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Yusa K, Ishikawa S, Suzuki N, Kunii S, Okuyama N, Hemmi T, Iino M. Clinical evaluation of bone quality of particulate cancellous bone and marrow, and implant prosthetic rehabilitation. JOURNAL OF STOMATOLOGY, ORAL AND MAXILLOFACIAL SURGERY 2024:101862. [PMID: 38561138 DOI: 10.1016/j.jormas.2024.101862] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/28/2023] [Accepted: 03/29/2024] [Indexed: 04/04/2024]
Abstract
This study aimed to subjectively evaluate bone quality in the particulate cancellous bone and marrow (PCBM) graft area and to assess the survival rates of implants. A retrospective review was conducted based on patient age, sex, diagnosis, reconstructed site, number of implants, prosthetic type, and duration of follow-up. Images from computed tomography (CT) before implant insertion were obtained and used in this study. We selected a 4.0-mm diameter × 8.0-mm length region of interest in the implant placement area, and measured the CT attenuation value. No significant correlations were seen between CT attenuation values and implant survival rates in the maxilla and mandible. On the other hand, CT attenuation values and implant survival rates were significantly lower in patients with malignancy than in non-malignant cases. Placing implants in PCBM grafted bone requires a full understanding of bone quality before surgery and drilling to ensure primary stability, along with consideration of soft tissue management and maintenance programs.
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Affiliation(s)
- Kazuyuki Yusa
- Department of Dentistry, Oral and Maxillofacial-Plastic and Reconstructive Surgery Faculty of Medicine, Yamagata University, Yamagata, Japan.
| | - Shigeo Ishikawa
- Department of Dentistry, Oral and Maxillofacial-Plastic and Reconstructive Surgery Faculty of Medicine, Yamagata University, Yamagata, Japan
| | - Nagiko Suzuki
- Department of Dentistry, Oral and Maxillofacial-Plastic and Reconstructive Surgery Faculty of Medicine, Yamagata University, Yamagata, Japan
| | - Shunsuke Kunii
- Department of Dentistry and Oral Surgery, Okitama Public General Hospital, Yamagata, Japan
| | - Naoki Okuyama
- Department of Dentistry, Oral and Maxillofacial-Plastic and Reconstructive Surgery Faculty of Medicine, Yamagata University, Yamagata, Japan
| | - Tomoharu Hemmi
- Department of Dentistry, Oral and Maxillofacial-Plastic and Reconstructive Surgery Faculty of Medicine, Yamagata University, Yamagata, Japan
| | - Mitsuyoshi Iino
- Department of Dentistry, Oral and Maxillofacial-Plastic and Reconstructive Surgery Faculty of Medicine, Yamagata University, Yamagata, Japan
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Li R, Meng Z, Zhang Y, Xu M, He Y. Digitally designed stent-assisted soft-tissue management after jaw reconstruction: a prospective cohort study. Clin Oral Investig 2024; 28:93. [PMID: 38217671 DOI: 10.1007/s00784-024-05502-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2023] [Accepted: 01/08/2024] [Indexed: 01/15/2024]
Abstract
OBJECTIVES A digitally designed stent was invented to assist vestibuloplasty and free gingival graft (FGG) after jaw reconstruction. This study aimed to compare the effects of conventional soft-tissue management comprising vestibuloplasty combined with FGG and modified soft-tissue management using a digitally designed stent on the vestibular sulcus depth (VD), keratinised-tissue width (KTW) and peri-implant tissue health in patients undergoing jaw reconstruction. MATERIALS AND METHODS This prospective cohort study enrolled patients who underwent jaw reconstruction using a fibular flap, iliac flap, or onlay bone graft followed by implant-supported rehabilitation at the Peking University School and Hospital of Stomatology between May 2019 and July 2022. Patients in the stent group received digitally designed stents following vestibuloplasty combined with FGG for peri-implant soft-tissue management. Patients in the control group underwent a conventional vestibuloplasty combined with FGG. VD and KTW were evaluated immediately after implant loading (T2) and 1 year after implant loading (T3), and the atrophy rates of VD and KTW were calculated. Peri-implant clinical parameters were evaluated at T3. Comparisons between the groups were performed using the Mann-Whitney U test. The effects of age, sex, primary disease, reconstruction type, reconstructed jaw and the number and location of implants on VD and KTW were evaluated using linear regression analysis. RESULTS There were no significant differences in the atrophy rates of VD and KTW between the stent and control groups at T2 and T3 (both P ≥ 0.05). There were no significant differences in peri-implant clinical parameters between the stent and control groups at T3 (P ≥ 0.05). Reconstruction type, location of implants and primary disease influenced VD, and reconstruction type and age influenced KTW. CONCLUSIONS There was no significant difference in the maintenance of VD and KTW after jaw reconstruction between soft-tissue management using a digitally designed stent and the conventional method. Further, digitally designed stents do not affect peri-implant tissue health. CLINICAL RELEVANCE Digitally designed stents can simplify clinical procedures without adverse effects on peri-implant tissue health, but they do not promote keratinized mucosa augmentation and vestibuloplasty.
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Affiliation(s)
- Ruiliu Li
- Department of Oral and Maxillofacial Surgery, Peking University School and Hospital of Stomatology, Beijing, China
| | - Zhaoqiang Meng
- Special Dental Care Clinic, Peking University School and Hospital of Stomatology, Beijing, China
| | - Yi Zhang
- Department of Oral and Maxillofacial Surgery, Peking University School and Hospital of Stomatology, Beijing, China
| | - Mingming Xu
- Special Dental Care Clinic, Peking University School and Hospital of Stomatology, Beijing, China
| | - Yang He
- Department of Oral and Maxillofacial Surgery, Peking University School and Hospital of Stomatology, Beijing, China.
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Bouzid L, Lescaille G, Pomes B, Friedlander L. Implant retained prosthesis on a free fibula flap: A challenging procedure for prosthetic and soft tissue management. J Prosthet Dent 2023:S0022-3913(23)00480-8. [PMID: 37643940 DOI: 10.1016/j.prosdent.2023.06.035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2023] [Revised: 06/14/2023] [Accepted: 06/16/2023] [Indexed: 08/31/2023]
Abstract
A 39-year-old woman who had undergone fibular flap reconstruction and simultaneous implant placement after the surgical removal of a cemento-ossifying fibroma was experiencing mild discomfort 3 years later and requested an implant-supported prosthesis to restore her edentulous left maxillary quadrant. Initially, an interim removable partial denture was provided and later duplicated with clear resin. The interim prosthesis identified the excessive thickness of the grafted cutaneous soft tissue and the inadequate emergence angle of the nonfunctioning implants. By using the interim prosthesis as a surgical guide, vestibuloplasty was performed to thin the peri-implant soft tissue and the excessive skin graft from the initial maxillofacial surgery. Concurrently, the emergence angle of the implant was corrected with angled multi-unit abutments. A tissue compression stent was then made and attached to the abutments to guide the soft tissue healing process. When the peri-implant soft tissue had stabilized, a definitive implant-supported prosthesis was provided.
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Affiliation(s)
- Linda Bouzid
- Postgraduate student, Rare Oral and Dental Competence Center, Pitié-Salpêtrière Hospital APHP, Paris, France.
| | - Géraldine Lescaille
- Department Head, Inserm U_1135, Center of Immunology and Infectious Diseases, Paris, France; Professor, Faculty of Odontology, Université Paris Cité, Paris, France
| | - Benjamin Pomes
- Department Head, Maxillofacial Prosthodontic Department, Rare Oral and Dental Competence Center, Pitié-Salpêtrière Hospital APHP, Paris, France; Post-doctoral student, Laboratory PIMM, Arts et Métiers, ParisTech, UMR_8006, Paris, France
| | - Lisa Friedlander
- Associate Professor, TETECOU Rare Diseases Health Network, Rare Malformations of the Head, Neck and Teeth, Necker Hospital, Paris, France; Researcher, Laboratory of Epidemiology and Health Economic Evaluation in Vulnerable Patients, Paris, France
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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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Analysis of Factors Determining Patient Survival after Receiving Free-Flap Reconstruction at a Single Center-A Retrospective Cohort Study. Diagnostics (Basel) 2022; 12:diagnostics12112877. [PMID: 36428937 PMCID: PMC9689428 DOI: 10.3390/diagnostics12112877] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2022] [Revised: 11/04/2022] [Accepted: 11/18/2022] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Microsurgical tissue transfer revolutionized reconstructive surgery after extensive trauma, oncological resections, and severe infections. Complex soft tissue reconstructions are increasingly performed in multimorbid and elderly patients. Therefore, it is crucial to investigate whether these patients benefit from these complex procedures. OBJECTIVE To evaluate the outcome for multimorbid patients who underwent microsurgical soft tissue reconstruction and to identify potential risk factors that may increase mortality. METHODS This single-center study retrospectively analyzed prospectively collected data of patients receiving free gracilis (GM) or latissimus dorsi muscle (LDM) flap reconstruction between September 2017 and December 2021. Cases were divided into two groups (dead vs. alive), depending on patient survival. Patient demographics, comorbidities and medication, perioperative details, free flap outcome, as well as microcirculation were determined. RESULTS A total of 151 flaps (LDM, n = 67; GM, n = 84) performed in 147 patients with a mean age of 61.15 ± 17.5 (range 19-94) years were included. A total of 33 patients (22.45%) passed away during the study period. Deceased patients were significantly older (Alive: 58.28 ± 17.91 vs. Dead: 71.39 ± 11.13; p = 0.001), were hospitalized significantly longer (Alive: 29.66 ± 26.97 vs. Dead: 36.88 ± 15.04 days; p = 0.046) and suffered from cardiovascular (Alive: 36.40% vs. Dead: 66.70%; p = 0.002) and metabolic diseases (Alive: 33.90% vs. Dead: 54.50%; p = 0.031) more frequently, which corresponded to a significantly higher ASA Score (p = 0.004). Revision rates (Alive: 11.00% vs. Dead: 18.20%; p = 0.371) and flap loss (Alive: 3.39% vs. Dead: 12.12%; p = 0.069) were higher in patients that died by the end of the study period. CONCLUSIONS Free flap transfer is safe and effective, even in multimorbid patients. However, patient age, comorbidities, preoperative ASA status, and medication significantly impact postoperative patient survival in the short- and mid-term and must, therefore, be taken into account in preoperative decision-making and informed consent.
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Kihara T, Ikawa T, Shigeta Y, Shigemoto S, Ando E, Hirai S, Harada N, Kawamura N, Nakaoka K, Hamada Y, Ogawa T. Fabrication of mucocompressive splints for free gingival grafts via medical engineering in patients with reconstructed mandibles. J Prosthodont Res 2022; 66:646-650. [DOI: 10.2186/jpr.jpr_d_21_00160] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Takuya Kihara
- Department of Fixed Prosthodontics, School of Dental Medicine, Tsurumi University, Kanagawa, Japan
| | - Tomoko Ikawa
- Department of Fixed Prosthodontics, School of Dental Medicine, Tsurumi University, Kanagawa, Japan
| | - Yuko Shigeta
- Department of Fixed Prosthodontics, School of Dental Medicine, Tsurumi University, Kanagawa, Japan
| | - Shuji Shigemoto
- Department of Fixed Prosthodontics, School of Dental Medicine, Tsurumi University, Kanagawa, Japan
| | - Eriko Ando
- Department of Fixed Prosthodontics, School of Dental Medicine, Tsurumi University, Kanagawa, Japan
| | - Shinya Hirai
- Department of Fixed Prosthodontics, School of Dental Medicine, Tsurumi University, Kanagawa, Japan
| | - Naohiko Harada
- Dental Technician Training Institute, School of Dental Medicine, Tsurumi University, Kanagawa, Japan
| | - Noboru Kawamura
- Department of Fixed Prosthodontics, School of Dental Medicine, Tsurumi University, Kanagawa, Japan
| | - Kazutoshi Nakaoka
- Department of Oral and Maxillofacial Surgery, School of Dental Medicine, Tsurumi University, Kanagawa, Japan
| | - Yoshiki Hamada
- Department of Oral and Maxillofacial Surgery, School of Dental Medicine, Tsurumi University, Kanagawa, Japan
| | - Takumi Ogawa
- Department of Fixed Prosthodontics, School of Dental Medicine, Tsurumi University, Kanagawa, Japan
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Shan X, Han D, Ge Y, Zhang H, Lu R. Clinical outcomes of keratinized mucosa augmentation in jaws reconstructed with fibula or iliac bone flaps. Int J Oral Maxillofac Surg 2021; 51:949-956. [PMID: 34924272 DOI: 10.1016/j.ijom.2021.11.013] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2021] [Revised: 08/25/2021] [Accepted: 11/23/2021] [Indexed: 10/19/2022]
Abstract
This prospective study was undertaken to evaluate the treatment outcomes of keratinized mucosa augmentation (KMA) on the buccal and palatal/lingual sides of implants in jaws reconstructed after oncological surgery. Forty-two implants in 12 patients whose jaws had been reconstructed with a fibula or iliac bone flap were included. KMA was performed at 3 months after implant placement; this included an apically displaced partial-thickness flap and a free gingival graft (FGG) around the implants to increase the keratinized mucosa width (KMW). Patients were followed up for at least 6 months post-surgery. KMW, shrinkage, and patient pain and discomfort measured on a visual analogue scale were analysed. A histological analysis was performed of tissue epithelium from two patients. The results showed that KMW was >2 mm on both the buccal and palatal/lingual sides during follow-up. Before surgery, histological analysis showed epithelium with no epithelial spikes; normal keratinized epithelial spikes were observed at 8 weeks after KMA. Greater KMW was observed around implants in reconstructed maxillae than around those in reconstructed mandibles (P < 0.001). Patients felt more pain at the donor site than at the recipient site during the first 3 days post-surgery. KMA with FGG was predictable in reconstructed jaws and may help maintain the long-term stability of implants.
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Affiliation(s)
- X Shan
- Department of Oral and Maxillofacial Surgery, Peking University School and Hospital of Stomatology, National Clinical Research Centre for Oral Diseases and National Engineering Laboratory for Digital and Material Technology of Stomatology and Beijing Key Laboratory of Digital Stomatology, Beijing, PR China
| | - D Han
- Department of Prosthodontics, Peking University School and Hospital of Stomatology, Beijing, PR China
| | - Y Ge
- Department of Prosthodontics, Peking University School and Hospital of Stomatology, Beijing, PR China
| | - H Zhang
- Department of Periodontology, Peking University School and Hospital of Stomatology, Beijing, PR China
| | - R Lu
- Department of Periodontology, Peking University School and Hospital of Stomatology, Beijing, PR China.
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