Autologous Ilium Grafts: Long-Term Results on Immediate or Staged Functional Rehabilitation of Mandibular Segmental Defects Using Dental Implants after Tumor Resection

Survival rate and complication-free survival rate of implant-retained prostheses in the oral rehabilitation of patients with head and neck cancer: A retrospective evaluation of a cohort from a regional service

STATEMENT OF PROBLEM

Literature reporting on the prosthetic survival and complications of implant-retained prostheses in patients with head and neck cancer is sparse.

PURPOSE

The purpose of this retrospective study was to present the survival rates and complication-free survival rates of both fixed and removable implant-retained oral prostheses in patients with head and neck cancer while also reporting on the frequency and causes of failure and complications for each prosthesis type.

MATERIAL AND METHODS

A retrospective analysis of the prosthetic survival rates and complication-free survival rates of implant-retained oral prostheses and the frequency and causes of failure and complications in patients with head and neck cancer treated in a regional unit from 2012 to 2017 was performed. Differences in categorical and continuous data were assessed for statistical significance by using the Pearson chi-squared test, Fisher exact test, t test, and analysis of variance as appropriate. Cox proportional hazard regression models were fitted to evaluate the association between prostheses type, clinical and medical factors, and the outcomes of survival and complication-free survival. Descriptive statistics were used to analyze the frequency and type of prosthetic complications.

RESULTS

The sample was composed of 153 patients diagnosed with head and neck cancer who had completed implant-retained prosthodontic rehabilitation and had been provided with 221 prostheses. The 5-year survival rate was 87% for maxillary fixed prostheses, 79% for mandibular fixed, 66% for maxillary removable, and 50% for mandibular removable. Hazard ratios were calculated showing that the 5-year survival rate of a mandibular removable prosthesis (HR=5.1; 95% CI 1.60-16.25) (P=.006) was greater than that of a maxillary fixed prosthesis (HR=1.0). The 5-year complication-free survival rate was highest for mandibular fixed prostheses (62%), followed by maxillary fixed (58%), maxillary removable (36%), and mandibular removable prostheses (29%). Hazard ratios showed that the 5-year survival rate of maxillary removable (HR=1.91; 95% CI 1.01-3.66) (P=.048) and mandibular removable prosthesis (HR=2.29; 95% CI 1.23-4.25) (P=.009) was greater than that of a maxillary fixed prosthesis (HR=1.0). Variables of radiotherapy, grafting, age, and sex and their influence on the survival rate and complication-free survival rate were assessed but were not statistically significant.

CONCLUSIONS

This evaluation indicated that fixed implant-retained prostheses had a higher 5-year survival rate and 5-year complication-free survival rate than removable implant-retained prostheses in patients with head and neck cancer.

Use of Plant Extracts in Polymeric Scaffolds in the Regeneration of Mandibular Injuries

Severe loss of bone mass may require grafting, and, among the alternatives available, there are natural biomaterials that can act as scaffolds for the cell growth necessary for tissue regeneration. Collagen and elastin polymers are a good alternative due to their biomimetic properties of bone tissue, and their characteristics can be improved with the addition of polysaccharides such as chitosan and bioactive compounds such as jatoba resin and pomegranate extract due to their antigenic actions. The aim of this experimental protocol was to evaluate bone neoformation in experimentally made defects in the mandible of rats using polymeric scaffolds with plant extracts added. Thirty rats were divided into group 1, with a mandibular defect filled with a clot from the lesion and no graft implant (G1-C, n = 10); group 2, filled with collagen/chitosan/jatoba resin scaffolds (G2-CCJ, n = 10); and group 3, with collagen/nanohydroxyapatite/elastin/pomegranate extract scaffolds (G3-CHER, n = 10). Six weeks after surgery, the animals were euthanized and samples from the surgical areas were submitted to macroscopic, radiological, histological, and morphometric analysis of the mandibular lesion repair process. The results showed no inflammatory infiltrates in the surgical area, indicating good acceptance of the scaffolds in the microenvironment of the host area. In the control group (G1), there was a predominance of reactive connective tissue, while in the grafted groups (G2 and G3), there was bone formation from the margins of the lesion, but it was still insufficient for total bone repair of the defect within the experimental period standardized in this study. The histomorphometric analysis showed that the mean percentage of bone volume formed in the surgical area of groups G1, G2, and G3 was 17.17 ± 2.68, 27.45 ± 1.65, and 34.07 ± 0.64 (mean ± standard deviation), respectively. It can be concluded that these scaffolds with plant extracts added can be a viable alternative for bone repair, as they are easily manipulated, have a low production cost, and stimulate the formation of new bone by osteoconduction.

Maxillary bone augmentation with calvarial bone graft for immediate full-arch rehabilitation: Insights from a 10-year proof-of-concept retrospective analysis

OBJECTIVE

Evaluate the long-term outcomes of full-arch rehabilitation using immediate dental implant placement and continuous functional loading with full-fixed dental prostheses (FFDPs).

MATERIALS AND METHODS

Fifty-six patients received temporary implants (n = 327) at maxillary augmentation with calvarial bone. A provisional acrylic FFDP was immediately loaded onto these implants. After 6 months, the temporary implants were replaced with definitive implants (n = 326) and immediately loaded with a second provisional FFDP (N = 55). Subsequently, a baseline radiograph was taken following a 6-month healing period. The second bridge was then substituted with a definitive FFDP. Primary outcomes included peri-implant marginal bone level (MBL) and definitive implant survival. Secondary outcomes evaluated provisional implant and prostheses survival, complications, and patient satisfaction.

RESULTS

The provisional implants had a survival rate of 97.9%. One patient was excluded from further analysis due to loss of temporary implants and first FFDP. The definitive implant survival rate after 10 years was 92.2%, with a moderate but significant decrease in MBL between baseline radiography and 10 years later (-0.08 ± 0.18 vs. -0.24 ± 0.44). However, large individual variations were observed, with 65.8% of implants showing no bone loss and 9.2% showing loss ≥0.5 mm. Sinusitis was experienced by 14.3% of patients upon surgery. Patient satisfaction was high or reported no issues after protocol completion (80%). One patient lost all six definitive implants and definitive FFDP 8.2 years after implant placement.

CONCLUSIONS

The described protocol can be regarded as a long-term, highly successful method for full-arch rehabilitation of atrophied maxillae while enabling continuous masticatory and speaking functionality.

Planning of physiotherapeutic procedure in patients after mandible reconstruction taking into account donor site: a literature review

BACKGROUND

Mandible tumors are very rare. One of the main methods of the treatments is resection of the tumor and then reconstruction of the mandible. The donor site is often distant tissue-fibula or ilium. Following this, it is necessary to improve the patient in two ways, on one hand restoring the function of the mandible, and on the other hand, improving the donor site area. For that reason, physiotherapy after tumor resection and reconstruction of the mandible is very complicated. The aim of this bibliographic review was to find the methods of the reconstruction of the mandible in the context of patients' functional assessment after surgeries to create effective physiotherapeutic procedures in the feature.

METHODS

PEDro, Medline (PubMed), Cochrane Clinical Trials were searched.

RESULTS

767 articles were found. 40 articles were included to this literature review.

CONCLUSIONS

Authors showed different kinds of surgeries strategy for patients with tumors of the mandible. They also showed manners of patients' functional assessment in the localization of transplantation and donor site. It could be useful for physiotherapists during planning of comprehensive physiotherapy.

Implant retained prosthesis on a free fibula flap: A challenging procedure for prosthetic and soft tissue management

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.

Survival Rates of Dental Implants in Autogenous and Allogeneic Bone Blocks: A Systematic Review

Background and Objectives: Preliminary studies emphasize the similar performance of autogenous bone blocks (AUBBs) and allogeneic bone blocks (ALBBs) in pre-implant surgery; however, most of these studies include limited subjects or hold a low level of evidence. The purpose of this review is to test the hypothesis of indifferent implant survival rates (ISRs) in AUBB and ALBB and determine the impact of various material-, surgery- and patient-related confounders and predictors. Materials and Methods: The national library of medicine (MEDLINE), Excerpta Medica database (EMBASE) and Cochrane Central Register of Controlled Trials (CENTRAL) were screened for studies reporting the ISRs of implants placed in AUBB and ALBB with ≥10 participants followed for ≥12 months from January 1995 to November 2021. The review was conducted in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. The risk of bias was assessed via several scoring tools, dependent on the study design. Means of sub-entities were presented as violin plots. Results: An electronic data search resulted in the identification of 9233 articles, of which 100 were included in the quantitative analysis. No significant difference (p = 0.54) was found between the ISR of AUBB (96.23 ± 5.27%; range: 75% to 100%; 2195 subjects, 6861 implants) and that of ALBB (97.66 ± 2.68%; range: 90.1% to 100%; 1202 subjects, 3434 implants). The ISR in AUBB was increased in blocks from intraoral as compared to extraoral donor sites (p = 0.0003), partially edentulous as compared to totally edentulous (p = 0.0002), as well as in patients younger than 45 as compared to those older (p = 0.044), cortical as compared to cortico-cancellous blocks (p = 0.005) and in delayed implantations within three months as compared to immediate implantations (p = 0.018). The ISR of ALBB was significantly increased in processed as compared to fresh-frozen ALBB (p = 0.004), but also in horizontal as compared to vertical augmentations (p = 0.009). Conclusions: The present findings widely emphasize the feasibility of achieving similar ISRs with AUBB and ALBB applied for pre-implant bone grafting. ISRs were negatively affected in sub-entities linked to more extensive augmentation procedures such as bone donor site and dentition status. The inclusion and pooling of literature with a low level of evidence, the absence of randomized controlled clinical trials (RCTs) comparing AUBB and ALBB and the limited count of comparative studies with short follow-ups increases the risk of bias and complicates data interpretation. Consequently, further long-term comparative studies are needed.

Comparing success of immediate versus delay loading of implants in fresh sockets: a systematic review and meta-analysis

BACKGROUND AND AIMS

The replacement of teeth with osseointegrated implants is one of the significant advances in the field of restorative dentistry. The time interval between tooth extraction and the implant can be very short or long. This systematic review and meta-analysis aimed to collect and evaluate articles related to determining the effect of instant loading of dental implants are placed in the fresh socket initial stability on the clinical success of the implant compared to delay loading dental implants.

MATERIALS AND METHODS

In this study, all the available articles indexed in leading databases, including PubMed, ISI Web of Science, Embase, PsycINFO, PROSPERO, and Scopus, were searched. The full text of the articles meeting the primary criteria to be included in this research was obtained and appraised. Data of studies were extracted if they were scored as a high or moderate level of evidence.

RESULTS

A total of 2258 published articles were found through electronic database searching. After screening the titles and abstracts, and full text of articles, 16 studies met the inclusion criteria and were included in the analysis. The results of this study revealed that regarding the success rate, although there was no significant difference between immediate and delayed of dental implants, immediate procedure showed a lower incidence of bone loss in single implants.

CONCLUSION

Based on the results of this study, immediate loading of dental implant, under certain conditions, is a successful treatment process and is effective in reducing treatment time. Thus, immediate loading represents a valid alternative to the traditional delayed loading rehabilitation.

Mandibular Reconstruction With Block Iliac Crest: An Institutional Experience

STUDY DESIGN

Mandibular reconstruction is a challenge. Several reconstructive techniques are available, and the individualization of choice for each patient leads to better results and quality of life for the individual.

OBJECTIVE

The aim of this study is to evaluate the characteristics and complications of cases submitted to mandibular reconstruction with autogenous bone graft block of the iliac crest.

METHODS

Records of 45 patients undergoing mandibular reconstruction with autogenous bone graft block of the iliac crest were analyzed from January 2000 to December 2014. The data collected included age, gender, etiology and graft size, surgical approach, complications, comorbidities, and habits and addictions. Analysis of variance, chi-square test, and Fisher exact test were used for analysis of the variables with a significance level of P < .05.

RESULTS

The success rate of the 45 charts analyzed was 75.6%. No statistical differences were found between age and presence of complications, between defect size and presence or absence of complications, and between type of surgical approach and presence or absence of complications.

CONCLUSION

According to our study, medical history may influence postoperative complications and require attention, though further studies should be performed to further elucidate the relationship between diseases and postoperative complications.

A Comparison of Immediate and Delayed Dental Implant Placement in Head and Neck Surgery Patients

PURPOSE

Implant-supported dental prostheses offer numerous benefits for patients after ablative procedures of the head and neck region, including restoration of function, improved self-esteem and body satisfaction, and overall quality of life. Increased experience is emerging with immediate placement of implants at the time of ablative surgery compared with the traditional delayed approach. The authors sought to identify variables affecting survival of osseointegrated dental implants in such patients and to assess the impact of timing of implant insertion (immediate vs delayed) on the time until final prosthesis insertion.

MATERIALS AND METHODS

Implant survival was assessed based on different factors: immediate versus delayed implants, benign versus malignant disease, postoperative radiotherapy, smoking status, alcohol status, age, 1- versus 2-stage surgery, hyperbaric oxygen therapy, and implant placement into native bone versus into osseous free flap reconstruction. Time to final prosthesis insertion was compared between immediate and delayed implant placement.

RESULTS

The study included 20 patients who received a total of 102 implants (39 immediate, 63 delayed). There were 7 failed implants (overall survival, 93.14%). There was no statistically relevant difference in implant survival between any of the groups assessed. However, there was a significant decrease in time to final prosthesis insertion for those patients receiving immediate implants compared with those who underwent delayed implant placement (321 days; standard error, 46.5 vs 726 days; standard error, 45 days; P < .0001).

CONCLUSIONS

Immediate implant placement is an effective approach to the prosthetic rehabilitation of patients undergoing ablative procedures of the jaws, which shortens time to final prosthesis placement without adversely affecting overall implant survival.

Survival of dental implants placed in autogenous bone grafts and bone flaps in head and neck oncology patients: a systematic review

Using implants to retain prostheses as part of the oral rehabilitation of head and neck cancer patients is an increasingly common treatment modality, particularly in transported bone which is used to reconstruct defects following oncological surgical resection. The aim of this systematic review is to evaluate the survival of dental implants placed into autogenous bone grafts and flaps, in head and neck cancer patients. MEDLINE, EMBASE, CENTRAL and Science Direct databases were searched (1980-August 2017) for studies evaluating intra-oral implant placement into autogenous bone grafts and flaps in H&N cancer patients. Twenty articles were included reporting on 1905 implants placed into autogenous bone in head and neck cancer patients. Implant survival varied from 54 to 100% within the studies with 11 studies reporting implant survival of over 90%. In conclusion, intra-oral implant survival in autogenous bone grafts in head and neck oncology patients is promising, however inconsistencies in data reporting and in outcome definitions precludes formal meta-analysis.

Long-term success of dental implant-supported dentures in postirradiated patients treated for neoplasms of the maxillofacial skeleton: a retrospective study

OBJECTIVES

The reconstruction of oral function in irradiated patients with craniofacial tumors is a significant challenge. The aim of this study was to detect long-term success of dental implant-supported dentures in postirradiated patients treated for neoplasms of the maxillofacial skeleton.

MATERIALS AND METHODS

From 2004 to 2011, 36 irradiated patients underwent oral function reconstruction using implant-supported prostheses. Bone augmentation was completed using vascularized bone grafts in 22 patients. Fourteen patients were treated by hyperbaric oxygen therapy (HBO). A total of 198 dental implants were used in jaw rehabilitation. After loading, implant success rates, biological and prosthetic complications, patient satisfaction, and psychological changes were recorded.

RESULTS

Bone augmentation of the jaw was successful and vascularized grafts provided an additional vascular supply in compromised irradiated tissue. Rehabilitation was successful in all of the patients after loading. Thirty-eight dental implants failed, and 35 implants were removed. The success rate of the implants was 93.6 % for 10 years after loading. It was not a significant difference in implant success rate between the HBO group and the other groups. The prosthodontic maintenance results and complication rates showed that patients required intervention 0.19 times per year. All patients were satisfied with the oral restoration results.

CONCLUSION

The restoration of oral function in radiotherapy patients with tumor resection using implant-supported prostheses is a viable treatment option.

CLINICAL RELEVANCE

Either alone or in combination with HBO, dental implant-supported prostheses can be used an effective therapeutic approach for irradiated patients with oral function reconstruction.

Mandibular reconstruction using free vascularized iliac crest grafts and dental implants

Background and aim

The mandible is frequently affected by tumor masses present in the oral cavity and is included in the tumor ablation procedure, with major functional and esthetic consequences for the patient. A method of high current interest in mandibular reconstruction is based on the use of free vascularized iliac crest grafts, followed by reconstruction using dental implants.

Methods

This study presents the case of four patients benefiting from this treatment method, and monitors the treatment stages and their clinical evolution after mandibular reconstruction and dental implant placement.

Results

The postoperative evolution of the patients was favorable, with the integration of the iliac crest grafts and dental implants. After prosthetic loading, the masticatory as well as the esthetic function of the patients was restored to a standard close to the initial one.

Conclusions

This mandibular reconstruction method proved to be effective, with a high degree of reliability and a significant improvement of the patients’ quality of life.

Oral Rehabilitation of Adult Edentulous Siblings Severely Lacking Alveolar Bone Due to Ectodermal Dysplasia: A Report of 2 Clinical Cases and a Literature Review

The oral conditions of adult edentulous patients with ectodermal dysplasia (ED) often lead to decreased physical and psychological health, and the negative effects can become as extreme as social and psychological isolation. However, restoring oral function of adult edentulous patients with ED using zygomatic implants (ZIs) or conventional implants (CIs) remains challenging for dentists because of the severe atrophy of these patients' alveolar ridges. This report describes 2 cases of adult edentulous siblings with ED; they exhibited severe alveolar bone atrophy and were treated with ZIs and CIs as bases to augment the bone in their anterior jaws. For these patients, bone augmentation was completed with an autogenous fibular graft. Although there was mild evidence of bone graft resorption in the maxilla, the bone augmentation procedures were successful in the 2 patients. Effective osseointegration of the implants was obtained. After placement, the functional and esthetic results of the oral rehabilitation were acceptable. More importantly, restoration of the patients' oral function enhanced their self-confidence and self-esteem. Therefore, restoring oral function in adult patients with ED and edentulous jaws using ZIs and CIs as the bases for bone augmentation is an effective approach.