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Sriram S, Njoroge MW, Lopez CD, Zhu L, Heron MJ, Zhu KJ, Yusuf CT, Yang R. Optimal Treatment Order With Fibula-Free Flap Reconstruction, Oncologic Treatment, and Dental Implants: A Systematic Review and Meta-Analysis. J Craniofac Surg 2024; 35:1065-1073. [PMID: 38666786 DOI: 10.1097/scs.0000000000010127] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2023] [Accepted: 02/05/2024] [Indexed: 06/04/2024] Open
Abstract
Head and neck cancer (HNC) patients benefit from craniofacial reconstruction, but no clear guidance exists for rehabilitation timing. This meta-analysis aims to clarify the impact of oncologic treatment order on implant survival. An algorithm to guide placement sequence is also proposed in this paper. PubMed, Embase, and Web of Science were searched for studies on HNC patients with ablative and fibula-free flap (FFF) reconstruction surgeries and radiotherapy (RTX). Primary outcomes included treatment sequence, implant survival rates, and RTX dose. Of 661 studies, 20 studies (617 implants, 199 patients) were included. Pooled survival rates for implants receiving >60 Gy RTX were significantly lower than implants receiving < 60 Gy (82.8% versus 90.1%, P =0.035). Placement >1 year after RTX completion improved implant survival rates (96.8% versus 82.5%, P =0.001). Implants receiving pre-placement RTX had increased survival with RTX postablation versus before (91.2% versus 74.8%, P <0.001). One hundred seventy-seven implants were placed only in FFF with higher survival than implants placed in FFF or native bone (90.4% versus 83.5%, P =0.035). Radiotherapy is detrimental to implant survival rates when administered too soon, in high doses, and before tumor resection. A novel evidence-based clinical decision-making algorithm was presented for utilization when determining the optimal treatment order for HNC patients. The overall survival of dental prostheses is acceptable, reaffirming their role as a key component in rehabilitating HNC patients. Considerations must be made regarding RTX dosage, timing, and implant location to optimize survival rates and patient outcomes for improved functionality, aesthetics, and comfort.
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Affiliation(s)
- Shreya Sriram
- Department of Plastic and Reconstructive Surgery, Johns Hopkins Hospital, Baltimore, MD
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2
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Kaiser M, Burg S, Speth U, Cotter ML, Smeets R, Gosau M, König D. Outcomes and influencing factors of dental implants in fibula, iliac crest, and scapula free flaps: a retrospective case-control study. Int J Implant Dent 2024; 10:8. [PMID: 38334913 PMCID: PMC10858007 DOI: 10.1186/s40729-024-00522-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2023] [Accepted: 01/11/2024] [Indexed: 02/10/2024] Open
Abstract
PURPOSE Reconstruction with vascularized bone grafts after ablative surgery and subsequent dental rehabilitation with implants is often challenging; however, it helps improve the patient's quality of life. This retrospective case-control study aimed to determine the implant survival/success rates in different vascularized bone grafts and potential risk factors. METHODS Only patients who received implants in free vascularized bone grafts between 2012 and 2020 were included. The free flap donor sites were the fibula, iliac crest, and scapula. The prosthetic restoration had to be completed, and the observation period had to be over one year after implantation. Implant success was defined according to the Health Scale for Dental Implants criteria. RESULTS Sixty-two patients with 227 implants were included. The implant survival rate was 86.3% after an average of 48.7 months. The causes of implant loss were peri-implantitis (n = 24), insufficient osseointegration (n = 1), removal due to tumor recurrence (n = 1), and osteoradionecrosis (n = 5). Of all implants, 52.4% were classified as successful, 19.8% as compromised, and 27.8% as failed. Removal of osteosynthesis material prior to or concurrent with implant placement resulted in significantly better implant success than material not removed (p = 0.035). Localization of the graft in the mandibular region was associated with a significantly better implant survival (p = 0.034) and success (p = 0.002), also a higher Karnofsky Performance Status Scale score with better implant survival (p = 0.014). CONCLUSION Implants placed in vascularized grafts showed acceptable survival rates despite the potential risk factors often present in these patient groups. However, peri-implantitis remains a challenge.
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Affiliation(s)
- Marina Kaiser
- Department of Oral and Maxillofacial Surgery, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246, Hamburg, Germany
| | - Simon Burg
- Department of Oral and Maxillofacial Surgery, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246, Hamburg, Germany
| | - Ulrike Speth
- Department of Oral and Maxillofacial Surgery, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246, Hamburg, Germany
| | - Marie-Luise Cotter
- Department of Oral and Maxillofacial Surgery, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246, Hamburg, Germany
| | - Ralf Smeets
- Department of Oral and Maxillofacial Surgery, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246, Hamburg, Germany
| | - Martin Gosau
- Department of Oral and Maxillofacial Surgery, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246, Hamburg, Germany
| | - Daniela König
- Department of Oral and Maxillofacial Surgery, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246, Hamburg, Germany.
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Lombardo G, D'Agostino A, Nocini PF, Signoriello A, Zangani A, Pardo A, Lonardi F, Trevisiol L. Clinical outcomes and periodontal conditions of dental implants placed in free fibula flaps (FFF): a retrospective study with a mean follow-up of 6 years. Clin Oral Investig 2023; 27:7737-7751. [PMID: 37917356 PMCID: PMC10713700 DOI: 10.1007/s00784-023-05364-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2023] [Accepted: 10/24/2023] [Indexed: 11/04/2023]
Abstract
OBJECTIVES Up-to-date literature regarding long-term success of implant rehabilitations after microvascular reconstructions with free fibula flap (FFF) is still very scarce. This study aimed to evaluate clinical outcomes, especially related to oral hygiene conditions, of patients rehabilitated with this technique. MATERIALS AND METHODS A total of 25 patients who underwent maxillofacial reconstructive surgery with FFF were retrospectively evaluated for soft tissues conditions, oral hygiene habits, and implant survival and success, assessed with a mean follow-up of 6 (range 2-15) years after loading. RESULTS Fourteen patients received full-arch fixed prostheses and 11 removable bar-supported overdentures. At the follow-up evaluation, 52% of prostheses did not allow proper accessibility for oral hygiene. Overall prosthetic survival was 100%, and implant survival and success were respectively 93.6% and 72%. Prevalence of peri-implantitis was 29% at implant level and that at patient level 96%. CONCLUSIONS Six-year clinical outcomes of this study reveal that poor oral hygiene practices and compliance by patients who underwent maxillofacial reconstruction with FFF are significantly associated with peri-implant disease. CLINICAL RELEVANCE Findings of the present study underline the need by clinicians for a careful assessment, in reference to a specific implant therapy, of patient's prosthetic accessibility for oral hygiene procedures.
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Affiliation(s)
- Giorgio Lombardo
- Dentistry and Maxillo-Facial Surgery Unit, Department of Surgery, Dentistry, Paediatrics and Gynaecology (DIPSCOMI), University of Verona, Piazzale L.A. Scuro 10, 37134, Verona, Italy
| | - Antonio D'Agostino
- Dentistry and Maxillo-Facial Surgery Unit, Department of Surgery, Dentistry, Paediatrics and Gynaecology (DIPSCOMI), University of Verona, Piazzale L.A. Scuro 10, 37134, Verona, Italy
| | - Pier Francesco Nocini
- Dentistry and Maxillo-Facial Surgery Unit, Department of Surgery, Dentistry, Paediatrics and Gynaecology (DIPSCOMI), University of Verona, Piazzale L.A. Scuro 10, 37134, Verona, Italy
| | - Annarita Signoriello
- Dentistry and Maxillo-Facial Surgery Unit, Department of Surgery, Dentistry, Paediatrics and Gynaecology (DIPSCOMI), University of Verona, Piazzale L.A. Scuro 10, 37134, Verona, Italy.
| | - Alessandro Zangani
- Dentistry and Maxillo-Facial Surgery Unit, Department of Surgery, Dentistry, Paediatrics and Gynaecology (DIPSCOMI), University of Verona, Piazzale L.A. Scuro 10, 37134, Verona, Italy
| | - Alessia Pardo
- Dentistry and Maxillo-Facial Surgery Unit, Department of Surgery, Dentistry, Paediatrics and Gynaecology (DIPSCOMI), University of Verona, Piazzale L.A. Scuro 10, 37134, Verona, Italy
| | - Fabio Lonardi
- Dentistry and Maxillo-Facial Surgery Unit, Department of Surgery, Dentistry, Paediatrics and Gynaecology (DIPSCOMI), University of Verona, Piazzale L.A. Scuro 10, 37134, Verona, Italy
| | - Lorenzo Trevisiol
- Dentistry and Maxillo-Facial Surgery Unit, Department of Surgery, Dentistry, Paediatrics and Gynaecology (DIPSCOMI), University of Verona, Piazzale L.A. Scuro 10, 37134, Verona, Italy
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4
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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] [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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Elmougy A. Expert view: Abdulrahman Elmougy. Br Dent J 2023; 234:324. [PMID: 36899242 DOI: 10.1038/s41415-023-5639-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/12/2023]
Affiliation(s)
- Abdulrahman Elmougy
- Consultant and Specialist in Restorative Dentistry, Charles Clifford Dental Hospital, Sheffield, UK.
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6
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Zhang X, Xiao T, Yang L, Ning C, Guan S, Li X. Application of a vascularized bone free flap and survival rate of dental implants after transplantation: A systematic review and meta-analysis. JOURNAL OF STOMATOLOGY, ORAL AND MAXILLOFACIAL SURGERY 2023; 124:101401. [PMID: 36717020 DOI: 10.1016/j.jormas.2023.101401] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/14/2022] [Revised: 01/08/2023] [Accepted: 01/26/2023] [Indexed: 01/30/2023]
Abstract
PURPOSE As maxillofacial surgical techniques have advanced, vascularized bone free flap transplantation has become the standard treatment for repairing maxillofacial defects. In this meta-analysis, we summarize the survival rates of implants after VBFF surgery for maxillary and mandibular reconstructions and investigate the factors affecting patient outcomes. METHODS The PubMed, Embase, and Wanfang databases were searched up to May 31, 2022. The results of the treatment effect are presented as the risk ratio or odds ratio, using 95% confidence intervals. Statistical significance was calculated at α = 0.05 (two-tailed z tests). RESULTS 35 studies were included in our analysis. The results revealed a 3-year and 5-year implant survival rate of 95.2% and 85.4% in VBFFs, respectively. The location of jaw defects (maxilla or mandible) or timing of implantation was not found to have a statistically significant influence on the survival rate. However, statistically significant differences were observed in the failure of implants placed in irradiated bone tissue. CONCLUSIONS Statistically significant differences were not found in the implant survival rate between simultaneous and delayed implantation, or between maxillary and mandibular defects. However, dental implants placed in irradiated flaps tended to have a lower survival rate than those surgically placed in non-irradiated flaps.
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Affiliation(s)
- Xingkui Zhang
- Department of Oral and Maxillofacial Surgery, School and Hospital of Stomatology, Hebei Medical University and Hebei Key Laboratory of Stomatology, Shijiazhuang 050017, China
| | - Tiepeng Xiao
- Department of Oral Orthodontics, The Second Affiliated Hospital of Hebei Medical University, Shijiazhuang 050000, China
| | - Lei Yang
- Department of Epidemiology and Statistics, School of Public Health, Hebei Key Laboratory of Environment and Human Health, Hebei Medical University, Shijiazhuang 050017, China
| | - Chunliu Ning
- Department of Oral and Maxillofacial Surgery, School and Hospital of Stomatology, Hebei Medical University and Hebei Key Laboratory of Stomatology, Shijiazhuang 050017, China
| | - Shuai Guan
- Department of Oral and Maxillofacial Surgery, School and Hospital of Stomatology, Hebei Medical University and Hebei Key Laboratory of Stomatology, Shijiazhuang 050017, China
| | - Xiangjun Li
- Department of Oral and Maxillofacial Surgery, School and Hospital of Stomatology, Hebei Medical University and Hebei Key Laboratory of Stomatology, Shijiazhuang 050017, China.
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7
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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: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2022] [Revised: 05/23/2022] [Accepted: 06/12/2022] [Indexed: 11/27/2022]
Abstract
PURPOSE The purpose of this meta-analysis was to compare implant survival in irradiated and non-irradiated bone and to investigate potential risk factors for implant therapy in oral cancer patients. MATERIAL AND METHODS An extensive search in the electronic databases of the National Library of Medicine was performed. Systematic review and meta-analysis were conducted according to PRISMA statement. The meta-analysis was performed for studies with a mean follow-up of at least three and five years, respectively. RESULTS The systematic review resulted in a mean overall implant survival of 87.8% (34%-100%). The meta-analysis revealed a significantly higher rate of implant failure in irradiated bone compared to non-irradiated bone (p < .00001, OR 1.97, CI [1.63, 2.37]). The studies also showed that implants placed into irradiated grafted bone were more likely to fail than those in irradiated native bone (p < .0001, OR 2.26, CI [1.50, 3.40]). CONCLUSION Even though overall implant survival was high, radiotherapy proves to be a significant risk factor for implant loss. Augmentation procedures may also increase the risk of an adverse outcome, especially in combination with radiotherapy. CLINICAL RELEVANCE The treatment of patients receiving radiotherapy of any form requires precise individual planning and a close aftercare. Implants should be placed in local bone rather than in bone grafts, if possible.
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Affiliation(s)
- Eik Schiegnitz
- Department of Oral and Maxillofacial Surgery, Plastic Surgery, University Medical Centre, Johannes Gutenberg-University, Mainz, Germany
| | - Katrin Reinicke
- Department of Oral and Maxillofacial Surgery, Plastic Surgery, University Medical Centre, Johannes Gutenberg-University, Mainz, Germany
| | - Keyvan Sagheb
- Department of Oral and Maxillofacial Surgery, Plastic Surgery, University Medical Centre, Johannes Gutenberg-University, Mainz, Germany
| | - Jochem König
- Institute of Medical Biometry, Epidemiology and Informatics, Johannes Gutenberg-University, Mainz, Germany
| | - Bilal Al-Nawas
- Department of Oral and Maxillofacial Surgery, Plastic Surgery, University Medical Centre, Johannes Gutenberg-University, Mainz, Germany
| | - Knut A Grötz
- Department of Oral and Maxillofacial Surgery, Dr. Horst Schmidt Clinic Wiesbaden, Wiesbaden, Germany
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8
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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] [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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Nyirjesy SC, Heller M, von Windheim N, Gingras A, Kang SY, Ozer E, Agrawal A, Old MO, Seim NB, Carrau RL, Rocco JW, VanKoevering KK. The role of computer aided design/computer assisted manufacturing (CAD/CAM) and 3- dimensional printing in head and neck oncologic surgery: A review and future directions. Oral Oncol 2022; 132:105976. [PMID: 35809506 DOI: 10.1016/j.oraloncology.2022.105976] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2022] [Accepted: 06/17/2022] [Indexed: 01/12/2023]
Abstract
Microvascular free flap reconstruction has remained the standard of care in reconstruction of large tissue defects following ablative head and neck oncologic surgery, especially for bony structures. Computer aided design/computer assisted manufacturing (CAD/CAM) and 3-dimensionally (3D) printed models and devices offer novel solutions for reconstruction of bony defects. Conventional free hand techniques have been enhanced using 3D printed anatomic models for reference and pre-bending of titanium reconstructive plates, which has dramatically improved intraoperative and microvascular ischemia times. Improvements led to current state of the art uses which include full virtual planning (VP), 3D printed osteotomy guides, and patient specific reconstructive plates, with advanced options incorporating dental rehabilitation and titanium bone replacements into the primary surgical plan through use of these tools. Limitations such as high costs and delays in device manufacturing may be mitigated with in house software and workflows. Future innovations still in development include printing custom prosthetics, 'bioprinting' of tissue engineered scaffolds, integration of therapeutic implants, and other possibilities as this technology continues to rapidly advance. This review summarizes the literature and serves as a summary guide to the historic, current, advanced, and future possibilities of 3D printing within head and neck oncologic surgery and bony reconstruction. This review serves as a summary guide to the historic, current, advanced, and future roles of CAD/CAM and 3D printing within the field of head and neck oncologic surgery and bony reconstruction.
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Affiliation(s)
- Sarah C Nyirjesy
- Department of Otolaryngology- Head and Neck Surgery, The James Cancer Hospital and Solove Research Institute, The Ohio State University Wexner Medical Center, 915 Olentangy River Road, Columbus, OH 43210, United States
| | - Margaret Heller
- Department of Otolaryngology- Head and Neck Surgery, The James Cancer Hospital and Solove Research Institute, The Ohio State University Wexner Medical Center, 915 Olentangy River Road, Columbus, OH 43210, United States
| | - Natalia von Windheim
- Department of Otolaryngology- Head and Neck Surgery, The James Cancer Hospital and Solove Research Institute, The Ohio State University Wexner Medical Center, 915 Olentangy River Road, Columbus, OH 43210, United States
| | - Amelia Gingras
- Department of Otolaryngology- Head and Neck Surgery, The James Cancer Hospital and Solove Research Institute, The Ohio State University Wexner Medical Center, 915 Olentangy River Road, Columbus, OH 43210, United States
| | - Stephen Y Kang
- Department of Otolaryngology- Head and Neck Surgery, The James Cancer Hospital and Solove Research Institute, The Ohio State University Wexner Medical Center, 915 Olentangy River Road, Columbus, OH 43210, United States
| | - Enver Ozer
- Department of Otolaryngology- Head and Neck Surgery, The James Cancer Hospital and Solove Research Institute, The Ohio State University Wexner Medical Center, 915 Olentangy River Road, Columbus, OH 43210, United States
| | - Amit Agrawal
- Department of Otolaryngology- Head and Neck Surgery, The James Cancer Hospital and Solove Research Institute, The Ohio State University Wexner Medical Center, 915 Olentangy River Road, Columbus, OH 43210, United States
| | - Matthew O Old
- Department of Otolaryngology- Head and Neck Surgery, The James Cancer Hospital and Solove Research Institute, The Ohio State University Wexner Medical Center, 915 Olentangy River Road, Columbus, OH 43210, United States
| | - Nolan B Seim
- Department of Otolaryngology- Head and Neck Surgery, The James Cancer Hospital and Solove Research Institute, The Ohio State University Wexner Medical Center, 915 Olentangy River Road, Columbus, OH 43210, United States
| | - Ricardo L Carrau
- Department of Otolaryngology- Head and Neck Surgery, The James Cancer Hospital and Solove Research Institute, The Ohio State University Wexner Medical Center, 915 Olentangy River Road, Columbus, OH 43210, United States
| | - James W Rocco
- Department of Otolaryngology- Head and Neck Surgery, The James Cancer Hospital and Solove Research Institute, The Ohio State University Wexner Medical Center, 915 Olentangy River Road, Columbus, OH 43210, United States
| | - Kyle K VanKoevering
- Department of Otolaryngology- Head and Neck Surgery, The James Cancer Hospital and Solove Research Institute, The Ohio State University Wexner Medical Center, 915 Olentangy River Road, Columbus, OH 43210, United States.
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10
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Ma H, Van Dessel J, Shujaat S, Bila M, Sun Y, Politis C, Jacobs R. Long-term survival of implant-based oral rehabilitation following maxillofacial reconstruction with vascularized bone flap. Int J Implant Dent 2022; 8:15. [PMID: 35378661 PMCID: PMC8980171 DOI: 10.1186/s40729-022-00413-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2022] [Accepted: 03/15/2022] [Indexed: 12/02/2022] Open
Abstract
Aim The aim of the study was to assess the 5-year cumulative survival rate of implant-based dental rehabilitation following maxillofacial reconstruction with a vascularized bone flap and to investigate the potential risk factors which might influence the survival rate. Materials and methods A retrospective cohort study was designed. Inclusion criteria involved 18 years old or above patients with the availability of clinical and radiological data and a minimum follow-up 1 year following implant placement. The cumulative survival rate was analyzed by Kaplan–Meier curves and the influential risk factors were assessed using univariate log-rank tests and multivariable Cox-regression analysis. Results 151 implants were assessed in 40 patients with a mean age of 56.43 ± 15.28 years at the time of implantation. The mean number of implants placed per patient was 3.8 ± 1.3 with a follow-up period of 50.0 ± 32.0 months. The cumulative survival at 1-, 2- and 5-years was 96%, 87%, and 81%. Patients with systemic diseases (HR = 3.75, 95% CI 1.65–8.52; p = 0.002), irradiated flap (HR = 2.27, 95% CI 1.00–5.17; p = 0.05) and poor oral hygiene (HR = 11.67; 95% CI 4.56–29.88; p < 0.0001) were at a significantly higher risk of implant failure. Conclusion The cumulative implant survival rate was highest at 1st year followed by 2nd and 5th year, indicating that the risk of implant failure increased over time. Risk indicators that seem to be detrimental to long-term survival include poor oral hygiene, irradiated flap and systemic diseases. Supplementary Information The online version contains supplementary material available at 10.1186/s40729-022-00413-7.
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Affiliation(s)
- Hongyang Ma
- OMFS IMPATH Research Group, Department of Imaging & Pathology, Faculty of Medicine, KU Leuven, Campus Sint-Rafaël, Kapucijnenvoer 33, 3000, Leuven, Belgium.,Department of Oral and Maxillofacial Surgery, University Hospitals Leuven, Leuven, Belgium
| | - Jeroen Van Dessel
- OMFS IMPATH Research Group, Department of Imaging & Pathology, Faculty of Medicine, KU Leuven, Campus Sint-Rafaël, Kapucijnenvoer 33, 3000, Leuven, Belgium.,Department of Oral and Maxillofacial Surgery, University Hospitals Leuven, Leuven, Belgium
| | - Sohaib Shujaat
- OMFS IMPATH Research Group, Department of Imaging & Pathology, Faculty of Medicine, KU Leuven, Campus Sint-Rafaël, Kapucijnenvoer 33, 3000, Leuven, Belgium.,Department of Oral and Maxillofacial Surgery, University Hospitals Leuven, Leuven, Belgium
| | - Michel Bila
- OMFS IMPATH Research Group, Department of Imaging & Pathology, Faculty of Medicine, KU Leuven, Campus Sint-Rafaël, Kapucijnenvoer 33, 3000, Leuven, Belgium.,Department of Oral and Maxillofacial Surgery, University Hospitals Leuven, Leuven, Belgium
| | - Yi Sun
- OMFS IMPATH Research Group, Department of Imaging & Pathology, Faculty of Medicine, KU Leuven, Campus Sint-Rafaël, Kapucijnenvoer 33, 3000, Leuven, Belgium.,Department of Oral and Maxillofacial Surgery, University Hospitals Leuven, Leuven, Belgium
| | - Constantinus Politis
- OMFS IMPATH Research Group, Department of Imaging & Pathology, Faculty of Medicine, KU Leuven, Campus Sint-Rafaël, Kapucijnenvoer 33, 3000, Leuven, Belgium.,Department of Oral and Maxillofacial Surgery, University Hospitals Leuven, Leuven, Belgium
| | - Reinhilde Jacobs
- OMFS IMPATH Research Group, Department of Imaging & Pathology, Faculty of Medicine, KU Leuven, Campus Sint-Rafaël, Kapucijnenvoer 33, 3000, Leuven, Belgium. .,Department of Oral and Maxillofacial Surgery, University Hospitals Leuven, Leuven, Belgium. .,Department of Dental Medicine, Karolinska Institutet, Stockholm, Sweden.
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11
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Toneatti DJ, Graf RR, Burkhard JP, Schaller B. Survival of dental implants and occurrence of osteoradionecrosis in irradiated head and neck cancer patients: a systematic review and meta-analysis. Clin Oral Investig 2021; 25:5579-5593. [PMID: 34401944 PMCID: PMC8443505 DOI: 10.1007/s00784-021-04065-6] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2021] [Accepted: 06/29/2021] [Indexed: 12/24/2022]
Abstract
OBJECTIVES This systematic review assesses dental implant survival, calculates the incidence rate of osteoradionecrosis, and evaluates risk factors in irradiated head and neck cancer patients. MATERIALS AND METHODS Various databases (e.g., Medline/Embase using Ovid) and gray literature platforms were searched using a combination of keywords and subject headings. When appropriate, meta-analysis was carried out using a random effects model. Otherwise, pooled analysis was applied. RESULTS A total of 425 of the 660 included patients received radiotherapy. In total, 2602 dental implants were placed, and 1637 were placed in irradiated patients. Implant survival after an average follow-up of 37.7 months was 97% (5% confidence interval, CI 95.2%, 95% CI 98.3%) in nonirradiated patients and 91.9% (5% CI 87.7%, 95% CI: 95.3%) after an average follow-up of 39.8 months in irradiated patients. Osteoradionecrosis occurred in 11 cases, leading to an incidence of 3% (5% CI 1.6%, 95% CI 4.9%). The main factors impacting implant survival were radiation and grafting status, while factors influencing osteoradionecrosis could not be determined using meta-analysis. CONCLUSION Our data show that implant survival in irradiated patients is lower than in nonirradiated patients, and osteoradionecrosis is-while rare-a serious complication that any OMF surgeon should be prepared for. The key to success could be a standardized patient selection and therapy to improve the standard of care, reduce risks and shorten treatment time. CLINICAL RELEVANCE Our analysis provides further evidence that implant placement is a feasible treatment option in irradiated head and neck cancer patients with diminished oral function and good long-term cancer prognosis.
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Affiliation(s)
- Daniel Jan Toneatti
- Department of Cranio-Maxillofacial Surgery, Inselspital, Bern University Hospital, University of Bern, CH-3010, Bern, Switzerland
| | - Ronny Roger Graf
- Department of Cranio-Maxillofacial Surgery, Inselspital, Bern University Hospital, University of Bern, CH-3010, Bern, Switzerland
| | - John-Patrik Burkhard
- Department of Cranio-Maxillofacial Surgery, Inselspital, Bern University Hospital, University of Bern, CH-3010, Bern, Switzerland
| | - Benoît Schaller
- Department of Cranio-Maxillofacial Surgery, Inselspital, Bern University Hospital, University of Bern, CH-3010, Bern, Switzerland.
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12
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Petrides GA, Hicks G, Dunn M, Froggatt C, Wallace C, Howes D, Leinkram D, Low THH, Ch'ng S, Wykes J, Palme CE, Clark JR. Dentoalveolar outcomes in maxillary reconstruction: A retrospective review of 85 maxillectomy reconstructions. ANZ J Surg 2021; 91:1472-1479. [PMID: 34124825 DOI: 10.1111/ans.17001] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2021] [Revised: 05/23/2021] [Accepted: 05/30/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND Although microvascular free flaps are often used to reconstruct maxillary defects, dentoalveolar rehabilitation is arguably less common despite its importance to midface function and aesthetics. The aim of this study is to review the contemporary management of maxillary defects in a single quaternary referral institution to identify factors that assist or impede dentoalveolar rehabilitation. METHODS A retrospective review of maxillary reconstructions performed between February 2017 and December 2020 was performed. Patient characteristics, defect classification, operative techniques, complications and dentoalveolar outcomes were recorded. RESULTS A total of 85 maxillary reconstructions were performed in 73 patients. Of the 64 patients where dental rehabilitation was required, 31 received a functional denture (48%) with 24 (38%) being implant-retained. Significant predictors of successful rehabilitation included the use of virtual surgical planning (VSP; 86% vs. 25%, p < 0.001), preoperative prosthodontic assessment (82% vs. 21%, p < 0.001), prefabrication (100% vs. 40%, p = 0.002) and use of the zygomatic implant perforator flap technique (100% vs. 39%, p = 0.001). Preoperative prosthodontic consultation was associated with 21-fold increase in the odds of rehabilitation (odds ratio 20.9, 95% confidence interval 6.54-66.66, p < 0.005). CONCLUSION Preoperative prosthodontic evaluation, VSP and reconstructive techniques developed to facilitate implant placement are associated with increased dental rehabilitation rates. Despite using an institutional algorithm, functional dentures are frequently prevented by factors including soft tissue constraints, disease recurrence and patient motivation.
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Affiliation(s)
- George A Petrides
- Faculty of Medicine and Health, The University of New South Wales, Sydney, New South Wales, Australia
| | - Gabrielle Hicks
- Department of Head and Neck Surgery, Sydney Head and Neck Cancer Institute, Chris O'Brien Lifehouse, Sydney, New South Wales, Australia
| | - Masako Dunn
- Department of Head and Neck Surgery, Sydney Head and Neck Cancer Institute, Chris O'Brien Lifehouse, Sydney, New South Wales, Australia
| | - Catriona Froggatt
- Department of Head and Neck Surgery, Sydney Head and Neck Cancer Institute, Chris O'Brien Lifehouse, Sydney, New South Wales, Australia
| | - Christine Wallace
- Department of Oral Restorative Sciences, Westmead Centre for Oral Health, NSW Health, Sydney, New South Wales, Australia
| | - Dale Howes
- Department of Head and Neck Surgery, Sydney Head and Neck Cancer Institute, Chris O'Brien Lifehouse, Sydney, New South Wales, Australia.,School of Dentistry, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
| | - David Leinkram
- Department of Head and Neck Surgery, Sydney Head and Neck Cancer Institute, Chris O'Brien Lifehouse, Sydney, New South Wales, Australia
| | - Tsu-Hui Hubert Low
- Department of Head and Neck Surgery, Sydney Head and Neck Cancer Institute, Chris O'Brien Lifehouse, Sydney, New South Wales, Australia.,Sydney Medical School, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
| | - Sydney Ch'ng
- Department of Head and Neck Surgery, Sydney Head and Neck Cancer Institute, Chris O'Brien Lifehouse, Sydney, New South Wales, Australia.,Sydney Medical School, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia.,Royal Prince Alfred Institute of Academic Surgery, Sydney Local Health District, Sydney, New South Wales, Australia.,Department of Plastic Surgery, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
| | - James Wykes
- Department of Head and Neck Surgery, Sydney Head and Neck Cancer Institute, Chris O'Brien Lifehouse, Sydney, New South Wales, Australia
| | - Carsten E Palme
- Department of Head and Neck Surgery, Sydney Head and Neck Cancer Institute, Chris O'Brien Lifehouse, Sydney, New South Wales, Australia.,Sydney Medical School, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
| | - Jonathan R Clark
- Department of Head and Neck Surgery, Sydney Head and Neck Cancer Institute, Chris O'Brien Lifehouse, Sydney, New South Wales, Australia.,Sydney Medical School, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia.,Royal Prince Alfred Institute of Academic Surgery, Sydney Local Health District, Sydney, New South Wales, Australia
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13
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Wolf F, Spoerl S, Gottsauner M, Klingelhöffer C, Spanier G, Kolbeck C, Reichert TE, Hautmann MG, Ettl T. Significance of site-specific radiation dose and technique for success of implant-based prosthetic rehabilitation in irradiated head and neck cancer patients-A cohort study. Clin Implant Dent Relat Res 2021; 23:444-455. [PMID: 33949108 DOI: 10.1111/cid.13005] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2021] [Revised: 03/29/2021] [Accepted: 04/12/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND Radiotherapy aggravates implant-based prosthetic rehabilitation in patients with head and neck cancer. PURPOSE To evaluate the impact of radiation dose at implant and parotid gland site for prosthetic rehabilitation. MATERIAL AND METHODS The retrospective study includes 121 irradiated head and neck cancer patients with 751 inserted implants. Radiation doses on implant bed and parotid gland site were recorded by 3-dimensional modulated radiation plans. Implant success was clinically and radiographically evaluated according to modified Albrektsson criteria and compared to treatment- and patient-specific data. RESULTS Implant overall survival after 5 years was 92.4% with an implant success rate of 74.9%. Main reasons for implant failure were marginal bone resorption (20.9%), implant not in situ or unloaded (9.6%) and peri-implantitis (7.5%). A mean radiation dose of 62.6 Gy was applied with a mean parotid dose of 35 Gy. Modulating radiation techniques went along with lower grades of xerostomia (p < 0.001). At implant site mean doses of 57.5, 42.0, and 32.3 Gy were recorded for oral, oropharyngeal, and hypopharyngeal/laryngeal carcinoma, respectively. Implant success inversely correlated to radiation dose at implant site. Strong predictors for implant failure in uni- and multivariate analysis were implant-specific dose >50 Gy (HR 7.9), parotid dose >30 Gy (HR 2.3), bone (HR 14.5) and soft tissue (HR 4.5) transplants, bad oral hygiene (HR 3.8), nonmodulated radiation treatment planning (HR 14.5), and nontelescopic prosthetics (HR 5.2). CONCLUSION Radiotherapy impedes implant success in a dose-dependent manner at implant site. Modern radiation techniques effectively reduce xerostomia favoring implant-based prosthetic rehabilitation. Implantation in bone grafts is more critical and telescopic-retained overdentures should be preferred.
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Affiliation(s)
- Franziska Wolf
- Department of Oral and Maxillofacial Surgery, University Hospital Regensburg, Regensburg, Germany
| | - Steffen Spoerl
- Department of Oral and Maxillofacial Surgery, University Hospital Regensburg, Regensburg, Germany
| | - Maximilian Gottsauner
- Department of Oral and Maxillofacial Surgery, University Hospital Regensburg, Regensburg, Germany
| | - Christoph Klingelhöffer
- Department of Oral and Maxillofacial Surgery, University Hospital Regensburg, Regensburg, Germany
| | - Gerrit Spanier
- Department of Oral and Maxillofacial Surgery, University Hospital Regensburg, Regensburg, Germany
| | - Carola Kolbeck
- Department of Prosthodontics, University Hospital Regensburg, Regensburg, Germany
| | - Torsten E Reichert
- Department of Oral and Maxillofacial Surgery, University Hospital Regensburg, Regensburg, Germany
| | - Matthias G Hautmann
- Department of Radiotherapy, University Hospital Regensburg, Regensburg, Germany
| | - Tobias Ettl
- Department of Oral and Maxillofacial Surgery, University Hospital Regensburg, Regensburg, Germany
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14
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Li R, Meng Z, Zhang Y, Shan X, Wang Y, He Y. Soft Tissue Management: A Critical Part of Implant Rehabilitation After Vascularized Free-Flap Reconstruction. J Oral Maxillofac Surg 2020; 79:560-574. [PMID: 33279473 DOI: 10.1016/j.joms.2020.11.006] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2020] [Revised: 11/08/2020] [Accepted: 11/08/2020] [Indexed: 11/20/2022]
Abstract
PURPOSE Implant rehabilitation after jaw reconstruction is challenging, and postoperative peri-implantitis is common. Our aim was to present our management protocol for implant rehabilitation after vascularized free-flap reconstruction and report the outcomes of soft tissue management. METHODS This retrospective cohort study included patients who received vascularized free-flap reconstruction, implant rehabilitation, apical reposition flaps (ARFs), and free gingival grafts (FGGs) at Peking University School and Hospital of Stomatology from January 1, 2009 to January 1, 2020. We assessed the association of age, gender, primary disease, flap choice, number and position of implants, timing of ARFs and FGGs, fixation stent use, and restoration type with the occurrence of peri-implantitis. Probing pocket depth, bleeding on probing, and marginal bone loss of the implants were measured as well. The data were analyzed by descriptive statistics, Kaplan-Meier statistics, and Cox regression analysis. RESULTS In total, 19 patients with 65 implants were included. The implants were placed immediately or 7 to 44 months after reconstruction of the jaw with fibular (n = 17) or iliac flaps (n = 2). ARFs and FGGs were performed 0 to 11 months later. No implants were lost. The mean probing pocket depth, bleeding on probing, and marginal bone loss at 26.6 ± 16.8 months were 3.5 ± 0.9 mm, 70.4 ± 35.1%, and 0.6 ± 0.4 mm, respectively. The incidence of peri-implantitis was 32.3%, showing no significant associations with the gender, age, primary disease, flap choice, number and position of implants, timing of ARFs and FGGs, use of a fixation stent, and type of restoration based on the adjusted multivariate model (P > .05). CONCLUSIONS Soft tissue management helps generate firmly attached keratinized mucosa around the implants, leads to a more precise impression, and reduces peri-implant bone loss. It should be considered as a critical part of implant rehabilitation after vascularized free-flap reconstruction.
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Affiliation(s)
- Ruiliu Li
- Resident, Department of Oral and Maxillofacial Surgery, Peking University School and Hospital of Stomatology, Beijing, China
| | - Zhaoqiang Meng
- Attending Doctor, Special Dental Care Clinic, Peking University School and Hospital of Stomatology, Beijing, China
| | - Yi Zhang
- Professor, Department of Oral and Maxillofacial Surgery, Peking University School and Hospital of Stomatology, Beijing, China
| | - Xiaofeng Shan
- Professor, Department of Oral and Maxillofacial Surgery, Peking University School and Hospital of Stomatology, Beijing, China
| | - Yang Wang
- Associate Professor, Department of Oral and Maxillofacial Surgery, Peking University School and Hospital of Stomatology, Beijing, China
| | - Yang He
- Associate Professor, Department of Oral and Maxillofacial Surgery, Peking University School and Hospital of Stomatology, Beijing, China.
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15
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Dental Implant Survival in Vascularized Bone Flaps: A Systematic Review and Meta-Analysis. Plast Reconstr Surg 2020; 146:637-648. [PMID: 32459736 DOI: 10.1097/prs.0000000000007077] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Maxillofacial reconstruction with vascularized bone restores facial contour and provides structural support and a foundation for dental rehabilitation. Routine implant placement in such cases, however, remains uncommon. This study aims to determine dental implant survival in patients undergoing vascularized maxillary or mandibular reconstruction through a systematic review of the literature. METHODS Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, the literature was queried for implant placement in reconstructed jaws using Medical Subject Headings terms on PubMed, Embase, and Cochrane platforms. Weighted implant survivals were calculated for the entire cohort and subcohorts stratified by radiotherapy. Meta-analyses were performed to estimate effect of radiation on implant osseointegration. RESULTS Of 3965 publications identified, 42 were reviewed, including 1084 patients with 3636 dental implants. Weighted implant survival was 92.2 percent at a median follow-up of 36 months. Survival was 97.0 percent in 269 implants placed immediately in 60 patients versus 89.9 percent in 1897 delayed implants placed in 597 patients, with follow-up of 14 and 40 months, respectively. Dental implants without radiotherapy exposure had better survival than those exposed to radiation (95.3 versus 84.6 percent; p < 0.01) at a median follow-up of 36 months. Meta-analyses showed that radiation significantly increased the risk of implant failure (risk ratio, 4.74; p < 0.01) and suggested that implants placed before radiotherapy trended toward better survival (88.9 percent versus 83.4 percent, p = 0.07; risk ratio, 0.52; p = 0.14). CONCLUSIONS Overall implant survival was 92.2 percent; however, radiotherapy adversely impacted outcomes. Implants placed before radiotherapy may demonstrate superior survival than implants placed after.
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16
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Khadembaschi D, Brierly GI, Chatfield MD, Beech N, Batstone MD. Systematic review and pooled analysis of survival rates, success, and outcomes of osseointegrated implants in a variety of composite free flaps. Head Neck 2020; 42:2669-2686. [PMID: 32400954 DOI: 10.1002/hed.26238] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2020] [Revised: 04/02/2020] [Accepted: 04/22/2020] [Indexed: 09/19/2023] Open
Abstract
The aim of this review was to provide an update on survival rates of osseointegrated implants into common composite free flaps used for maxillary and mandibular reconstructions and identify factors affecting outcomes. PubMed, Medline, Embase, and Cochrane databases were searched. Included studies reported implant survival by flap type. Results were pooled and survival was estimated with the Kaplan-Meier method. Variables affecting survival were assessed using Cox regression. Thirty-two of the 2631 articles retrieved were included, totaling 2626 implants placed into fibula, iliac crest, scapula, and radial forearm free flaps. Pooled survival showed 94% 5-year survival of implants in fibula and iliac crest with no difference between groups (P = .3). Factors effecting survival included radiotherapy (HR 2.3, 95% CI 1.2-4.6, P = .027) and malignant disease (HR 2.2, 95%CI 1.6-3.1, P < .001). Implant survival appears adequate across common flap types; however, there are limited numbers reported in less common flaps.
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Affiliation(s)
- Darius Khadembaschi
- Faculty of Medicine, University of Queensland, Herston, Queensland, Australia
| | - Gary I Brierly
- Department of Maxillofacial Surgery, Royal Brisbane and Women's Hospital, Herston, Queensland, Australia
| | - Mark D Chatfield
- Faculty of Medicine, University of Queensland, Herston, Queensland, Australia
| | - Nicholas Beech
- Department of Maxillofacial Surgery, Royal Brisbane and Women's Hospital, Herston, Queensland, Australia
| | - Martin D Batstone
- Department of Maxillofacial Surgery, Royal Brisbane and Women's Hospital, Herston, Queensland, Australia
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17
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Breik O, Goodrum H, Koria H, Edmondson S, Praveen P, Parmar S. Rehabilitation post maxillary and mandibular reconstruction: Current status and future approaches. Oral Oncol 2020; 105:104663. [DOI: 10.1016/j.oraloncology.2020.104663] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2019] [Revised: 03/22/2020] [Accepted: 03/23/2020] [Indexed: 10/24/2022]
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18
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Wiedenmann F, Liebermann A, Probst F, Troeltzsch M, Balermpas P, Guckenberger M, Edelhoff D, Mayinger M. A pattern of care analysis: Prosthetic rehabilitation of head and neck cancer patients after radiotherapy. Clin Implant Dent Relat Res 2020; 22:333-341. [DOI: 10.1111/cid.12912] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2020] [Revised: 03/19/2020] [Accepted: 03/31/2020] [Indexed: 12/24/2022]
Affiliation(s)
- Felicitas Wiedenmann
- Department of Prosthetic Dentistry University Hospital, LMU Munich Munich Germany
| | - Anja Liebermann
- Department of Prosthetic Dentistry University Hospital, LMU Munich Munich Germany
| | - Florian Probst
- Department of Oral and Maxillofacial Surgery and Facial Plastic Surgery University Hospital, LMU Munich Munich Germany
| | - Matthias Troeltzsch
- Department of Oral and Maxillofacial Surgery and Facial Plastic Surgery University Hospital, LMU Munich Munich Germany
| | - Panagiotis Balermpas
- Department of Radiation Oncology University Hospital Zurich, University of Zurich Zurich Switzerland
| | - Matthias Guckenberger
- Department of Radiation Oncology University Hospital Zurich, University of Zurich Zurich Switzerland
| | - Daniel Edelhoff
- Department of Prosthetic Dentistry University Hospital, LMU Munich Munich Germany
| | - Michael Mayinger
- Department of Radiation Oncology University Hospital Zurich, University of Zurich Zurich Switzerland
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19
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Virtual Surgical Planning for Mandible Reconstruction With a Double Barrel Fibula Flap and Immediate Implant Placement. J Craniofac Surg 2020; 31:e41-e43. [PMID: 31449213 DOI: 10.1097/scs.0000000000005842] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
This brief clinical report describes our experience with virtual surgical planning in a case of mandibulectomy and mandibular reconstruction with a double barrel vascularized osteofasciocutaneous fibula free flap and immediate implant placement in a case of mandibular ameloblastoma. Fibular segments were positioned to obtain the best result both for masticatory function and for aesthetic facial appearance. Furthermore, in this particular case, as well as being positioned for future masticatory rehabilitation, the implants have served to stabilize the fibula segments in the reconstructive intraoperative phase. A superimposition of programed surgery and 6 months postoperative computed tomography scan was performed and results are presented.
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20
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Seikaly H, Idris S, Chuka R, Jeffery C, Dzioba A, Makki F, Logan H, O'Connell DA, Harris J, Ansari K, Biron V, Cote D, Osswald M, Nayar S, Wolfaardt J. The Alberta Reconstructive Technique: An Occlusion‐Driven and Digitally Based Jaw Reconstruction. Laryngoscope 2019; 129 Suppl 4:S1-S14. [DOI: 10.1002/lary.28064] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2019] [Accepted: 04/23/2019] [Indexed: 12/18/2022]
Affiliation(s)
- Hadi Seikaly
- Division of Otolaryngology–Head and Neck Surgery, Department of SurgeryUniversity of Alberta Edmonton Alberta Canada
- Institute for Reconstructive Sciences in MedicineMisericordia Hospital Edmonton Alberta Canada
| | - Sherif Idris
- Division of Otolaryngology–Head and Neck Surgery, Department of SurgeryUniversity of Alberta Edmonton Alberta Canada
| | - Richelle Chuka
- Institute for Reconstructive Sciences in MedicineMisericordia Hospital Edmonton Alberta Canada
| | - Caroline Jeffery
- Division of Otolaryngology–Head and Neck Surgery, Department of SurgeryUniversity of Alberta Edmonton Alberta Canada
- Institute for Reconstructive Sciences in MedicineMisericordia Hospital Edmonton Alberta Canada
| | - Agnieszka Dzioba
- Division of Otolaryngology–Head and Neck Surgery, Department of SurgeryUniversity of Alberta Edmonton Alberta Canada
| | - Fawaz Makki
- Division of Otolaryngology–Head and Neck Surgery, Department of SurgeryUniversity of Alberta Edmonton Alberta Canada
| | - Heather Logan
- Institute for Reconstructive Sciences in MedicineMisericordia Hospital Edmonton Alberta Canada
| | - Daniel A. O'Connell
- Division of Otolaryngology–Head and Neck Surgery, Department of SurgeryUniversity of Alberta Edmonton Alberta Canada
- Institute for Reconstructive Sciences in MedicineMisericordia Hospital Edmonton Alberta Canada
| | - Jeffrey Harris
- Division of Otolaryngology–Head and Neck Surgery, Department of SurgeryUniversity of Alberta Edmonton Alberta Canada
| | - Kal Ansari
- Division of Otolaryngology–Head and Neck Surgery, Department of SurgeryUniversity of Alberta Edmonton Alberta Canada
| | - Vincent Biron
- Division of Otolaryngology–Head and Neck Surgery, Department of SurgeryUniversity of Alberta Edmonton Alberta Canada
| | - David Cote
- Division of Otolaryngology–Head and Neck Surgery, Department of SurgeryUniversity of Alberta Edmonton Alberta Canada
| | - Martin Osswald
- Division of Otolaryngology–Head and Neck Surgery, Department of SurgeryUniversity of Alberta Edmonton Alberta Canada
- Institute for Reconstructive Sciences in MedicineMisericordia Hospital Edmonton Alberta Canada
| | - Suresh Nayar
- Division of Otolaryngology–Head and Neck Surgery, Department of SurgeryUniversity of Alberta Edmonton Alberta Canada
- Institute for Reconstructive Sciences in MedicineMisericordia Hospital Edmonton Alberta Canada
| | - John Wolfaardt
- Division of Otolaryngology–Head and Neck Surgery, Department of SurgeryUniversity of Alberta Edmonton Alberta Canada
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21
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A Comparison of Immediate and Delayed Dental Implant Placement in Head and Neck Surgery Patients. J Oral Maxillofac Surg 2019; 77:1156-1164. [PMID: 30851250 DOI: 10.1016/j.joms.2019.02.007] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2018] [Revised: 02/05/2019] [Accepted: 02/05/2019] [Indexed: 11/20/2022]
Abstract
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.
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22
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Schimmel M, Srinivasan M, McKenna G, Müller F. Effect of advanced age and/or systemic medical conditions on dental implant survival: A systematic review and meta‐analysis. Clin Oral Implants Res 2018; 29 Suppl 16:311-330. [DOI: 10.1111/clr.13288] [Citation(s) in RCA: 70] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/30/2018] [Indexed: 01/26/2023]
Affiliation(s)
- Martin Schimmel
- Division of GerodontologySchool of Dental MedicineUniversity of Bern Bern Switzerland
- Division of Gerodontology and Removable ProsthodonticsUniversity Clinics of Dental MedicineUniversity of Geneva Geneva Switzerland
| | - Murali Srinivasan
- Division of Gerodontology and Removable ProsthodonticsUniversity Clinics of Dental MedicineUniversity of Geneva Geneva Switzerland
| | - Gerald McKenna
- Centre for Public HealthQueen's University Belfast Institute of Clinical Sciences Belfast UK
| | - Frauke Müller
- Division of Gerodontology and Removable ProsthodonticsUniversity Clinics of Dental MedicineUniversity of Geneva Geneva Switzerland
- Department of Internal Medicine, Rehabilitation and GeriatricsUniversity Hospitals of Geneva Thônex Switzerland
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23
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Laverty DP, Kelly R, Addison O. Survival of dental implants placed in autogenous bone grafts and bone flaps in head and neck oncology patients: a systematic review. Int J Implant Dent 2018; 4:19. [PMID: 29971513 PMCID: PMC6029983 DOI: 10.1186/s40729-018-0131-9] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2018] [Accepted: 04/23/2018] [Indexed: 11/13/2022] Open
Abstract
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.
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Affiliation(s)
- Dominic P. Laverty
- Birmingham Community Healthcare NHS Foundation Trust, Birmingham, B5 7EG UK
| | - Robert Kelly
- University of Birmingham School of Dentistry, 5 Mill Pool Way, Birmingham, B5 7EG UK
| | - Owen Addison
- University of Birmingham School of Dentistry, 5 Mill Pool Way, Birmingham, B5 7EG UK
- School of Dentistry, University of Alberta, Edmonton, AB T6G 1C9 Canada
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Petrovic I, Rosen EB, Matros E, Huryn JM, Shah JP. Oral rehabilitation of the cancer patient: A formidable challenge. J Surg Oncol 2018; 117:1729-1735. [PMID: 29723421 PMCID: PMC6135661 DOI: 10.1002/jso.25075] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2018] [Accepted: 03/28/2018] [Indexed: 02/03/2023]
Abstract
Rehabilitation of oral functions following surgery on the jaws is a goal that is often difficult to achieve. Removable dentures supported by remaining teeth or gum are often unstable and seldom satisfactory. On the other hand, endosseous (dental) implants offer a mechanism to provide stability to the dentures. This review, discusses factors related to the tumor, patient, treatment, and physicians which impact upon the feasibility and success of dental implants in patients with oral cancer.
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Affiliation(s)
- Ivana Petrovic
- Straumann Maxillofacial Dental Implantology Research Fellow, Dental Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Evan B Rosen
- Dental Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Evan Matros
- Plastic Surgery Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Joseph M Huryn
- Dental Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Jatin P Shah
- Head and Neck Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York
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Sozzi D, Novelli G, Silva R, Connelly ST, Tartaglia GM. Implant rehabilitation in fibula-free flap reconstruction: A retrospective study of cases at 1-18 years following surgery. J Craniomaxillofac Surg 2017; 45:1655-1661. [PMID: 28823690 DOI: 10.1016/j.jcms.2017.06.021] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2017] [Revised: 05/03/2017] [Accepted: 06/27/2017] [Indexed: 10/19/2022] Open
Abstract
PURPOSE To determine the dental implant and prostheses success rate in a cohort of patients who underwent a vascularized fibula-free flap (FFF) for maxillary or mandibular reconstruction. METHODS The investigators implemented a retrospective cohort study composed of patients who had undergone primary or secondary FFF reconstruction jaw surgery plus placement of 2-6 implants in the reconstructed arch, which were restored with an implant-supported prosthesis. The sample was composed of all patients who underwent FFF surgery between 1998 and 2012 and had either simultaneous or secondary dental implant placement. A total of 28 patients met inclusion criteria. Of these, 22 patients participated in the retrospective review. Patients were examined by an independent observer between January-December 2015. In addition, all patients completed a questionnaire to access satisfaction with the implant-supported prosthesis. RESULTS The patient cohort consisted of 12 males and 10 females, age 12-70 years. A total of 100 implants were placed, 92 implants in fibular bone and 8 implants in native bone. In the maxilla, 35 implants were placed into fibular bone and 4 into native bone (11 in irradiated patients and 28 in non-irradiated patients). In the mandible, 57 implants were placed into fibular bone and 4 into native bone (15 in irradiated patients and 46 in non-irradiated patients). The mean follow-up after implant loading was 7.8 years (range 1.3-17.5 years). The implant survival rate was 98% (95% CI: 92.2%-99.5%). No statistically significant difference was found in implant success between maxillary and mandibular implants, or between radiated and non-radiated bone. The prostheses success rate, determined by clinical exam and patient satisfaction, was 100%. CONCLUSION The results of this study suggest that implant survival is high and implant-supported prostheses are a reliable rehabilitation option in patients whose jaws have been reconstruction with a FFF.
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Affiliation(s)
- Davide Sozzi
- Maxillofacial O.U.S. Gerardo Hospital Monza, Dept. of Medicine and Surgery, School of Medicine, University of Milano-Bicocca, Milan, Italy
| | - Giorgio Novelli
- Maxillofacial O.U.S. Gerardo Hospital Monza, Dept. of Medicine and Surgery, School of Medicine, University of Milano-Bicocca, Milan, Italy
| | - Rebeka Silva
- Department of Veterans Affairs Medical Center, San Francisco, CA, USA
| | | | - Gianluca M Tartaglia
- Department of Biomedical Sciences for Health, Functional Anatomy Research Center (FARC), Universita degli Studi di Milano, Milano, Italy; SST Dental Clinic, Segrate, Italy.
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26
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Restorative dentistry and oral rehabilitation: United Kingdom National Multidisciplinary Guidelines. The Journal of Laryngology & Otology 2017; 130:S41-S44. [PMID: 27841112 PMCID: PMC4873898 DOI: 10.1017/s0022215116000414] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
This is the official guideline endorsed by the specialty associations involved in the care of head and neck cancer patients in the UK and provides recommendations on the pre-treatment oral and dental assessment, during and after treatment and oral rehabilitation. Restorative dentists are core members of the multidisciplinary team treating head and neck cancer patients, involved from the treatment planning phase through to long-term rehabilitation.
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Brown J, Schache A, Butterworth C. Liverpool Opinion on Unfavorable Results in Microsurgical Head and Neck Reconstruction. Clin Plast Surg 2016; 43:707-18. [DOI: 10.1016/j.cps.2016.05.007] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Critchlow SB, Morgan C, Leung T. The oral health status of pre-treatment head and neck cancer patients. Br Dent J 2015; 216:E1. [PMID: 24413141 DOI: 10.1038/sj.bdj.2013.1246] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/25/2013] [Indexed: 11/10/2022]
Abstract
BACKGROUND It is sometimes stated anecdotally that patients with head and neck cancer have poor oral health at the time of oncology diagnosis; however, there is little data in the literature to confirm or refute this claim. AIM To assess, in the first UK study of its type, the oral health status of 100 patients attending for a dental assessment at a single centre before head and neck cancer treatment was commenced. SUBJECTS Sixty-six male patients and 34 female patients were included. RESULTS Of all 100 patients, 2% (2/100) were edentulous. Of the dentate patients, 71% (70/98) were clinically diagnosed with periodontal disease. Fifty-one percent (50/98) had a maximum probing pocket depth in excess of 6 mm. The mean number of carious teeth per dentate subject was 2.4 (95% C.I. 1.6-3.1). Sixty-one percent (60/98) of dentate patients presented with one or more carious teeth. CONCLUSIONS Within this cohort, head and neck cancer patients had poor oral health at the time of oncology diagnosis, with caries and periodontal disease being important clinical issues. The implications for the dental management of these patients are discussed.
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Affiliation(s)
- S B Critchlow
- Specialist Registrar in Restorative Dentistry, New Road, Whitechapel, London, E1 1BB
| | - C Morgan
- Consultant in Restorative Dentistry, Department of Restorative Dentistry, Royal London Hospital Dental Institute, New Road, Whitechapel, London, E1 1BB
| | - T Leung
- Consultant in Restorative Dentistry, Department of Restorative Dentistry, Royal London Hospital Dental Institute, New Road, Whitechapel, London, E1 1BB
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Chrcanovic BR, Albrektsson T, Wennerberg A. Dental implants in irradiated versus nonirradiated patients: A meta-analysis. Head Neck 2015; 38:448-81. [PMID: 25242560 DOI: 10.1002/hed.23875] [Citation(s) in RCA: 61] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/17/2014] [Indexed: 11/06/2022] Open
Abstract
The purpose of the present meta-analysis was to test the null hypothesis of no difference in dental implant failure rates, postoperative infection, and marginal bone loss for patients being rehabilitated by dental implants and being previously irradiated in the head and neck region versus nonirradiated patients against the alternative hypothesis of a difference. The study suggests that irradiation negatively affects the survival of implants, as well as the difference in implant location (maxilla vs mandible), but there is no statistically significant difference in survival when implants are inserted before or after 12 months after radiotherapy. The study failed to support the effectiveness of hyperbaric oxygen therapy in irradiated patients. It was observed that there was a tendency of lower survival rates of implants inserted in the patients submitted to higher irradiation doses. The results should be interpreted with caution because of the presence of uncontrolled confounding factors in the included studies.
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Affiliation(s)
| | - Tomas Albrektsson
- Department of Prosthodontics, Faculty of Odontology, Malmö University, Malmö, Sweden.,Department of Biomaterials, Göteborg University, Göteborg, Sweden
| | - Ann Wennerberg
- Department of Prosthodontics, Faculty of Odontology, Malmö University, Malmö, Sweden
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Dewan K, Kelly RD, Bardsley P. A national survey of consultants, specialists and specialist registrars in restorative dentistry for the assessment and treatment planning of oral cancer patients. Br Dent J 2014; 216:E27. [DOI: 10.1038/sj.bdj.2014.544] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/16/2013] [Indexed: 11/09/2022]
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31
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Ray-Chaudhuri A, Shah K, Porter RJ. The oral management of patients who have received radiotherapy to the head and neck region. Br Dent J 2014; 214:387-93. [PMID: 23619856 DOI: 10.1038/sj.bdj.2013.380] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/07/2012] [Indexed: 01/22/2023]
Abstract
Several thousand patients are diagnosed annually with head and neck cancer (HANC) in the United Kingdom. This represents a significant proportion of all cancers that are diagnosed and a common treatment modality for this is radiotherapy to the head and neck region. Radiotherapy can be highly successful in managing HANC but also has several side-effects in the oral cavity and associated structures. These sequelae present considerable short and long-term problems for dental professionals involved in the care of HANC suffers.
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Affiliation(s)
- A Ray-Chaudhuri
- Restorative Dentistry, St George's Hospital, London, SW17 OQT, UK
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Miyamoto I, Yamashita Y, Yamamoto N, Nogami S, Yamauchi K, Yoshiga D, Kaneuji T, Takahashi T. Evaluation of mandibular reconstruction with particulate cancellous bone marrow and titanium mesh after mandibular resection due to tumor surgery. IMPLANT DENT 2014; 23:108-15. [PMID: 24637525 DOI: 10.1097/id.0000000000000041] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
There are numerous treatment modalities for mandibular defects after tumor surgery. Autogenous particulate cancellous bone marrow graft combined with titanium mesh (PCBM-MESH) is an alternative procedure. The purpose of this study was to evaluate PCBM-MESH for mandibular reconstruction. There were a total of 10 cases from 2000 to 2011. Mandibles were successfully reconstructed in 9 cases; however, reconstruction failed in 1 case. Overall, the recovery of facial contours was excellent; conversely, the evaluation of prosthetic treatment varied widely. Thus, we suggest 3 steps for mandibular reconstruction: (1) recover the continuity of bone segments; (2) simulate optimum facial contours and dental occlusion; and (3) perform the occlusion with dental prostheses. PCBM-MESH is a valuable method for mandibular defects-particularly for restoring facial contours and a favorable alveolar ridge.
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Affiliation(s)
- Ikuya Miyamoto
- *Lecturer, Division of Oral Medicine, Kyushu Dental University, Fukuoka, Japan. †Associate Professor, Department of Oral and Maxillofacial Surgery, Miyazaki University, Miyazaki, Japan. ‡Assistant Professor, Department of Oral and Maxillofacial Surgery, Oita University, Oita, Japan. §Assistant Professor, Division of Oral and Maxillofacial Surgery, Kyushu Dental University, Fukuoka, Japan. ‖Lecturer, Division of Oral and Maxillofacial Surgery, Department of Oral Medicine and Surgery, Tohoku University Graduate School of Dentistry, Sendai, Japan. ¶Professor and Chairman, Division of Oral and Maxillofacial Surgery, Department of Oral Medicine and Surgery, Tohoku University Graduate School of Dentistry, Sendai, Japan
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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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2013] [Accepted: 10/31/2013] [Indexed: 01/03/2023]
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Chen H, Liu N, Xu X, Qu X, Lu E. Smoking, radiotherapy, diabetes and osteoporosis as risk factors for dental implant failure: a meta-analysis. PLoS One 2013; 8:e71955. [PMID: 23940794 PMCID: PMC3733795 DOI: 10.1371/journal.pone.0071955] [Citation(s) in RCA: 128] [Impact Index Per Article: 11.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2013] [Accepted: 07/03/2013] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND There are conflicting reports as to the association between smoking, radiotherapy, diabetes and osteoporosis and the risk of dental implant failure. We undertook a meta-analysis to evaluate the association between smoking, radiotherapy, diabetes and osteoporosis and the risk of dental implant failure. METHODS A comprehensive research on MEDLINE and EMBASE, up to January 2013, was conducted to identify potential studies. References of relevant studies were also searched. Screening, data extraction and quality assessment were conducted independently and in duplicate. A random-effects meta-analysis was used to pool estimates of relative risks (RRs) with 95% confidence intervals (CIs). RESULTS A total of 51 studies were identified in this meta-analysis, with more than 40,000 dental implants placed under risk-threatening conditions. The pooled RRs showed a direct association between smoking (n = 33; RR = 1.92; 95% CI, 1.67-2.21) and radiotherapy (n = 16; RR = 2.28; 95% CI, 1.49-3.51) and the risk of dental implant failure, whereas no inverse impact of diabetes (n = 5; RR = 0.90; 95% CI, 0.62-1.32) on the risk of dental implant failure was found. The influence of osteoporosis on the risk of dental implant failure was direct but not significant (n = 4; RR = 1.09; 95% CI, 0.79-1.52). The subgroup analysis indicated no influence of study design, geographical location, length of follow-up, sample size, or mean age of recruited patients. CONCLUSIONS Smoking and radiotherapy were associated with an increased risk of dental implant failure. The relationship between diabetes and osteoporosis and the risk of implant failure warrant further study.
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Affiliation(s)
- Hui Chen
- College of Stomatology, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Nizhou Liu
- Department of Prosthodontics, Shanghai Ninth People's Hospital, College of Stomatology, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Xinchen Xu
- College of Stomatology, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Xinhua Qu
- Department of Orthopaedics, Shanghai Key Laboratory of Orthopaedic Implant, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Eryi Lu
- Department of Prosthodontics, Shanghai Ninth People's Hospital, College of Stomatology, Shanghai Jiao Tong University School of Medicine, Shanghai, China
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Ray-Chaudhuri A, Shah K, Porter RJ. Radiotherapy: Oral management of patients who have received radiotherapy to the head and neck region. ACTA ACUST UNITED AC 2013. [DOI: 10.1038/vital1650] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
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36
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Holmes JD, Aponte-Wesson R. Dental implants after reconstruction with free tissue transfer. Oral Maxillofac Surg Clin North Am 2010; 22:407-18, vii. [PMID: 20713271 DOI: 10.1016/j.coms.2010.04.002] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
The transfer of composite tissue flaps by microvascular techniques has become the standard for reconstructing complex defects of the oral and maxillofacial regions. Despite advances in these techniques, sites reconstructed by free tissue transfer (free flaps) are often compromised by scarring, bulky tissue, and altered architecture. Dental rehabilitation is often impossible without endosseous implants to aid in stabilization and retention of prostheses. The most commonly used free flaps, however, have significant shortcomings with regard to implant placement, prosthetics, and maintenance. This article describes some site development and prosthetic techniques that can be applied to improve outcomes when dental implants are used in conjunction with free flap reconstruction.
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Affiliation(s)
- Jon D Holmes
- Private practice, Oral and Facial Surgery of Alabama, 1500, 19th Street South, Birmingham, AL 35205, USA.
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