of Oral Disease, Stomatology Hospital of Guangzhou Medical University, Guangdong, Guangzhou, China
- Jibla University for Medical Sciences, Jibla Hospital, Ibb City, Yemen
- * E-mail: (MAM); (YF); (LW)
| | - Taghrid Aldhohrah
- Guanghua Stomatology Hospital, Sun Yat-Sen University, Guangdong, Guangzhou, China
| | - Ahmed Abdelrehem
- Department of Craniomaxillofacial and Plastic Surgery, Faculty of Dentistry, Alexandria University, Alexandria, Egypt
| | - Karim Ahmed Sakran
- State Key Laboratory of Oral Diseases and National Clinical Research Center for Oral Diseases and Department of Oral and Maxillofacial Surgery, West China Hospital of Stomatology, Sichuan University, Chengdu, Sichuan, China
| | - Hyat Ahmad
- Department of Oral Pathology, Dalian Medical University, China
| | - Hamada Mahran
- Maxillofacial Surgery Unit, General Surgery Department, Faculty of Medicine, Assiut University, Assiut, Egypt
| | - Faisal Abu-lohom
- Jibla University for Medical Sciences, Jibla Hospital, Ibb City, Yemen
| | - Hanfu Su
- Key Laboratory of Oral Medicine, Guangzhou Institute of Oral Disease, Stomatology Hospital of Guangzhou Medical University, Guangdong, Guangzhou, China
| | - Ying Fang
- Key Laboratory of Oral Medicine, Guangzhou Institute of Oral Disease, Stomatology Hospital of Guangzhou Medical University, Guangdong, Guangzhou, China
- * E-mail: (MAM); (YF); (LW)
| | - Liping Wang
- Key Laboratory of Oral Medicine, Guangzhou Institute of Oral Disease, Stomatology Hospital of Guangzhou Medical University, Guangdong, Guangzhou, China
- * E-mail: (MAM); (YF); (LW)
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Khadembaschi D, Russell P, Beech N, Batstone MD. Osseointegrated implant survival, success and prosthodontic outcomes in composite free flaps: A 10-year retrospective cohort study. Clin Oral Implants Res 2021; 32:1251-1261. [PMID: 34352129 DOI: 10.1111/clr.13822] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2020] [Revised: 06/24/2021] [Accepted: 07/26/2021] [Indexed: 11/28/2022]
Abstract
OBJECTIVES To evaluate implant survival, success and prosthodontic outcomes in a variety of composite free flaps. MATERIAL AND METHODS A retrospective analysis of patient records was used for data collection of implants placed into flaps. Free flap donor sites included fibula, iliac crest, scapula, medial femoral condyle and radial forearm. Kaplan-Meier survival curves were used to estimate survival. Cox regression was used to assess variables affecting survival, and binary logistic regression was utilised to determine effect of variables on prosthodontic outcomes. RESULTS There were 150 implants placed into 45 fibula, 98 implants into 29 iliac crest, 62 implants into 22 scapula, 6 implants into 3 medial femoral condyle and 2 implants in radial forearm composite free flaps. There was no difference in survival or success between or within the various flaps. Active smoking, increasing age, male gender and radiotherapy were associated with implant failure. Of patients completing prosthodontic rehabilitation, 93% were successful. There was no difference in likelihood of failure between different flap types. Fixed implant-supported dentures were associated with poor oral hygiene compared with removable designs (OR2.9, 95%CI 1.1-7.8, p = .03). CONCLUSIONS There is adequate survival and success of implants in common flaps. Caution is required when planning implants in patients exposed to radiotherapy and smokers. Ability to maintain adequate oral hygiene is an important prosthetic design consideration.
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Affiliation(s)
- Darius Khadembaschi
- School of Medicine, University of Queensland, Herston, Queensland, Australia
| | - Peter Russell
- Metro North Oral Health Centre, Metro North Hospital and Health Service, Herston, Queensland, Australia
| | - Nicholas Beech
- School of Medicine, University of Queensland, Herston, Queensland, Australia.,Department of Maxillofacial Surgery, Royal Brisbane and Women's Hospital, Herston, Queensland, Australia
| | - Martin D Batstone
- School of Medicine, University of Queensland, Herston, Queensland, Australia.,Department of Maxillofacial Surgery, Royal Brisbane and Women's Hospital, Herston, Queensland, Australia
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Immediate dental implant placement and restoration in the edentulous mandible in head and neck cancer patients: a systematic review and meta-analysis. Curr Opin Otolaryngol Head Neck Surg 2021; 29:126-137. [PMID: 33278135 PMCID: PMC7969163 DOI: 10.1097/moo.0000000000000685] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
PURPOSE OF REVIEW Oral rehabilitation with dental implants in head and neck cancer (HNC) patients is challenging. After tooth removal prior to radiotherapy, immediate placement of dental implants during panendoscopy or surgery is thought to reduce the oral rehabilitation time improving patients' quality of life. RECENT FINDINGS There is lack of consensus on the timing of dental implant placement and loading protocols. The aim of this study was to perform a systematic review of the literature regarding the performance and survival rate of immediately inserted dental implants placed prior to radiotherapy. Of 1003 articles, 10 were finally included comparing immediate vs. delayed placement of implants and comparing the effect of radiotherapy on immediately placed implants. Meta-analysis demonstrated a slightly higher survival of immediately placed implants compared with postponed placed implants [risk ratio: 0.92, 95% confidence interval (95% CI): 0.48-1.78, P = 0.81, I2 = 0%]. The other meta-analysis comparing radiotherapy vs. nonradiotherapy showed a clearly better survival of immediately placed implants not having received radiotherapy (risk ratio: 5.02, 95% CI: 0.92-27.38, P = 0.10, I2 = 56%). SUMMARY Guidelines are recommended for immediate dental implant placement in the edentulous mandible in HNC patients prior to radiotherapy to allow homogeneity regarding the treatment protocols and thus comparison of treatment outcomes.
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Wetzels JGH, Meijer GJ, de Haan AFJ, Merkx MAW, Speksnijder CM. Immediate implant placement in edentulous oral cancer patients: a long-term retrospective analysis of 207 patients. Int J Oral Maxillofac Surg 2021; 50:1521-1528. [PMID: 33642151 DOI: 10.1016/j.ijom.2021.01.015] [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: 04/07/2020] [Revised: 10/18/2020] [Accepted: 01/21/2021] [Indexed: 11/18/2022]
Abstract
Although the functional benefits of implants in the rehabilitation of edentulous cancer patients are well-known, most studies report on postponed implant placement. The outcome of immediate implant placement regarding successful rehabilitation, implant loading and survival is unclear. Two hundred and seven edentulous oral cancer patients that received implants during ablative surgery at the Radboud University Medical Centre between 2000 and 2011 were included. Data regarding the oncological treatment, implant placement, follow-up and prosthodontic rehabilitation were recorded retrospectively with a follow-up period of 5-17 years. Functioning implant-retained dentures were made in 73.9% of the patients. Of the surviving patients, 81.9% had functioning dentures after 2 years and 86.3% after 10 years. Patients with ASA score 1 and younger patients were rehabilitated more frequently. The median time of functioning denture placement was 336 days after surgery, with a negative influence of postoperative radiotherapy. Implant survival was 90.7%, and was lower when the implant was placed in a jaw involved in the tumour. Immediate implant placement during oral cancer surgery led to a high number of edentulous patients rehabilitated with implant-retained dentures, which are placed at an early time.
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Affiliation(s)
- J G H Wetzels
- Department of Oral and Maxillofacial Surgery, Radboud University Medical Center, Nijmegen, The Netherlands; Department of Oral and Maxillofacial Surgery and Special Dental Care, University Medical Center Utrecht, The Netherlands
| | - G J Meijer
- Department of Oral and Maxillofacial Surgery, Radboud University Medical Center, Nijmegen, The Netherlands
| | - A F J de Haan
- Department for Health Evidence, Section Biostatistics, Radboud University Medical Center, Nijmegen, The Netherlands
| | - M A W Merkx
- Department of Oral and Maxillofacial Surgery, Radboud University Medical Center, Nijmegen, The Netherlands; Netherlands Comprehensive Cancer Organization (IKNL), Utrecht, The Netherlands
| | - C M Speksnijder
- Department of Oral and Maxillofacial Surgery, Radboud University Medical Center, Nijmegen, The Netherlands; Department of Oral and Maxillofacial Surgery and Special Dental Care, University Medical Center Utrecht, The Netherlands; Julius Center Sciences, University Medical Center Utrecht, Utrecht, The Netherlands.
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Walia A, Mendoza J, Bollig CA, Craig EJ, Jackson RS, Rich JT, Puram SV, Massa ST, Pipkorn P. A Comprehensive Analysis of Complications of Free Flaps for Oromandibular Reconstruction. Laryngoscope 2021; 131:1997-2005. [PMID: 33571385 DOI: 10.1002/lary.29430] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2020] [Revised: 01/04/2021] [Accepted: 01/20/2021] [Indexed: 11/08/2022]
Abstract
OBJECTIVES/HYPOTHESIS To determine the frequency and management of short- and long-term complications related to oromandibular free flap reconstruction and identify potentially predictive factors of hardware complications. STUDY DESIGN Retrospective chart review. METHODS A retrospective database from chart review was formed consisting of 266 oromandibular free flap reconstructions performed at a single institution over a 15-year period. Data were collected on demographics, surgical treatment, complications, and management of complications. Subgroup univariate and multivariate analyses were performed to compare patients with hardware complications and those without. RESULTS Eighty-one of 266 patients (30.5%) that underwent oromandibular reconstruction had an early complication (<4 weeks after surgery), and the most common complications were cervical wound dehiscence (11.3%) and fistulas (9.40%). Eighty of 266 patients (30.1%) had a long-term complication (>4 weeks after surgery) and the most common complication was plate exposure (26.7%). Univariate and multivariate analyses showed no association between whether there was hardware extrusion and fibula versus scapula, smoking history, virtual surgical planning (VSP), and dental implantation (P > .05). Only early complications (OR, 3.59, 95% CI, 1.83-7.05, P < .01) and patients undergoing oromandibular reconstruction for osteoradionecrosis (OR, 2.26, 95% CI, 1.10-4.64, P = .03) were strongly and independently associated with subsequent hardware extrusion on univariate analysis. CONCLUSIONS Both short- and long-term complications are common after oromandibular reconstruction. The most important predictive factor for a late complication is an early complication and prior radiation. There was no difference of plate complications among the various free flap types. Dental implantation and use of VSP were not associated with hardware complications. LEVEL OF EVIDENCE 4 Laryngoscope, 131:1997-2005, 2021.
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Affiliation(s)
- Amit Walia
- Department of Otolaryngology-Head and Neck Surgery, Washington University School of Medicine in St. Louis, St Louis, Missouri, U.S.A
| | - Joshua Mendoza
- Department of Otolaryngology-Head and Neck Surgery, Washington University School of Medicine in St. Louis, St Louis, Missouri, U.S.A
| | - Craig A Bollig
- Department of Otolaryngology-Head and Neck Surgery, Washington University School of Medicine in St. Louis, St Louis, Missouri, U.S.A
| | - Ethan J Craig
- Department of Otolaryngology-Head and Neck Surgery, Washington University School of Medicine in St. Louis, St Louis, Missouri, U.S.A
| | - Ryan S Jackson
- Department of Otolaryngology-Head and Neck Surgery, Washington University School of Medicine in St. Louis, St Louis, Missouri, U.S.A
| | - Jason T Rich
- Department of Otolaryngology-Head and Neck Surgery, Washington University School of Medicine in St. Louis, St Louis, Missouri, U.S.A
| | - Sidharth V Puram
- Department of Otolaryngology-Head and Neck Surgery, Washington University School of Medicine in St. Louis, St Louis, Missouri, U.S.A.,Department of Genetics, Washington University School of Medicine in St. Louis, St. Louis, Missouri, U.S.A
| | - Sean T Massa
- Department of Otolaryngology-Head and Neck Surgery, Washington University School of Medicine in St. Louis, St Louis, Missouri, U.S.A
| | - Patrik Pipkorn
- Department of Otolaryngology-Head and Neck Surgery, Washington University School of Medicine in St. Louis, St Louis, Missouri, U.S.A
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Silva IFVD, Omaña-Cepeda C, Marí-Roig A, López-López J, Jané-Salas E. Survival of Dental Implants in Oncology Patients versus Non-Oncology Patients: A 5-Year Retrospective Study. Braz Dent J 2020; 31:650-656. [PMID: 33237237 DOI: 10.1590/0103-6440202003622] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2020] [Accepted: 10/20/2020] [Indexed: 12/24/2022] Open
Abstract
Patients with a history of cancer are increasingly common in the dental office. Treating cancer patients requires a multidisciplinary team, which should include the dentist, in order to control the complications that occur in the oral cavity and also to recover the patient undergoing treatment in any of its types: surgical, medical, radiotherapeutic, or its possible combinations. Dental implants can be a safe and predictable treatment option for prosthetic rehabilitation. The aim of this paper is to describe in retrospect the success rate of osseointegrated implants in oncology and non-oncology patients placed by the Master of Dentistry in Oncology and Immunocompromised Patients, as well as the Master of Medicine, Surgery and Oral Implantology of the University of Barcelona Dental Hospital, between July 2011 and March 2016. 466 patients were reviewed, with a total of 1405 implants placed, considering the oncological history of the patients and the implant success rate. The total success rate in the concerned period was 96.65%. When comparing cancer patients with healthy ones, the success rate has been 93.02% in the first case, and 97.16% in the latter. According to the literature review, our results encourage implant placement in cancer patients, it is important to recognize that this is an analysis of a complex care pathway with a large number of confounding variables. However, the findings should not be considered as generalizable.
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Affiliation(s)
| | - Carlos Omaña-Cepeda
- School of Dentistry, Department of Odonto-Stomatology, University of Barcelona Dental Hospital, Barcelona, Spain
| | - Antonio Marí-Roig
- School of Dentistry, Department of Odonto-Stomatology, University of Barcelona Dental Hospital, Barcelona, Spain
| | - José López-López
- School of Dentistry, Department of Odonto-Stomatology, University of Barcelona Dental Hospital, Barcelona, Spain
| | - Enric Jané-Salas
- School of Dentistry, Department of Odonto-Stomatology, University of Barcelona Dental Hospital, Barcelona, Spain
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Complex Mandibular Reconstruction for Head and Neck Squamous Cell Carcinoma-The Ongoing Challenge in Reconstruction and Rehabilitation. Cancers (Basel) 2020; 12:cancers12113198. [PMID: 33143098 PMCID: PMC7693398 DOI: 10.3390/cancers12113198] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2020] [Revised: 10/17/2020] [Accepted: 10/23/2020] [Indexed: 11/21/2022] Open
Abstract
Simple Summary Cancer therapy includes a broad range of microvascular free flaps that may restore defects and improve patients’ quality of life. This is particularly important for head and neck squamous cell carcinoma (HNSCC) and composite mandibular reconstructions, containing tissues of bone, muscle, and skin, which may be problematic due to their magnitude and sensitive location. The subscapular system offers a highly valuable donor site with the most versatility and the potential for rapid rehabilitation. Interestingly, other donor sites are more commonly used internationally. Therefore, we evaluated the use of the subscapular system free flap (SFF), which is the most commonly used free flap at our department. To our knowledge, this retrospective study represents the largest number of SFF cases reported to date in the literature. Furthermore, we examined the quality of life in a subgroup of patients, combining prospective occurrences to provide insight into overall rehabilitation from the patients’ viewpoints. Abstract Large head and neck squamous cell carcinoma (HNSCC) tumors affecting the mandible require a versatile reconstruction to maintain form, function, and quality of life. Large defect reconstruction of soft and hard tissue in the head and neck necessitates, at best, one vascular system including various tissues by large dimensions. The subscapular flap system seems to meet these standards. A retrospective study was conducted focusing on clinical data, including an analysis of the quality of life with the European Organization for Research and Treatment of Cancer (EORTC) Quality of Life Questionnaires, (QLQ-C30 and QLQ-H&N43). A total of 154 patients (122 males, 32 females; age range: 31–71 years, mean: 54.5 years) treated at our department from 1983 through to 2019 were included. Of the subscapular system free flaps (SFFs), 147 were based on the angular artery branch of the thoracodorsal pedicle (95.45%), and the remaining seven cases (4.55%) were lateral scapular border flaps. Mean mandible defect length was 7.3 cm. The mean skin paddle dimension was 86.8 cm2. The most common recipient artery was the thyroid superior artery (79.22%). Major postoperative complications occurred in 13 patients (8.44%). This study confirms that SFFs offer excellent soft and hard tissue quality, component independence, a large arc of rotation length, and a large gauge of pedicle, making them the gold standard for the reconstruction of large composite defects of mandibular HNSCC tumors.
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Patel J, Antov H, Nixon P. Implant-supported oral rehabilitation in oncology patients: a retrospective cohort study. Br J Oral Maxillofac Surg 2020; 58:1003-1007. [DOI: 10.1016/j.bjoms.2020.05.016] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2019] [Accepted: 05/11/2020] [Indexed: 10/24/2022]
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Breik O, Goodrum H, Koria H, Edmondson S, Praveen P, Parmar S. Rehabilitation post maxillary and mandibular reconstruction: Current status and future approaches. Oral Oncol 2020; 105:104663. [DOI: 10.1016/j.oraloncology.2020.104663] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2019] [Revised: 03/22/2020] [Accepted: 03/23/2020] [Indexed: 10/24/2022]
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