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Camolesi GCV, Veronese HRM, Celestino MA, Blum DFC, Márquez-Zambrano JA, Carmona-Pérez FA, Jara-Venegas TA, Pellizzon ACA, Bernaola-Paredes WE. Survival of osseointegrated implants in head and neck cancer patients submitted to multimodal treatment: a systematic review and meta-analysis. Support Care Cancer 2023; 31:641. [PMID: 37851170 DOI: 10.1007/s00520-023-08088-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2023] [Accepted: 09/27/2023] [Indexed: 10/19/2023]
Abstract
PURPOSE To investigate the survival rate in implants placement in irradiated and non-irradiated bone in patients undergoing head and neck cancer (HNC) treatment. We focused on the consequences of the main complications, such as osteoradionecrosis and peri-implantitis. METHODS An electronic search conducted by PRISMA protocol was performed. Full texts were carefully assessed, and data were assimilated into a tabular form for discussion and consensus among the expert panel. The quality assessment and the risk of bias are verified by Joanna Briggs Institute checklist (JBI) and The Newcastle-Ottawa Scale (NOS), and Risk of Bias in Non-Randomized Studies of Interventions (ROBINS-I) assessment tool. RESULTS A total of 452 records were identified in the based on our PICOs strategy and after screening, 19 articles were included in the descriptive analysis of the review. Totaling 473 implants placed in irradiated and non-irradiated bone, and 31.6% of the patients were over 60 years of age. 57.9%) performed implant placement in a period of 12 months or more after the ending of radiotherapy. Only 5 studies had a follow-up period longer than 5 years after implant placement, of which three were used for the meta-analysis. In the meta-analysis of 5-year survival rate, analysis of implants in irradiated bone was assessed; a random effect model was used and a weighted proportion (PP) of 93.13% (95% CI: 87.20-99.06; p < 0.001), and in the 5-year survival rate, analysis of implants in non-irradiated bone was analysed; a fixed effect model was used and a weighted proportion (PP) of 98.52% survival (95% CI: 97.56-99.48, p < 0.001). CONCLUSIONS Survival rates of implants placed in irradiated bone are clinically satisfactory after a follow-up of 5 years, with a fewer percentage than in implants placed in non-irradiated bone after metanalyses performed.
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Affiliation(s)
- Gisela Cristina Vianna Camolesi
- Oral Medicine, Oral Surgery, and Implantology Unit (MedOralRes), Faculty of Medicine and Dentistry, University of Santiago de Compostela, 15782, Santiago de Compostela, Spain.
| | | | | | - Davi Francisco Casa Blum
- Department of Oral and Maxillofacial Surgery, Atitus Education, Passo Fundo, Rio Grande Do Sul, 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] [What about the content of this article? (0)] [Affiliation(s)] [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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Guabello G, Zuffetti F, Ravidà A, Deflorian M, Carta G, Saleh MHA, Serroni M, Pommer B, Watzek G, Francetti L, Testori T. Avoiding implant-related complications in medically compromised patients with or without unhealthy lifestyle/Elevated oxidative stress. Periodontol 2000 2023; 92:329-349. [PMID: 37350348 DOI: 10.1111/prd.12503] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2023] [Revised: 04/11/2023] [Accepted: 04/26/2023] [Indexed: 06/24/2023]
Abstract
Increased human life expectancy broadens the alternatives for missing teeth and played a role in the widespread use of dental implants and related augmentation procedures for the aging population. Though, many of these patients may have one or more diseases. These systemic conditions may directly lead to surgical complications, compromise implant/bone healing, or influence long-term peri-implant health and its response to biologic nuisances. Offering patients credible expectations regarding intra- and postoperative complications and therapeutic prognosis is an ethical and legal obligation. Clear identification of potential types of adverse effects, complications, or errors is important for decision-making processes as they may be related to different local, systemic, and technical aspects. Therefore, the present review structures the underlying biological mechanisms, clinical evidence, and clinical recommendations for the most common systemic risk factors for implant-related complications.
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Affiliation(s)
- Gregorio Guabello
- Endocrinology Unit, IRCCS Galeazzi Sant'Ambrogio Hospital, Milan, Italy
| | - Francesco Zuffetti
- Section of Implant Dentistry and Oral Rehabilitation, IRCCS Galeazzi Sant'Ambrogio Hospital, Dental Clinic, Milan, Italy
| | - Andrea Ravidà
- Department of Periodontics and Preventive Dentistry, University of Pittsburgh School of Dental Medicine, Pittsburgh, Pennsylvania, USA
| | - Matteo Deflorian
- Section of Implant Dentistry and Oral Rehabilitation, IRCCS Galeazzi Sant'Ambrogio Hospital, Dental Clinic, Milan, Italy
| | - Giorgio Carta
- Argo Academy International Research Bologna, Bologna, Italy
- Private Practice, Bologna, Italy
- Lake Como Institute, Como, Italy
| | - Muhammad H A Saleh
- Department of Periodontics and Oral Medicine, University of Michigan School of Dentistry, Ann Arbor, Michigan, USA
| | - Matteo Serroni
- Department of Innovative Technologies in Medicine & Dentistry, University 'G. D'Annunzio', Chieti-Pescara, Italy
| | - Bernhard Pommer
- Academy for Oral Implantology, Vienna, Austria
- Department of Biomedical, Surgical and Dental Sciences, Università degli Studi di Milano, Milan, Italy
| | | | - Luca Francetti
- IRCCS Galeazzi Sant'Ambrogio Hospital, Dental Clinic, Milan, Italy
- Department of Biomedical, Surgical and Dental Sciences, Università degli Studi di Milano, Milan, Italy
| | - Tiziano Testori
- Section of Implant Dentistry and Oral Rehabilitation, IRCCS Galeazzi Sant'Ambrogio Hospital, Dental Clinic, Milan, Italy
- Department of Periodontics and Oral Medicine, University of Michigan School of Dentistry, Ann Arbor, Michigan, USA
- Department of Biomedical, Surgical and Dental Sciences, Università degli Studi di Milano, Milan, Italy
- Department of Oral Medicine, Infection and Immunity, Harvard School of Dental Medicine, Boston, Massachusetts, USA
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Kende PP, Ranganath S, Landge JS, Sarda A, Wadewale M, Patil A, Singhavi HR. Survival of Dental Implants on Irradiated Jaws: A Systematic Review and Meta-analysis. J Maxillofac Oral Surg 2022; 21:787-795. [PMID: 36274870 PMCID: PMC9474974 DOI: 10.1007/s12663-022-01686-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2021] [Accepted: 01/03/2022] [Indexed: 12/24/2022] Open
Abstract
Objectives Dental implants play a significant role in functional rehabilitation of the oral cavity after debilitating jaw surgeries for oral cavity cancers followed by radiotherapy. Design The meta-analysis was done using Preferred Reporting Items for Systematic Review (PRISMA) guidelines published from January 1947 till August 2020. Twenty three articles consisting of 1246 participants with 4838 implants were included in our analysis. Results The mean age of the included participants was 51.4 years. 2186 and 1685 implants were placed on irradiated and non-irradiated jaws and showed a success rate of 82.47% and 89.37% respectively. Correspondingly, publication bias of p value = 0.2129 and p-value = 0.6525 was found by Egger's and Begg's test respectively for pooled data of 16 studies. The implant success rate of 70.4% on maxillary bone and 94.5% were observed on mandibular bone. Timing of implant placement and its influence on survival rate have resulted in a 75.5% survival rate of dental implants when placed primarily in comparison with 87.7% on delayed placement. The waiting interval of 14 months in delayed implant placement has shown better results. Conclusion Presence of radiotherapy does not play a significant role in the success rate of dental implants in oral cavity cancers. However, delayed implant placement may have a better chance of survival. Supplementary Information The online version contains supplementary material available at 10.1007/s12663-022-01686-6.
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Affiliation(s)
- Prajwalit Prakash Kende
- Department of Oral and Maxillofacial Surgery, Government Dental College and Hospital, Mumbai, 400001 India
| | - Suleka Ranganath
- Department of Oral and Maxillofacial Surgery, Government Dental College and Hospital, Mumbai, 400001 India
| | - Jayant Shivaji Landge
- Department of Oral and Maxillofacial Surgery, Government Dental College and Hospital, Mumbai, 400001 India
| | - Ashish Sarda
- Department of Oral and Maxillofacial Surgery, Government Dental College and Hospital, Mumbai, 400001 India
| | - Maroti Wadewale
- Department of Oral and Maxillofacial Surgery, Government Dental College and Hospital, Mumbai, 400001 India
| | - Akshay Patil
- Department of Biostatistics, Tata Memorial Hospital, Mumbai, India
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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] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [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<0.00001, 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<0.0001, 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.
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Affiliation(s)
- Eik Schiegnitz
- Department of Oral and Maxillofacial Surgery, Plastic Surgery, University Medical Centre, Johannes Gutenberg-University, Mainz
| | - Katrin Reinicke
- Department of Oral and Maxillofacial Surgery, Plastic Surgery, University Medical Centre, Johannes Gutenberg-University, Mainz
| | - Keyvan Sagheb
- Department of Oral and Maxillofacial Surgery, Plastic Surgery, University Medical Centre, Johannes Gutenberg-University, Mainz
| | - Jochem König
- Institute of Medical Biometry, Epidemiology and Informatics, Johannes Gutenberg-University, Germany
| | - Bilal Al-Nawas
- Department of Oral and Maxillofacial Surgery, Plastic Surgery, University Medical Centre, Johannes Gutenberg-University, Mainz
| | - Knut A Grötz
- Department of Oral and Maxillofacial Surgery, Dr. Horst Schmidt Clinic Wiesbaden, Germany
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Hasegawa T, Sasaki A, Saito I, Arimoto S, Yatagai N, Hiraoka Y, Takeda D, Kakei Y, Akashi M. Success of dental implants in patients with large bone defect and analysis of risk factors for implant failure: a non-randomized retrospective cohort study. Clin Oral Investig 2021; 26:2743-2750. [PMID: 34783914 DOI: 10.1007/s00784-021-04249-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2021] [Accepted: 10/23/2021] [Indexed: 11/27/2022]
Abstract
OBJECTIVES This study aimed to retrospectively investigate the success and survival rates of dental implants used for dentomaxillary prostheses at our hospital and the risk factors associated with large bone defects. MATERIALS AND METHODS A total of 138 external joint system implants used for dentomaxillary prostheses in 40 patients with large bone defects were included in this study. The alveolar bone at the site of implant insertion was evaluated using panoramic radiography and computed tomography. Various risk factors (demographic characteristics, dental status, and operative factors such as the employment of alveolar bone augmentation, the site, the length, and diameter of implants) for implant failure and complete implant loss were investigated using univariate and multivariate analyses. The associations between the variables and the success and survival rates of dental implants were analyzed using the multivariate Cox proportional hazard models. RESULTS The 10-year overall success and survival rates were 81.3% and 88.4% in this study. Multivariable analysis showed that the male sex (HR 6.22), shorter implants (≤ 8.5 mm) (HR 5.21), and bone augmentation (HR 2.58) were independent predictors of success rate. Bone augmentation (HR 5.14) and narrow implants (≤ 3.3 mm) (HR 3.86) were independent predictors of the survival rate. CONCLUSION Male sex, shorter or narrow implants, and bone augmentation were independent risk factors for dental implants used in dentomaxillary prostheses in patients with large bone defects. CLINICAL RELEVANCE Clinicians should consider these risk factors and pay close attention to the management of these patients.
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Affiliation(s)
- Takumi Hasegawa
- Department of Oral and Maxillofacial Surgery, Kobe University Graduate School of Medicine, 7-5-1, Kusunoki-cho, Chuo-ku, Kobe, 650-0017, Japan.
| | - Aki Sasaki
- Department of Oral and Maxillofacial Surgery, Kobe University Graduate School of Medicine, 7-5-1, Kusunoki-cho, Chuo-ku, Kobe, 650-0017, Japan
| | - Izumi Saito
- Department of Oral and Maxillofacial Surgery, Kobe University Graduate School of Medicine, 7-5-1, Kusunoki-cho, Chuo-ku, Kobe, 650-0017, Japan
| | - Satomi Arimoto
- Department of Oral and Maxillofacial Surgery, Kobe University Graduate School of Medicine, 7-5-1, Kusunoki-cho, Chuo-ku, Kobe, 650-0017, Japan
| | - Nanae Yatagai
- Department of Oral and Maxillofacial Surgery, Kobe University Graduate School of Medicine, 7-5-1, Kusunoki-cho, Chuo-ku, Kobe, 650-0017, Japan
| | - Yujiro Hiraoka
- Department of Oral and Maxillofacial Surgery, Kobe University Graduate School of Medicine, 7-5-1, Kusunoki-cho, Chuo-ku, Kobe, 650-0017, Japan
| | - Daisuke Takeda
- Department of Oral and Maxillofacial Surgery, Kobe University Graduate School of Medicine, 7-5-1, Kusunoki-cho, Chuo-ku, Kobe, 650-0017, Japan
| | - Yasumasa Kakei
- Department of Oral and Maxillofacial Surgery, Kobe University Graduate School of Medicine, 7-5-1, Kusunoki-cho, Chuo-ku, Kobe, 650-0017, Japan
| | - Masaya Akashi
- Department of Oral and Maxillofacial Surgery, Kobe University Graduate School of Medicine, 7-5-1, Kusunoki-cho, Chuo-ku, Kobe, 650-0017, Japan
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Ettl T, Junold N, Zeman F, Hautmann M, Hahnel S, Kolbeck C, Müller S, Klingelhöffer C, Reichert TE, Meier JK. Implant survival or implant success? Evaluation of implant-based prosthetic rehabilitation in head and neck cancer patients—a prospective observational study. Clin Oral Investig 2019; 24:3039-3047. [DOI: 10.1007/s00784-019-03172-9] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2019] [Accepted: 12/04/2019] [Indexed: 12/11/2022]
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8
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Laverty DP, Addison O, Wubie BA, Heo G, Parmar S, Martin T, Praveen P, Pearson D, Newsum D, Murphy M, Bateman G. Outcomes of implant-based oral rehabilitation in head and neck oncology patients-a retrospective evaluation of a large, single regional service cohort. Int J Implant Dent 2019; 5:8. [PMID: 30834461 PMCID: PMC6399356 DOI: 10.1186/s40729-019-0161-y] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2018] [Accepted: 01/14/2019] [Indexed: 11/22/2022] Open
Abstract
Background The study reports on implant survival outcomes in head and neck cancer patients who received implant-based oral rehabilitation in a regional service centre. Methods A retrospective analysis of implant survival outcomes in patients treated in a regional service from 2012 to 2017 was performed. The primary outcome measure was implant survival. The secondary outcome measure was to assess the effect of covariates associated with implant failure including bone type, radiotherapy, chemotherapy, gender and surgical implant complications. Kaplan-Meier survival curves were applied to compare differences in the survival rates of groups of variables. Cox proportional hazards models were applied to identify covariates associated with implant failure. p value was set at 0.05. Results The sample was composed of 167 head and neck cancer patients who had 779 dental implants placed. Implant survival estimates were calculated: 3 years, 95.7% [95%CI 94.3–97.2%] and 5 years, 95.5% [95%CI 93.9–97.0%], with a median follow-up of 38 months. Gender (p = 0.09), radiotherapy (p = 0.16) and chemotherapy (p = 0.17) did not significantly influence implant survival, whereas implant failure was higher in transported (reconstructed) bone sites in comparison with native bone (p < 0.01). Conclusion The result of this study suggests that overall implant survival as part of the routine oral rehabilitation is high in this patient cohort; however, implant failure was found to be statistically higher for implant placed into transported bone in comparison to native bone.
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Affiliation(s)
- Dominic P Laverty
- University of Birmingham School of Dentistry, Birmingham Dental Hospital, 5 Mill Pool Way, Birmingham, B5 7EG, UK. .,Birmingham Community Healthcare NHS Foundation Trust, Birmingham, B5 7EG, UK.
| | - Owen Addison
- University of Birmingham School of Dentistry, Birmingham Dental Hospital, 5 Mill Pool Way, Birmingham, B5 7EG, UK.,Birmingham Community Healthcare NHS Foundation Trust, Birmingham, B5 7EG, UK.,School of Dentistry, University of Alberta, Edmonton, AB, T6G 1C9, Canada
| | - Berhanu A Wubie
- Department of Mathematical & Statistical Sciences, University of Alberta, Edmonton, AB, T6G 1C9, Canada
| | - Giseon Heo
- School of Dentistry, University of Alberta, Edmonton, AB, T6G 1C9, Canada.,Department of Mathematical & Statistical Sciences, University of Alberta, Edmonton, AB, T6G 1C9, Canada
| | - Sat Parmar
- University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Timothy Martin
- University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Prav Praveen
- University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - David Pearson
- Birmingham Community Healthcare NHS Foundation Trust, Birmingham, B5 7EG, UK
| | - David Newsum
- Birmingham Community Healthcare NHS Foundation Trust, Birmingham, B5 7EG, UK
| | - Michael Murphy
- Birmingham Community Healthcare NHS Foundation Trust, Birmingham, B5 7EG, UK
| | - Geoffrey Bateman
- University Hospitals Coventry and Warwickshire NHS Trust, Coventry, UK
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9
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Kumar VV, Srinivasan M. Masticatory efficiency of implant-supported removable partial dental prostheses in patients with free fibula flap reconstructed mandibles: A split-mouth, observational study. Clin Oral Implants Res 2018; 29:855-863. [PMID: 29920778 DOI: 10.1111/clr.13304] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2017] [Revised: 04/09/2018] [Accepted: 05/22/2018] [Indexed: 12/25/2022]
Abstract
OBJECTIVES The aim of this split-mouth study was to evaluate the masticatory efficiency in patients with segmentally reconstructed mandibles using free fibula flaps, with and without stabilizing osteosynthesis material in-situ during implant placement for rehabilitation with implant-supported removable partial dental prostheses (ISRPDPs). METHODS Ten participants (n = 10; ♀ = 2, ♂ = 8; mean age = 38.1 years) consented to participate in this study. The participants' normal side (Side N) of the mandible served as the control side, for comparing the masticatory efficiency of the segmentally reconstructed and rehabilitated side (Side R). Masticatory efficiency was evaluated using the two-colored chewing gum test, measured as subjective assessment (SA) and electronically evaluated variance of hue (VOH). Data were checked for normal distribution and statistically analyzed with the level of significance set to p < 0.05. RESULTS Thirty-four tissue-level implants were placed in reconstructed mandibles of 10 participants. There was no significant difference observed in the masticatory efficiencies between Side N and Side R, in both subjective and electronic assessments. No implant loss was observed after a post-rehabilitated mean follow-up period of 42.7 months, revealing an implant survival rate of 100%. CONCLUSIONS In patients with surgically reconstructed mandibles, a normal masticatory function can be successfully achieved with a rehabilitation of the reconstructed side with implant-supported removable partial dental prostheses. Implant-supported prostheses should be actively advocated in patients with reconstructive surgeries to restore their masticatory function, extend their food choices, and improve their overall oral health-related quality of life.
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Affiliation(s)
- Vinay V Kumar
- Department of Head and Neck Surgery, Mazumdar Shaw Medical Center, Narayana Health, Bengaluru, India
| | - Murali Srinivasan
- Division of Gerodontology and Removable Prosthodontics, University Clinics of Dental Medicine, University of Geneva, Geneva, Switzerland
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Karayazgan-Saracoglu B, Atay A, Korkmaz C, Gunay Y. Quality of life assessment of implant-retained overdentures and fixed metal-acrylic resin prostheses in patients with marginal mandibulectomy. J Prosthet Dent 2017; 118:551-560. [DOI: 10.1016/j.prosdent.2017.01.025] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2016] [Revised: 01/25/2017] [Accepted: 01/26/2017] [Indexed: 12/17/2022]
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Smith Nobrega A, Santiago JF, de Faria Almeida DA, dos Santos DM, Pellizzer EP, Goiato MC. Irradiated patients and survival rate of dental implants: A systematic review and meta-analysis. J Prosthet Dent 2016; 116:858-866. [DOI: 10.1016/j.prosdent.2016.04.025] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2015] [Revised: 04/26/2016] [Accepted: 04/28/2016] [Indexed: 10/21/2022]
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12
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Ernst N, Sachse C, Raguse JD, Stromberger C, Nelson K, Nahles S. Changes in Peri-Implant Bone Level and Effect of Potential Influential Factors on Dental Implants in Irradiated and Nonirradiated Patients Following Multimodal Therapy Due to Head and Neck Cancer: A Retrospective Study. J Oral Maxillofac Surg 2016; 74:1965-73. [DOI: 10.1016/j.joms.2016.06.005] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2016] [Revised: 06/03/2016] [Accepted: 06/03/2016] [Indexed: 11/19/2022]
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Kumar VV, Ebenezer S, Kämmerer PW, Jacob PC, Kuriakose MA, Hedne N, Wagner W, Al-Nawas B. Implants in free fibula flap supporting dental rehabilitation - Implant and peri-implant related outcomes of a randomized clinical trial. J Craniomaxillofac Surg 2016; 44:1849-1858. [PMID: 27697397 DOI: 10.1016/j.jcms.2016.08.023] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2016] [Revised: 07/20/2016] [Accepted: 08/29/2016] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVES The objective of this study was to assess the difference in success rates of implants when using two or four implant-supported-overdentures following segmental mandibular reconstruction with fibula free flap. METHODS AND DESIGNS This prospective, parallel designed, randomized clinical study was conducted with 1:1 ratio. At baseline, all participants already had segmental reconstruction of mandible with free fibula flap. The participants were randomized into two groups: Group-I received implant-supported-overdentures on two tissue-level implants and Group-II received implant-supported-overdentures on four tissue-level implants. Success rates of the implants were evaluated at 3 months, 6 months and 12 months following implant loading using marginal bone level changes as well as peri-implant indices (Buser et al., 1990). RESULTS 52 patients were randomized into two treatment groups (26 each), out of which 18 patients (36 implants) of Group-I and 17 patients (68 implants) of Group-II were evaluated. One implant in Group-I was lost due to infective complications and one patient in the same group had superior barrel necrosis. There was a statistically significant increase at both time points (p = 0.03, p = 0.04 at 6 months, 12 months) in the amount of marginal bone loss in Group-I (0.4 mm, 0.5 mm at 6 months, 12 months) as compared to Group-II (0.1 mm, 0.2 mm at 6 months, 12 months). There were no clinically significant changes peri-implant parameters between both groups. Peri-implant soft tissue hyperplasia was seen in both groups, 32% of implants at 3-months, 26% at 6-months and 3% at 12-months follow-up. CONCLUSION The results of this study show that patients with 2-implant-supported-overdentures had higher marginal bone loss as compared to patients with 4-implant-supported-overdentures. There were no clinically significant differences in peri-implant soft tissue factors in patients with 2- or 4-implant-supported-overdentures. Hyperplastic peri-implant tissues are common in the early implant-loading phase and tend to decrease over time under appropriate management.
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Affiliation(s)
- Vinay V Kumar
- Head and Neck Institute (Head: Dr. Moni A. Kuriakose), Mazumdar Shaw Cancer Center, Narayana Health, Bommasandra, Bangalore, India; Department of Oral and Maxillofacial Surgery-Plastic Surgery, University Medical Center of Johannes Gutenberg University, Mainz, Germany.
| | - Supriya Ebenezer
- Department of Periodontics, M. R. Ambedkar Dental College & Hospital, Bangalore, India.
| | - Peer W Kämmerer
- Department of Oral and Maxillofacial Surgery-Plastic Surgery, University Medical Center of Rostock University, Rostock, Germany.
| | - P C Jacob
- Head and Neck Institute (Head: Dr. Moni A. Kuriakose), Mazumdar Shaw Cancer Center, Narayana Health, Bommasandra, Bangalore, India.
| | - Moni A Kuriakose
- Head and Neck Institute (Head: Dr. Moni A. Kuriakose), Mazumdar Shaw Cancer Center, Narayana Health, Bommasandra, Bangalore, India.
| | - Naveen Hedne
- Head and Neck Institute (Head: Dr. Moni A. Kuriakose), Mazumdar Shaw Cancer Center, Narayana Health, Bommasandra, Bangalore, India.
| | - Wilfried Wagner
- Department of Oral and Maxillofacial Surgery-Plastic Surgery, University Medical Center of Johannes Gutenberg University, Mainz, Germany.
| | - Bilal Al-Nawas
- Department of Oral and Maxillofacial Surgery-Plastic Surgery, University Medical Center of Johannes Gutenberg University, Mainz, Germany.
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Ettl T, Weindler J, Gosau M, Müller S, Hautmann M, Zeman F, Koller M, Papavasileiou D, Bürgers R, Driemel O, Schneider I, Klingelhöffer C, Meier J, Wahlmann U, Reichert TE. Impact of radiotherapy on implant-based prosthetic rehabilitation in patients with head and neck cancer: A prospective observational study on implant survival and quality of life—Preliminary results. J Craniomaxillofac Surg 2016; 44:1453-62. [DOI: 10.1016/j.jcms.2016.07.016] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2016] [Revised: 06/13/2016] [Accepted: 07/15/2016] [Indexed: 11/19/2022] Open
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Kumar VV, Jacob P, Ebenezer S, Kuriakose MA, Kekatpure V, Baliarsing AS, Al-nawas B, Wagner W. Implant supported dental rehabilitation following segmental mandibular reconstruction- quality of life outcomes of a prospective randomized trial. J Craniomaxillofac Surg 2016; 44:800-10. [DOI: 10.1016/j.jcms.2016.04.013] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2016] [Revised: 03/08/2016] [Accepted: 04/06/2016] [Indexed: 11/24/2022] Open
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Ch'ng S, Skoracki RJ, Selber JC, Yu P, Martin JW, Hofstede TM, Chambers MS, Liu J, Hanasono MM. Osseointegrated implant-based dental rehabilitation in head and neck reconstruction patients. Head Neck 2015; 38 Suppl 1:E321-7. [DOI: 10.1002/hed.23993] [Citation(s) in RCA: 61] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/18/2014] [Indexed: 11/07/2022] Open
Affiliation(s)
- Sydney Ch'ng
- Department of Plastic Surgery; The University of Texas MD Anderson Cancer Center; Houston Texas
- Department of Plastic Surgery; Royal Prince Alfred Hospital; Sydney New South Wales Australia
- The Institute of Academic Surgery, University of Sydney; New South Wales Australia
| | - Roman J. Skoracki
- Department of Plastic Surgery; The University of Texas MD Anderson Cancer Center; Houston Texas
| | - Jesse C. Selber
- Department of Plastic Surgery; The University of Texas MD Anderson Cancer Center; Houston Texas
| | - Peirong Yu
- Department of Plastic Surgery; The University of Texas MD Anderson Cancer Center; Houston Texas
| | - Jack W. Martin
- Dental Oncology Section; Department of Head and Neck Surgery; The University of Texas MD Anderson Cancer Center; Houston Texas
| | - Theresa M. Hofstede
- Dental Oncology Section; Department of Head and Neck Surgery; The University of Texas MD Anderson Cancer Center; Houston Texas
| | - Mark S. Chambers
- Dental Oncology Section; Department of Head and Neck Surgery; The University of Texas MD Anderson Cancer Center; Houston Texas
| | - Jun Liu
- Department of Plastic Surgery; The University of Texas MD Anderson Cancer Center; Houston Texas
| | - Matthew M. Hanasono
- Department of Plastic Surgery; The University of Texas MD Anderson Cancer Center; Houston Texas
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Duttenhoefer F, Nack C, Doll C, Raguse J, Hell B, Stricker A, Nelson K, Nahles S. Long-term peri-implant bone level changes of non-vascularized fibula bone grafted edentulous patients. J Craniomaxillofac Surg 2015; 43:611-5. [DOI: 10.1016/j.jcms.2015.02.020] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2014] [Revised: 02/26/2015] [Accepted: 02/27/2015] [Indexed: 11/19/2022] Open
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Schultz BD, Sosin M, Nam A, Mohan R, Zhang P, Khalifian S, Vranis N, Manson PN, Bojovic B, Rodriguez ED. Classification of Mandible Defects and Algorithm for Microvascular Reconstruction: . Plast Reconstr Surg 2015; 135:743e-54e. [DOI: 10.1097/prs.0000000000001106] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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de Souza JG, Claus JD, Ouriques FD, Gil LF, Gil JN, Cardoso AC, Bianchini MA. Treatment of odontogenic myxoma: a multidisciplinary approach-6-year follow-up case. Case Rep Dent 2014; 2014:795808. [PMID: 25580309 DOI: 10.1155/2014/795808] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2014] [Revised: 11/12/2014] [Accepted: 11/26/2014] [Indexed: 11/29/2022] Open
Abstract
The most aggressive diseases that affect the oral environment are considered tumors of the jaw. The surgical treatment is preferably done by surgical resection of the lesion, resulting in a great loss of tissue and esthetics. Multidisciplinary planning is required for the rehabilitation of these cases. Autogenous grafting techniques or vascularized flaps allow ridge reconstruction for implant placement, restoring function, and esthetics. This paper reports a 6-year follow-up case of an odontogenic myxoma treated with wide resection and mandibular bone reconstruction for posterior rehabilitation with dental implants.
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Doll C, Nack C, Raguse J, Stricker A, Duttenhoefer F, Nelson K, Nahles S. Survival analysis of dental implants and implant-retained prostheses in oral cancer patients up to 20 years. Clin Oral Investig 2015; 19:1347-52. [DOI: 10.1007/s00784-014-1359-2] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2014] [Accepted: 11/10/2014] [Indexed: 10/24/2022]
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Fishero BA, Kohli N, Das A, Christophel JJ, Cui Q. Current concepts of bone tissue engineering for craniofacial bone defect repair. Craniomaxillofac Trauma Reconstr 2014; 8:23-30. [PMID: 25709750 DOI: 10.1055/s-0034-1393724] [Citation(s) in RCA: 53] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2013] [Accepted: 02/28/2014] [Indexed: 12/17/2022] Open
Abstract
Craniofacial fractures and bony defects are common causes of morbidity and contribute to increasing health care costs. Successful regeneration of bone requires the concomitant processes of osteogenesis and neovascularization. Current methods of repair and reconstruction include rigid fixation, grafting, and free tissue transfer. However, these methods carry innate complications, including plate extrusion, nonunion, graft/flap failure, and donor site morbidity. Recent research efforts have focused on using stem cells and synthetic scaffolds to heal critical-sized bone defects similar to those sustained from traumatic injury or ablative oncologic surgery. Growth factors can be used to augment both osteogenesis and neovascularization across these defects. Many different growth factor delivery techniques and scaffold compositions have been explored yet none have emerged as the universally accepted standard. In this review, we will discuss the recent literature regarding the use of stem cells, growth factors, and synthetic scaffolds as alternative methods of craniofacial fracture repair.
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Affiliation(s)
- Brian Alan Fishero
- Department of Otolaryngology-Head and Neck Surgery, School of Medicine, University of Virginia, Charlottesville, Virginia
| | - Nikita Kohli
- Department of Otolaryngology-Head and Neck Surgery, SUNY Downstate Medical Center, Brooklyn, New York
| | - Anusuya Das
- Orthopaedic Surgery Research Center, University of Virginia, Charlottesville, Virginia
| | - John Jared Christophel
- Department of Otolaryngology-Head and Neck Surgery, School of Medicine, University of Virginia, Charlottesville, Virginia
| | - Quanjun Cui
- Department of Orthopaedic Surgery, School of Medicine, University of Virginia, Charlottesville, Virginia
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Schiegnitz E, Al-Nawas B, Kämmerer PW, Grötz KA. Oral rehabilitation with dental implants in irradiated patients: a meta-analysis on implant survival. Clin Oral Investig 2013; 18:687-98. [DOI: 10.1007/s00784-013-1134-9] [Citation(s) in RCA: 78] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2013] [Accepted: 10/31/2013] [Indexed: 01/03/2023]
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Abstract
The aim of this study was to assess the survival rate of titanium implants placed in irradiated jaws. MEDLINE, EMBASE, and CENTRAL were searched for studies assessing implants that had been placed in nongrafted sites of irradiated patients. Random effects meta-analyses assessed implant loss in irradiated versus nonirradiated patients and in irradiated patients treated with hyperbaric oxygen (HBO) therapy. Of 1,051 potentially eligible publications, 15 were included. A total of 10,150 implants were assessed in the included studies, and of these, 1,689 (14.3%) had been placed in irradiated jaws. The mean survival rate in the studies ranged from 46.3% to 98.0%. The pooled estimates indicated a significant increase in the risk of implant failure in irradiated patients (risk ratio: 2.74; 95% confidence interval: 1.86, 4.05; p < .00001) and in maxillary sites (risk ratio: 5.96; 95% confidence interval: 2.71, 13.12; p < .00001). Conversely, HBO therapy did not reduce the risk of implant failure (risk ratio: 1.28; 95% confidence interval: 0.19, 8.82; p = .80). Radiotherapy was linked to higher implant failure in the maxilla, and HBO therapy did not improve implant survival. Most included publications reported data on machined implants, and only 3 studies on HBO therapy were included. Overall, implant therapy appears to be a viable treatment option for reestablishing adequate occlusion and masticatory conditions in irradiated patients.
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Affiliation(s)
- L Chambrone
- Division of Periodontics, Department of Stomatology, School of Dentistry, University of São Paulo, São Paulo, SP, Brazil
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Karayazgan-Saracoglu B, Atay A, Zulfikar H, Erpardo Y. Assessment of implant stability of patients with and without radiotherapy using resonance frequency analysis. J ORAL IMPLANTOL 2012; 41:30-5. [PMID: 23270595 DOI: 10.1563/aaid-joi-d-12-00107] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
The purpose of this study was to clinically monitor the stability of dental implants in patients with and without a history of radiotherapy, using resonance frequency analysis over 1 year. The stability of patients with 80 implants was monitored with resonance frequency analysis (Osstell Mentor) over 1 year. Data were assessed with Mann-Whitney U test and correlation analysis. Irradiated maxillary implants showed statistically lower values than the mandibular implants at a significant level (P < .05).
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25
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Ma Y, Shen G. Distraction osteogenesis after irradiation in rabbit mandibles. Br J Oral Maxillofac Surg 2012; 50:662-7. [DOI: 10.1016/j.bjoms.2011.10.008] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2011] [Accepted: 10/19/2011] [Indexed: 11/15/2022]
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Mancha de la Plata M, Gías LN, Díez PM, Muñoz-guerra M, González-garcía R, Lee GC, Castrejón-castrejón S, Rodríguez-campo FJ. Osseointegrated Implant Rehabilitation of Irradiated Oral Cancer Patients. J Oral Maxillofac Surg 2012; 70:1052-63. [DOI: 10.1016/j.joms.2011.03.032] [Citation(s) in RCA: 53] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2010] [Revised: 03/13/2011] [Accepted: 03/30/2011] [Indexed: 11/23/2022]
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27
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Juergens P, Klug C, Krol Z, Beinemann J, Kim H, Reyes M, Guevara-rojas G, Zeilhofer H, Ewers R, Schicho K. Navigation-Guided Harvesting of Autologous Iliac Crest Graft for Mandibular Reconstruction. J Oral Maxillofac Surg 2011; 69:2915-23. [DOI: 10.1016/j.joms.2010.12.045] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2010] [Accepted: 12/28/2010] [Indexed: 11/21/2022]
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Dholam KP, Bachher GK, Yadav PS, Quazi GA, Pusalkar HA. Assessment of quality of life after implant-retained prosthetically reconstructed maxillae and mandibles postcancer treatments. IMPLANT DENT 2011; 20:85-94. [PMID: 21278531 DOI: 10.1097/ID.0b013e31820031ab] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE The aim of this prospective study was to assess treatment outcome and impact on quality of life with implant-retained prosthesis in reconstructed jaws in head and neck cancer patients. MATERIALS AND METHODS Twelve patients were rehabilitated with implant-retained dental prosthesis following free fibular graft after segmental resection. These subjects were evaluated by standardized questionnaires European Organization for Research and Treatment of Cancer QLQ-C30 (version 3) and clinical assessment for quality of life. Objective assessment of speech parameters was done with Dr. Speech Software (Tiger DRS Inc., Seattle, WA). The questionnaire consisting of information on evaluation of deglutition, salivation, status of the mandible and teeth in relation to predisease level was used for subjective judgment of speech. RESULTS Consumption of solid, semisolid, and overcooked food was considerably better with the prosthesis. Drinking ability was not affected. Patients' voice resonance was improved, and they could sustain phonation for longer duration without difficulty. They were able to speak loudly, and their intonation pattern was also slightly better. Failure of the implants to osseointegrate at the end of 18 months was observed in 37% of the patients. This was attributed to radiation before implant insertions and periimplantitis. Despite the observed improvement in some patients, the statistical analysis of speech, swallowing parameters, and quality of life were not significant because of the paucity of numbers in this pilot study. There was no improvement in the symptoms scale scores. CONCLUSION Reconstruction and rehabilitation of the jaws affected by tumor restores the patient anatomically, esthetically, and functionally to optimum levels. However, a study with larger numbers of patients is necessary to ascertain the benefits of this treatment modality.
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Jegoux F, Aguado E, Cognet R, Malard O, Moreau F, Daculsi G, Goyenvalle E. Alveolar ridge augmentation in irradiated rabbit mandibles. J Biomed Mater Res A 2010; 93:1519-26. [PMID: 20014287 DOI: 10.1002/jbm.a.32644] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Oral carcinomas are frequently treated with a nonsegmental mandibulectomy plus radiotherapy. Improving the quality of life of these patients depends on the possibilities for dental rehabilitation. The aim of this study was to increase the alveolar ridge height. Twelve white New Zealand rabbits underwent surgery to produce a 11 x 9 x 7 mm(3) horizontal bicortical full-thickness defect at the alveolar ridge of the left mandible. Six were implanted with a composite associating resorbable collagen membrane filled with micro-macroporous biphasic calcium phosphate granules. After a daily radiation delivery schedule for 4 weeks, a total autologous bone marrow graft was injected percutaneously into the center of the implant. All animals were sacrificed at 16 weeks. Successful osseous colonization was observed in all implants. Significant ridge augmentation was observed (p = 0.0349) in the implanted group compared with the control group. This study contributed to producing an experimental model for oncological mandible defects in rabbits.
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De Ceulaer J, Magremanne M, van Veen A, Scheerlinck J. Squamous Cell Carcinoma Recurrence Around Dental Implants. J Oral Maxillofac Surg 2010; 68:2507-12. [DOI: 10.1016/j.joms.2010.01.023] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2009] [Accepted: 01/29/2010] [Indexed: 10/19/2022]
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Jegoux F, Malard O, Goyenvalle E, Aguado E, Daculsi G. Radiation effects on bone healing and reconstruction: interpretation of the literature. ACTA ACUST UNITED AC 2010; 109:173-84. [PMID: 20123406 DOI: 10.1016/j.tripleo.2009.10.001] [Citation(s) in RCA: 76] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2009] [Revised: 09/03/2009] [Accepted: 10/04/2009] [Indexed: 10/20/2022]
Abstract
OBJECTIVE Reconstructing irradiated mandibles with biomaterials is still a challenge but little investigated. We collected data that could help us understand studies in the field of regeneration with biomaterials and irradiated bone. STUDY DESIGN Systematic review of the literature. RESULTS Delay and duration of radiation delivery and total equivalent dose are the most variable parameters in the various studies, resulting in confusion when interpreting the literature. Most reproducible experiments show that radiation reduces osteogenic cell numbers, alters cytokine capacity, and delays and damages bone remodeling. Interindividual variations and how such changes become irreversible lesions are still uncertain. In the case of regeneration using biomaterials, most studies have addressed the question of reconstruction in previously irradiated bone. The results show that osseointegration is often possible, although the failure rate is higher. The sooner the implantation takes place after the end of the radiation, the higher the likelihood of failure. Few studies have focused on primary reconstruction followed by early irradiation, and most of the currently available engineering models would be altered by radiation. Good outcomes have been obtained with bone morphogenetic protein and with total bone marrow transplanation. CONCLUSION This review points out the difficulties in achieving reproducible experiments and interpreting literature in this underinvestigated field.
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Kwon YD, Karbach J, Wagner W, Al-Nawas B. Peri-implant parameters in head and neck reconstruction: influence of extraoral skin or intraoral mucosa. Clin Oral Implants Res 2010; 21:316-20. [DOI: 10.1111/j.1600-0501.2009.01763.x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Jégoux F, Goyenvalle E, Cognet R, Malard O, Moreau F, Daculsi G, Aguado E. Reconstruction of irradiated bone segmental defects with a biomaterial associating MBCP+(R), microstructured collagen membrane and total bone marrow grafting: an experimental study in rabbits. J Biomed Mater Res A 2010; 91:1160-9. [PMID: 19148925 DOI: 10.1002/jbm.a.32274] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
The bone tissue engineering models used today are still a long way from any oncologic application as immediate postimplantation irradiation would decrease their osteoinductive potential. The aim of this study was to reconstruct a segmental critical size defect in a weight-bearing bone irradiated after implantation. Six white New Zealand rabbits were immediately implanted with a biomaterial associating resorbable collagen membrane EZ(R) filled and micro-macroporous biphasic calcium phosphate granules (MBCP+(R)). After a daily schedule of radiation delivery, and within 4 weeks, a total autologous bone marrow (BM) graft was injected percutaneously into the center of the implant. All the animals were sacrificed at 16 weeks. Successful osseous colonization was found to have bridged the entire length of the defects. Identical distribution of bone ingrowth and residual ceramics at the different levels of the implant suggests that the BM graft plays an osteoinductive role in the center of the defect. Periosteum-like formation was observed at the periphery, with the collagen membrane most likely playing a role. This model succeeded in bridging a large segmental defect in weight-bearing bone with immediate postimplantation fractionated radiation delivery. This has significant implications for the bone tissue engineering approach to patients with cancer-related bone defects.
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Messer RLW, Seta F, Mickalonis J, Brown Y, Lewis JB, Wataha JC. Corrosion of phosphate-enriched titanium oxide surface dental implants (TiUnite) under in vitro inflammatory and hyperglycemic conditions. J Biomed Mater Res B Appl Biomater 2009; 92:525-34. [PMID: 20024965 DOI: 10.1002/jbm.b.31548] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
Endosseous dental implants use is increasing in patients with systemic conditions that compromise wound healing. Manufacturers recently have redesigned implants to ensure more reliable and faster osseointegration. One design strategy has been to create a porous phosphate-enriched titanium oxide (TiUnite) surface to increase surface area and enhance interactions with bone. In the current study, the corrosion properties of TiUnite implants were studied in cultures of monocytic cells and solutions simulating inflammatory and hyperglycemic conditions. Furthermore, to investigate whether placement into bone causes enough mechanical damage to alter implant corrosion properties, the enhanced surface implants as well as machined titanium implants were placed into human cadaver mandibular bone, the bone removed, and the corrosion properties measured. Implant corrosion behavior was characterized by open circuit potentials, linear polarization resistance, and electrical impedance spectroscopy. In selected samples, THP1 cells were activated with lipopolysaccharide prior to implant exposure to simulate an inflammatory environment. No significant differences in corrosion potentials were measured between the TiUnite implants and the machined titanium implants in previous studies. TiUnite implants exhibited lower corrosion rates in all simulated conditions than observed in PBS, and EIS measurements revealed two time constants which shifted with protein-containing electrolytes. In addition, the TiUnite implants displayed a significantly lower corrosion rate than the machined titanium implants after placement into bone. The current study suggests that the corrosion risk of the enhanced oxide implant is lower than its machined surface titanium implant counterpart under simulated conditions of inflammation, elevated dextrose concentrations, and after implantation into bone.
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Affiliation(s)
- Regina L W Messer
- Department of Oral Biology, Medical College of Georgia, Augusta, Georgia, USA
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Cuesta-Gil M, Ochandiano Caicoya S, Riba-García F, Duarte Ruiz B, Navarro Cuéllar C, Navarro Vila C. Oral rehabilitation with osseointegrated implants in oncologic patients. J Oral Maxillofac Surg 2009; 67:2485-96. [PMID: 19837322 DOI: 10.1016/j.joms.2008.03.001] [Citation(s) in RCA: 55] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
PURPOSE The esthetic and functional rehabilitation of oncologic patients subjected to major resection surgery constitutes one of the greatest challenges for the head and neck surgeon. Immediate bone reconstruction with microsurgical free tissue transfer and dental implants has constituted a genuine revolution in the management of such patients. MATERIALS AND METHODS We present a series of 111 oncologic patients, involving a total of 706 implants, who underwent reconstruction with pedicled or free microsurgical flaps. RESULTS The osseointegration success rate was 92.9%, with a global failure rate (malpositioning or failed osseointegration or loading) of 15%. Failure particularly affected the group of irradiated patients and those subjected to lateral osseomyocutaneous trapezial pedicled flap reconstruction. Excellent results were obtained with the fibular and iliac crest free flaps and osseointegrated dental implants. CONCLUSIONS The difficulties of prosthetic rehabilitation are discussed, along with the individualized solutions applied, the repercussions on the temporomandibular joint, and the management protocol adopted by our service.
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Affiliation(s)
- Matías Cuesta-Gil
- Oral and Maxillofacial Department, Ciudad Real General, Ciudad Real, Spain
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Linsen SS, Martini M, Stark H. Long-term results of endosteal implants following radical oral cancer surgery with and without adjuvant radiation therapy. Clin Implant Dent Relat Res 2009; 14:250-8. [PMID: 19843104 DOI: 10.1111/j.1708-8208.2009.00248.x] [Citation(s) in RCA: 61] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
PURPOSE The aim of this study was to analyze the long-term survival of implants and implant-retained prostheses in patients after ablative surgery of oral cancer with or without adjunctive radiation therapy. MATERIALS AND METHODS Between 1997 and 2008, 66 patients who had undergone ablative tumor surgery in the oral cavity were treated with dental implants (n = 262). Thirty-four patients received radiation therapy in daily fractions of 2 Gy administered on 18 to 30 days. Implants were inserted in the maxilla (49; 18.7%) or mandible (213; 81.3%), in non-irradiated residual (65; 24.8%) or grafted bone (44; 16.8%) and in irradiated residual (15.6%) or grafted bone (39; 14.9%). Seventeen fixed protheses and 53 removable dentures (34 bar attachments, 9 telescopic and 10 ball retained dentures) were inserted. RESULTS Mean follow-up after implant insertion was 47.99 (±34.31) months (range 12-140 months). The overall 1-, 5-, and 10-year survival rates of all implants were 96.6%, 96.6%, and 86.9%, respectively. Fourteen implants were lost in nine patients (5.3% of all implants); eight implants were primary losses, and five secondary losses because of an operation of tumor recurrence. There was no significantly lower implant survival for implants inserted into irradiated bone (p = .302), bone and/or soft-tissue grafts (p = .436), and maxilla or mandible (p = .563). All prosthetic restorations in patients without tumor recurrence could be maintained during the observation period. CONCLUSIONS Implant survival is not significantly influenced by radiation therapy, grafts (bone and/or soft tissue), or location (maxilla or mandible). However, implants placed in irradiated bone exhibit a higher failure rate during the healing period than those placed in non-irradiated bone. No superstructure was particularly favorable. Osseointegrated implants can be used successfully in patients with prior history of ablative surgery with and without additional radiation therapy.
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Affiliation(s)
- Sabine S Linsen
- Department of Prosthodontics, Preclinical Education and Dental Materials Science, Rheinische Friedrich-Wilhelms University of Bonn, Bonn, Germany.
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Örtorp A. Three tumor patients with total maxillectomy rehabilitated with implant-supported frameworks and maxillary obturators: a follow-up report. Clin Implant Dent Relat Res 2009; 12:315-23. [PMID: 19438940 DOI: 10.1111/j.1708-8208.2009.00164.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND Few reports are available on treatment using implant-supported frameworks with maxillary obturators after total maxillectomy on tumor patients. PURPOSE To describe, evaluate, and report the clinical and radiographic performance of implant-supported frameworks and maxillary obturators after maxillectomy during the first years of function. MATERIALS AND METHODS Three patients with cancer in the maxillary region treated by total maxillectomy were rehabilitated. Seventeen dental and two craniofacial implants were installed, and the patients each received implant-supported, screw-retained, three-unit frameworks with a U-shaped bar and obturators retained by four magnetic attachments. Clinical and radiographic data were collected up to 7 years of follow-up. RESULTS The frequency of complications was low. Two craniofacial implants and one dental implant were loose and removed at abutment connection. No implants were lost after framework connection, and the mean marginal bone loss was small. CONCLUSION Within the limitations of this report, dental implants are useful for rehabilitation of total maxillectomy patients, and a three-unit, screw-retained, implant-supported framework with maxillary obturator retained by magnetic attachment is a successful treatment concept for this patient group.
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Affiliation(s)
- Anders Örtorp
- Department of Prosthetic Dentistry/Dental Materials Science, Institute of Odontology, The Sahlgrenska Academy, University of Gothenburg, Göteborg, Sweden.
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Messer RLW, Tackas G, Mickalonis J, Brown Y, Lewis JB, Wataha JC. Corrosion of machined titanium dental implants under inflammatory conditions. J Biomed Mater Res B Appl Biomater 2009; 88:474-81. [DOI: 10.1002/jbm.b.31162] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
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Adell R, Svensson B, Bågenholm T. Dental rehabilitation in 101 primarily reconstructed jaws after segmental resections – Possibilities and problems. An 18-year study. J Craniomaxillofac Surg 2008; 36:395-402. [DOI: 10.1016/j.jcms.2007.11.006] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2007] [Accepted: 11/02/2007] [Indexed: 10/22/2022] Open
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Goh BT, Lee S, Tideman H, Stoelinga PJ. Mandibular reconstruction in adults: a review. Int J Oral Maxillofac Surg 2008; 37:597-605. [DOI: 10.1016/j.ijom.2008.03.002] [Citation(s) in RCA: 198] [Impact Index Per Article: 12.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2007] [Revised: 02/12/2008] [Accepted: 03/03/2008] [Indexed: 11/29/2022]
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Smolka K, Kraehenbuehl M, Eggensperger N, Hallermann W, Thoren H, Iizuka T, Smolka W. Fibula free flap reconstruction of the mandible in cancer patients: Evaluation of a combined surgical and prosthodontic treatment concept. Oral Oncol 2008; 44:571-81. [DOI: 10.1016/j.oraloncology.2007.07.005] [Citation(s) in RCA: 112] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2007] [Revised: 07/26/2007] [Accepted: 07/27/2007] [Indexed: 11/29/2022]
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Nelson K, Heberer S, Glatzer C. Survival analysis and clinical evaluation of implant-retained prostheses in oral cancer resection patients over a mean follow-up period of 10 years. J Prosthet Dent 2008; 98:405-10. [PMID: 18021829 DOI: 10.1016/s0022-3913(07)60125-5] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
STATEMENT OF PROBLEM Dental implants have been increasingly used for prosthodontic rehabilitation of patients following oral tumor resection and postsurgical radiotherapy. However, only a few long-term studies have examined the implant survival rate and other factors related to prosthodontic treatment in oral tumor resection patients. PURPOSE The purpose of this study was to evaluate the long-term survival of dental implants and implant-retained prostheses in oral cancer resection patients. MATERIAL AND METHODS Ninety-three patients (63 men, 30 women) with a mean age of 59 years (range of 26-89 years) received 435 implants after the resection of a head and neck tumor. Twenty-nine patients received postsurgical radiotherapy prior to implant placement. The factors related to implant survival or failure were monitored over a mean observation period of 10.3 years (range of 5 to 161 months). Prosthodontic rehabilitation was evaluated with respect to the rates of technical failures and complications. Data were analyzed using a Kaplan-Meier curve and comparisons were made with the log-rank test or the Wilcoxon test (a=.05). RESULTS Of the 435 implants, 43 implants were lost; the cumulative survival rate was 92%, 84%, and 69% after 3.5, 8.5, and 13 years, respectively. Twenty-eight implants in 6 patients were counted as lost since the patients had died. Twenty-nine irradiated patients received 124 implants, of which 6 implants were lost prior to prosthodontic rehabilitation. In 68 patients with 78 rigid bar-retained dentures, only minor technical complications were identified. However, all 25 fixed implant-supported restorations had no technical component failures and did not require technical maintenance. CONCLUSIONS This study demonstrates that implant-retained and -supported prostheses in oral cancer resection patients, irrespective of the cancer treatment procedure, show lower long-term survival rates than those in patients without prior cancer surgery. Rigid fixation of the implant-supported prosthesis appears to minimize the complication rates. The poor implant survival rate was due to the higher mortality rate among these patients, and not to a lack of osseointegration.
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Affiliation(s)
- Katja Nelson
- Department of Oral and Maxillofacial Surgery, Charité Campus Virchow Clinic, Humboldt University, Augustenburger Platz 1, 13353 Berlin, Germany.
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Petrovic L, Schlegel KA, Wiltfang J, Neukam FW, Rupprecht S. Preclinical animal study and clinical trail of modified extraoral craniofacial implants. J Plast Reconstr Aesthet Surg 2007; 60:615-21. [PMID: 17392045 DOI: 10.1016/j.bjps.2005.12.067] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2005] [Revised: 10/21/2005] [Accepted: 12/07/2005] [Indexed: 11/23/2022]
Abstract
We report on our experience using a new endosseous implant designed to provide sufficient retention to various types of facial prostheses. In a preclinical animal experiment implants (N=12, 4 x 3.5 mm) were placed in the frontal calvarial region of nine adult pigs. The animals were sacrificed at 2, 4 and 8 weeks to evaluate the implant incorporation microradiographically. The clinical outcome and patient satisfaction of implant-retained prostheses were evaluated in a group of 10 patients with facial defects by using clinical assessment and standardized questionnaires for patients and relatives. In the prospective clinical study 33 identical modified implants for extraoral anchorage were placed for the fixation of various prostheses in the midfacial (eye, nose) and ear regions in the course of a clinical trial and observed over a follow-up period of 34 months. The bone-implant contact in the animal experiment reached 31% (+/-2) at 2 weeks, 39% (+/-1) after 4 weeks and 51% (+/-5) at 8 weeks. In the clinical trial, no implants were lost and all implants remained osseointegrated as confirmed clinically and radiographically, providing a stable prosthetic restoration. The analysis of the questionnaire indicates an improvement of the quality of life of patients with respect to aesthetic and psychological well-being. The results demonstrate that extraoral implants not only achieve sufficient osseointegration but also show good clinical handling and easy fixation possibilities for prosthetic anchorage.
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Affiliation(s)
- L Petrovic
- Department of Oral and Maxillofacial Surgery, Friedrich Alexander University, Glückstr 11, Erlangen-Nuremberg, Germany.
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Garrett N, Roumanas ED, Blackwell KE, Freymiller E, Abemayor E, Wong WK, Gerratt B, Berke G, Beumer J, Kapur KK. Efficacy of conventional and implant-supported mandibular resection prostheses: study overview and treatment outcomes. J Prosthet Dent 2006; 96:13-24. [PMID: 16872926 DOI: 10.1016/j.prosdent.2006.05.010] [Citation(s) in RCA: 74] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
STATEMENT OF PROBLEM While surgical restoration of mandibular resections has advanced dramatically with free-flap techniques, oral function and patient perceptions of function, as well as treatment outcomes, often indicate significant impairment. PURPOSE This longitudinal prospective study was designed to determine whether conventional prostheses (CP) or implant-supported prostheses (IP) and current surgical reconstructive procedures restore patients' oral functions and quality of life to their status prior to segmental mandibulectomy with immediate fibula free-flap reconstruction. Study design and implementation, characteristics of the study sample, treatment completion rates, and selected presurgical and postsurgical functional and perceptual outcomes are presented. MATERIAL AND METHODS Forty-six subjects were enrolled. Longitudinal evaluations of medical and dental histories, oromaxillofacial examinations, questionnaires, and sensory and functional tests were planned before and after surgery and after CP and IP treatment. Sample characteristics are described with descriptive statistics and comparisons of subject responses to questionnaire items at entry and postsurgical intervals were made with Fisher exact tests (alpha=.05). RESULTS Conventional prostheses were completed in 33 of 46 subjects, and 16 of 33 CP subjects were treated with IP. Reasons for noncompletion of IP were recurrent/metastatic disease (16), refusal of implant therapy (7), lost to follow-up (4), treatment with a reconstruction plate (1), excessive radiation at implant sites (1), and death (1). All 16 recurrences/metastases occurred within 13 months of surgery. Only 3 of the 58 implants placed in 17 participants were considered failures. One failed due to lack of integration 31 weeks following placement, and 2 were buried due to unacceptable positioning for prosthetic restoration during denture fabrication. The remaining 55 implants were successful at final evaluation, ranging from 58 to 123 weeks following implant placement (mean duration=78.9 +/- 16.0 weeks). CONCLUSIONS While 72% (33/46) of the subjects enrolled were able and willing to complete treatment with CP, only 35% (16/46) completed IP treatment. Careful consideration must be given to selection of the type of prosthetic rehabilitation and the timing of implant placement if an IP is planned.
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Affiliation(s)
- Neal Garrett
- Division of Advanced Prosthodontics, Biomaterials and Hospital Dentistry, UCLA School of Dentistry, University of California-Los Angeles, 10833 Le Conte Avenue, Los Angeles, CA 90095, USA.
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Hallermann W, Olsen S, Bardyn T, Taghizadeh F, Banic A, Iizuka T. A New Method for Computer-Aided Operation Planning for Extensive Mandibular Reconstruction. Plast Reconstr Surg 2006; 117:2431-7. [PMID: 16772952 DOI: 10.1097/01.prs.0000219076.83890.e8] [Citation(s) in RCA: 78] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- Wock Hallermann
- Department of Craniomaxillofacial Surgery, University Hospital of Berne, Inselspital, Switzerland
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Affiliation(s)
- Gösta Granström
- Department of Otolaryngology, Head and Neck Surgery, Göteborg University, Gothenburg, Sweden.
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Shaw RJ, Sutton AF, Cawood JI, Howell RA, Lowe D, Brown JS, Rogers SN, Vaughan ED. Oral rehabilitation after treatment for head and neck malignancy. Head Neck 2005; 27:459-70. [PMID: 15880417 DOI: 10.1002/hed.20176] [Citation(s) in RCA: 102] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Advances in the management of oral malignancy have resulted in significant improvements in survival and functional outcome. Ablation of oral tissues and radiotherapy render many patients unable to wear conventional prostheses, and these patients are, thus, candidates for oral rehabilitation with osseointegrated implants. We aim to present outcomes and complications of such treatment over a 14-year period in a single unit. METHODS Data were collected for 81 consecutive patients, most of whom had received microvascular free flap reconstruction after surgical ablation of oral squamous cell carcinoma. Three hundred eighty-six implants were placed after a delay of 12 months after surgery. Sixty-five percent of implants were placed in the anterior mandible. Radiotherapy was used in 47% of the patients, and hyperbaric oxygen treatment was routinely used in irradiated subjects during the latter half of the series. Retrospective analysis of implants and prostheses was made by use of case notes, radiographs, and a computerized database. RESULTS Data are presented for 364 of the 386 implants in 77 of the 81 patients after a median follow-up of 4 years. Two hundred sixty-five (73%) of the implants were in function supporting prostheses, 56 (15%) had been lost, and 43 (12%) were present but not loaded (ie, "sleepers"). Implant loss seemed patient specific and was also correlated with host bone type. Thirteen percent of patients in whom implants were placed in the mandible lost at least one implant, and the equivalent values for the maxilla was 40%. Thirty-six percent of patients in whom implants were placed in bone graft or flap lost at least one implant. The effects of implant manufacture, dimensions, radiotherapy, and hyperbaric oxygen did not reach statistical significance in this series. Cases of a second primary malignancy were noteworthy; however, the impact of recurrence was minimized by the delay between resection and rehabilitation. Of the 42 fixed and 29 removable prostheses fitted, 12 (17%) failed. CONCLUSIONS Implants placed in mandible were reliable, but failure rates in vascularized bone graft and maxilla were higher. Radiotherapy did not seem to prejudice implant survival, and hyperbaric oxygen had no demonstrable benefit in this series. Despite some persistent soft tissue problems and implant loss, most patients reached a successful prosthetic and functional outcome.
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Affiliation(s)
- Richard J Shaw
- Regional Maxillofacial Unit, University Hospital Aintree, Lower Lane, Aintree, Liverpool, United Kingdom, L9 7AL.
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Sjöström M, Lundgren S, Nilson H, Sennerby L. Monitoring of implant stability in grafted bone using resonance frequency analysis. A clinical study from implant placement to 6 months of loading. Int J Oral Maxillofac Surg 2005; 34:45-51. [PMID: 15617966 DOI: 10.1016/j.ijom.2004.03.007] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/29/2004] [Indexed: 11/19/2022]
Abstract
The aim of this prospective study was to compare implants placed in grafted and normal non-grafted maxilla by means of resonance frequency analysis (RFA), clinical stability and implant failure. Twenty-nine patients with severe atrophy of the edentulous maxilla were treated with autogenous bone grafts as onlay (24 patients) or as interpositional grafts in conjunction with a Le Fort I osteotomy (five patients) 6 months prior to placement of 222 implants. Ten non-grafted patients treated with 75 Brånemark implants in the edentulous maxillae served as a control group. RFA was performed at implant placement, abutment connection and after 6 months of bridge loading. Seventeen (8%) implants were lost in the grafted bone and one (1%) in normal bone. RFA revealed a similar pattern in both grafted and normal maxillae, i.e. increasing resonance frequency (RF) with time (Wilcoxon Signed Rank test for paired data). Twenty implants that were rotation mobile (low primary stability) at the time of insertion showed a significantly lower value at implant placement according to RFA (Mann-Whitney U-test, P = 0.020). The RF for the failed implants revealed a tendency towards lower values (Mann-Whitney U-test, P = 0.072), compared to the successful implants. It is concluded that implants placed in grafted bone when using a two-stage technique achieve a stability similar to that of implants placed in normal non-grafted bone.
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Affiliation(s)
- M Sjöström
- Department of Oral and Maxillofacial Surgery, Umeå University, SE 901 78 Umeå, Sweden.
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Rogers SN, Panasar J, Pritchard K, Lowe D, Howell R, Cawood JI. Survey of oral rehabilitation in a consecutive series of 130 patients treated by primary resection for oral and oropharyngeal squamous cell carcinoma. Br J Oral Maxillofac Surg 2005; 43:23-30. [PMID: 15620770 DOI: 10.1016/j.bjoms.2004.08.020] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/20/2004] [Indexed: 11/20/2022]
Abstract
The purpose of this study was to investigate the use of oral rehabilitation in a group of patients who had primary resection of oral and oropharyngeal squamous cell carcinoma. Of 132 consecutive patients operated on for previously untreated disease between January 1995 and June 1997, 130 were recruited. The University of Washington Quality of Life questionnaire was completed on the day before operation at 6 and 12 months, and at last review. A larger similar dataset was used to predict survival. Twenty-eight patients (22%) were seen by the oral rehabilitation team. The median (IQR) time from operation to start of treatment was 12 months (6-21). The median (IQR) time from beginning to end of rehabilitation was 14 months (5-49). Patients with larger tumours (P=0.06) and patients who were edentulous with dentures in the maxilla (P=0.07) were most likely to be seen for oral rehabilitation.
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Affiliation(s)
- S N Rogers
- Regional Maxillofacial Unit, University Hospital Aintree, Aintree Trust, Liverpool L9 1AL, UK.
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