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Pellegrino G, Bertacci A, Relics D, Ferri A, Grande F, Felice P. Hygienic maintenance in patients with maxillae atrophy and in oncological patients with maxillary resection rehabilitated with zygomatic implants: A nested monocentric prospective cohort study. Int J Dent Hyg 2024; 22:696-702. [PMID: 37831522 DOI: 10.1111/idh.12776] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2022] [Revised: 07/14/2023] [Accepted: 09/19/2023] [Indexed: 10/14/2023]
Abstract
OBJECTIVE To assess peri-implant soft tissues condition, comparing clinical parameters of implants placed in patients with atrophic upper jaws and patients who underwent maxillary resection for oncological reasons. BACKGROUND Zygomatic implants (ZIs) in oncologic patients could be affected by more complications compared to implants placed in atrophic maxillae. The soft tissue condition is an essential requirement for implant success, but few studies have investigated this topic. METHODS A nested monocentric prospective parallel cohort (atrophic vs. oncological patients) study was performed. Clinical visits and professional hygiene sessions were performed every three months, and bleeding on probing (BOP), probing pocket depth (PPD), gingival index (GI), plaque index (PI) and implant mobility were recorded by a blind outcome assessor. RESULTS In total, 77 ZIs placed in 21 patients were evaluated: 54 (70.1%) ZIs were inserted in patients belonging to the atrophic cohort (PAM) and 23 (29.9%) ZIs in the oncologic cohort (OP). The probability of having BOP at the considered mean follow-up (27 months) was 24.8% (95% CI 19.0-31.9) for PAM and 22.9% (95% CI 15.1-33.9) OP. The mean PPD values were 2.78 ± 1.28 (range 1-8) in PAM and 2.91 ± 1.98 (range 0-10) in OP. None of the implants showed mobility. No associations between group belongingness and the entity of PPD, PI, GI and the risk of BOP were found, adjusting for the considered confounding factors (age, smoking and implant position). CONCLUSIONS Under a strict supportive hygiene therapy protocol ZIs in oncologic patients showed similar peri-implant tissue conditions to that of patients with maxillary atrophy.
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Affiliation(s)
- Gerardo Pellegrino
- Department of Biomedical and Neuromotor Sciences (DiBiNeM), School of Dentistry, University of Bologna, Bologna, Italy
| | - Angelica Bertacci
- Department of Biomedical and Neuromotor Sciences (DiBiNeM), School of Dentistry, University of Bologna, Bologna, Italy
| | - Daniela Relics
- Department of Translational Medicine, University of Ferrara, Ferrara, Italy
| | - Agnese Ferri
- Department of Biomedical and Neuromotor Sciences (DiBiNeM), School of Dentistry, University of Bologna, Bologna, Italy
| | - Francesco Grande
- Department of Translational Medicine, University of Ferrara, Ferrara, Italy
| | - Pietro Felice
- Department of Biomedical and Neuromotor Sciences (DiBiNeM), School of Dentistry, University of Bologna, Bologna, Italy
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Mathevosyan D, Hovhannisyan S, Mashinyan K, Khachatryan L, Badalyan A, Hakobyan G. Prosthetic rehabilitation of patients with maxillary oncology defects using zygomatic implants. Int J Implant Dent 2024; 10:31. [PMID: 38856842 PMCID: PMC11164848 DOI: 10.1186/s40729-024-00545-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2024] [Accepted: 05/21/2024] [Indexed: 06/11/2024] Open
Abstract
PURPOSE Prosthetics for patients after oncological resection of the upper jaw is a complex problem associated with the physiological and anatomical separation of the oral cavity and the nasal/paranasal region. This study reports the clinical results of the use of the zygomatic implants for prosthetic rehabilitation in patients with maxillectomy due to upper jaw tumors. MATERIALS AND METHODS The study included 16 patients who underwent prosthetic rehabilitation using a zygomatic implant after maxillectomy period from 2021 to 2023. After the tumor was removed, immediate surgical obturators were placed. Main prosthetic rehabilitation was performed 6-12 months after tumor removal, but before that, a temporary obturator was made and used. Six-twelve months after tumor resection, 1-4 zygomatic implants were inserted into the zygomatic bone unilaterally or bilaterally. A total of 42 zygomatic implants were installed, 2 of which were unsuccessful and were removed in 1 patient. The implants were placed using the surgical guide, which was planned and prepared digitally. RESULTS No postsurgical complications were seen, and the patients were discharged from the hospital after 7-10 days. The patients were able to return to a normal diet (hard food) after just 7 days following surgery, with no further complaints regarding function or pain, apart from the residual edema caused by the intervention. CONCLUSIONS The use of prostheses fixed on zygomatic implants in patients with maxillary defects is an effective method of prosthodontic rehabilitation in complex clinical cases after maxillectomy.
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Affiliation(s)
- Davit Mathevosyan
- Department of Oral and Maxillofacial Surgery, Yerevan State Medical University after M. Heratsi, Yerevan, Abovyan, Armenia
| | - Sergo Hovhannisyan
- Department of Prosthodontics, Yerevan State Medical University after M. Heratsi, Yerevan, Armenia
| | - Karen Mashinyan
- Department of Prosthodontics, Yerevan State Medical University after M. Heratsi, Yerevan, Armenia
| | - Levon Khachatryan
- Department Head and Neck Surgery Modern Implant Medicine, Yerevan, Armenia
| | - Aram Badalyan
- Department Head and Neck Surgery, NAIRI Medical Center, Yerevan, Armenia
| | - Gagik Hakobyan
- Department of Oral and Maxillofacial Surgery, Yerevan State Medical University after M. Heratsi, Yerevan, Abovyan, Armenia.
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3
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Polido WD, Machado-Fernandez A, Lin WS, Aghaloo T. Indications for zygomatic implants: a systematic review. Int J Implant Dent 2023; 9:17. [PMID: 37391575 DOI: 10.1186/s40729-023-00480-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2023] [Accepted: 05/09/2023] [Indexed: 07/02/2023] Open
Abstract
PURPOSE The purpose of this systematic review was to assess the evidence regarding the indications for placement of zygomatic implants to rehabilitate edentulous maxillae. MATERIAL AND METHODS A focused question using the PIO format was developed, questioning "in patients in need of an implant-supported rehabilitation of the edentulous maxillae, what are the indications for the use of zygomatic implants''. The primary information analyzed and collected was a clear description of the indication for the use of zygomatic implants. RESULTS A total of 1266 records were identified through database searching. The full-text review was conducted for 117 papers, and 10 were selected to be included in this review. Zygomatic implant indications were extreme bone atrophy or deficiency secondary to different factors. The quad zygoma concept (two zygomatic implants bilaterally placed and splinted) was applied to 107 patients, the classic zygoma concept (one zygomatic implant bilaterally placed and splinted to standard anterior implants) was used in 88 patients, and the unilateral concept (one zygomatic implant on one side, splinted with one or more conventional implants) was employed in 14 patients. CONCLUSIONS The main indication for the use of zygomatic implants was considered extreme maxillary bone atrophy, resulting from many factors. The clear definition of what was considered "extreme bone atrophy" is not uniquely defined in each paper. Further studies are needed to develop clear indications for zygomatic implants.
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Affiliation(s)
- Waldemar D Polido
- Department of Oral and Maxillofacial Surgery, Indiana University School of Dentistry, Indianapolis, USA.
| | | | - Wei-Shao Lin
- Department of Prosthodontics, Indiana University School of Dentistry, Indianapolis, USA
| | - Tara Aghaloo
- Section of Oral and Maxillofacial Surgery, UCLA School of Dentistry, Los Angeles, CA, USA
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4
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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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Sharaf MY, Eskander AE. Patient Satisfaction regarding Conventional One-Piece Versus Two-Piece Magnet-Retained Obturator for Patients with Complete Edentulism: A Preliminary Crossover Clinical Trial. Open Dent J 2022. [DOI: 10.2174/18742106-v16-e2203140] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Purpose:
This study aimed at evaluating patients' satisfaction with conventional one-piece obturators versus two-piece magnet-retained obturators in completely edentulous patient maxillectomy cases.
Materials and Methods:
Ten completely edentulous participants with hemimaxillectomy (8 males and 2 females) were selected in a crossover study. Participants received a conventional obturator one-piece and two-piece obturators connected by magnet attachment in alternate periods (sequences A‐B and B‐A), and outcomes were assessed after 1 week, 3 months, and 6 months Evaluation was made using Obturator Functioning Scale (OFS) and Oral Health Impact Profile for edentulous people (OHIP-EDENT). One way ANOVA test and multivariate analysis of variance with a general linear model with repeated measures was used to test the impact of the group, time, and order on each of the studied scores (α=.05).
Results:
Magnet design showed a statistically significant lower score (P <.050) than the conventional design regarding the overall satisfaction score of OFS along all follow-up periods. Concerning OHIP-EDENT, the magnet design showed a statistically significant lower score (P <.050) than the conventional design regarding total functional limitations, total physical pain, and total social disability along all follow-up periods while for total psychological discomfort, total physical disability, and total handicap, no statistically significant difference was observed between both groups (P >.050).
Conclusion:
Two-pieces magnet-retained obturator could provide better satisfaction and better restoration of orofacial function than the conventional one to manage completely edentulous patients.
Clinical Trial Registration Number:
NCT05066828
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6
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Rogers SN, Adatia A, Hackett S, Boscarino A, Patel A, Lowe D, Butterworth CJ. Changing trends in the microvascular reconstruction and oral rehabilitation following maxillary cancer. Eur Arch Otorhinolaryngol 2022; 279:4113-4126. [PMID: 35106619 PMCID: PMC9249696 DOI: 10.1007/s00405-022-07277-y] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2021] [Accepted: 01/17/2022] [Indexed: 11/22/2022]
Abstract
Purpose The maxillectomy defect is complex and the best means to achieve optimal reconstruction, and dental rehabilitation is a source of debate. The refinements in zygomatic implant techniques have altered the means and speed by which rehabilitation can be achieved and has also influenced the choice regarding ideal flap reconstruction. The aim of this study is to report on how the method of reconstruction and oral rehabilitation of the maxilla has changed since 1994 in our Institution, and to reflect on case mix and survival. Methods Consecutive head and neck oncology cases involving maxillary resections over a 27-year period between January 1994 and November 2020 were identified from hospital records and previous studies. Case note review focussed on clinical characteristics, reconstruction, prosthetic rehabilitation, and survival. Results There were 186 patients and the tumour sites were: alveolus for 56% (104), hard palate for 19% (35), maxillary sinus for 18% (34) and nasal for 7% (13). 52% (97) were Brown class 2 defects. Forty-five patients were managed by obturation and 78% (142/183) had free tissue transfer. The main flaps used were radial (52), anterolateral thigh (27), DCIA (22), scapula (13) and fibula (11). There were significant changes over time regarding reconstruction type, use of primary implants, type of dental restoration, and length of hospital stay. Overall survival after 24 months was 64% (SE 4%) and after 60 months was 42% (SE 4%). Conclusion These data reflect a shift in the reconstruction of the maxillary defect afforded by the utilisation of zygomatic implants.
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Affiliation(s)
- Simon N Rogers
- Regional Maxillofacial Unit, Liverpool Head and Neck Centre, Liverpool University Hospital NHS Foundation Trust, Lower Lane, Liverpool, UK. .,Faculty of Health, Social Care and Medicine, Edge Hill University, Ormskirk, L39 4QP, England.
| | - Ashni Adatia
- Regional Maxillofacial Unit, Liverpool Head and Neck Centre, Liverpool University Hospital NHS Foundation Trust, Lower Lane, Liverpool, UK
| | - Stephanie Hackett
- Regional Maxillofacial Unit, Liverpool Head and Neck Centre, Liverpool University Hospital NHS Foundation Trust, Lower Lane, Liverpool, UK
| | - Angela Boscarino
- Regional Maxillofacial Unit, Liverpool Head and Neck Centre, Liverpool University Hospital NHS Foundation Trust, Lower Lane, Liverpool, UK
| | - Anika Patel
- Regional Maxillofacial Unit, Liverpool Head and Neck Centre, Liverpool University Hospital NHS Foundation Trust, Lower Lane, Liverpool, UK
| | - Derek Lowe
- Astraglobe Ltd, Congleton, Cheshire, England
| | - Christopher J Butterworth
- Regional Maxillofacial Unit, Liverpool Head and Neck Centre, Liverpool University Hospital NHS Foundation Trust, Lower Lane, Liverpool, UK.,Faculty of Health and Life Sciences, University of Liverpool, Liverpool, UK
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7
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Soft Tissue Dehiscence Associated with a Titanium Patient-Specific Implant: A Prosthetic Solution as an Alternative to Soft Tissue Grafting. Case Rep Dent 2022; 2021:5125375. [PMID: 34970459 PMCID: PMC8714330 DOI: 10.1155/2021/5125375] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2021] [Accepted: 10/29/2021] [Indexed: 11/18/2022] Open
Abstract
Patients. This clinical report describes the detailed prosthodontic management of a 23-year-old male patient suffering from soft tissue complication following the placement of a 3d-printed titanium patient-specific implant. This implant was implemented simultaneously with the resection of a calcifying cystic odontogenic tumor related to the maxillary arch. Later, soft tissue dehiscence and implant exposure were encountered with subsequent food impaction, infection, and pus discharge. The treatment plan was to fabricate removable partial denture. The prosthesis was planned to be retained by bar and clip attachment on the patient-specific implant side, while on the other side, the removable prosthesis was allowed to engage two abutments with an embrasure clasp assembly in addition to covering the palatal tissues to offer protection for the soft tissue dehiscence against food impaction. Discussion. Soft tissue dehiscence and implant exposure are among the frequently reported complications associated with the patient-specific implant. The resulting infection complicates the prognosis of the implemented implant and necessitates, in some occasions, its removal. The selection of the removable prosthesis to cover soft tissue dehiscence was a conservative alternative to the implant removal as it protects the exposed titanium surface from food impaction while maintaining the implant functionality. Conclusion. Three-year follow-up showed complete resolution of the patient's complaints while fulfilling the patient's aesthetic and functional demands and indicates that the use of detachable overlay prosthesis could be one of the proposed treatment options.
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8
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Kumari A, Mandal N, Baldev K, Shobana T, Warghane K, Doddy L, Peela P. A clinical evaluation of implant-supported maxillary obturator prostheses: An original study. J Pharm Bioallied Sci 2022; 14:S313-S314. [PMID: 36110761 PMCID: PMC9469456 DOI: 10.4103/jpbs.jpbs_777_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2021] [Revised: 12/16/2021] [Accepted: 12/30/2021] [Indexed: 11/12/2022] Open
Abstract
Introduction: Rehabilitation after the maxillectomy is challenging to the clinician and the patient. Since the invention of the implants, the rehabilitation has changed the treatment strategies. Hence in our study, we evaluated the maxillary obturator that is implant supported. Materials and Methods: We piloted a retrospective analysis of the patients who received the maxillary obturator prosthesis with implant support from the department records from 2010 to 2020. We finalized 50 subjects who fit the criteria and evaluated clinically for various parameters. The comparison of these parameters was done using the Chi-square tests deliberating P < 0.05 as significant. Results: We observed that the implant survival was 94%. There was significant variation for the implant bone height (P = 0.001) and the implant threads exposed (P = 0.044) for the posterior and the anterior regions. Conclusion: The implant-supported maxillary obturator prosthesis has been shown to perform clinically satisfactorily. The success of the implant-supported maxillary obturator is dependent on the time of the placement, load applied, the radiation regime, and the patient follow-up.
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9
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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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10
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Hackett S, El-Wazani B, Butterworth C. Zygomatic implant-based rehabilitation for patients with maxillary and mid-facial oncology defects: A review. Oral Dis 2020; 27:27-41. [PMID: 32048429 DOI: 10.1111/odi.13305] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2020] [Revised: 01/28/2020] [Accepted: 01/30/2020] [Indexed: 11/30/2022]
Abstract
OBJECTIVES This literature review reports the current evidence for the use of zygomatic implants in head and neck oncology patients for the prosthetic rehabilitation of defects of the mid-face and maxilla. METHODS MEDLINE, Embase and Cochrane databases were searched using strict search terms. Two independent reviewers reviewed the articles and applied inclusion and exclusion criteria. RESULTS Literature search revealed 437 articles, and following application of the inclusion criteria, 32 articles were included for analysis. Overall survival rates of 77%-100% were reported with few complications, although only four centres presented data on 20 or more patients. Primary implant placement at time of resective surgery has been shown to be an effective means of accelerating rehabilitation along with early loading protocols. The role of radiotherapy in implant failure has not been fully elucidated, and it is clear that zygomatic implants can be successfully used in the irradiated patient. Providing support for maxillary obturators was the most common use reported with both splinted and unsplinted implants. CONCLUSIONS Zygomatic implants provide remote anchorage for a variety of oral and facial prostheses that contribute to the improved function and quality of life for patients being treated for maxillary and mid-facial tumours.
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Affiliation(s)
- Stephanie Hackett
- Department of Maxillofacial Prosthodontics, Liverpool University Hospitals NHS Foundation Trust, Liverpool, UK
| | - Basma El-Wazani
- Department of Maxillofacial Prosthodontics, Liverpool University Hospitals NHS Foundation Trust, Liverpool, UK
| | - Chris Butterworth
- Department of Maxillofacial Prosthodontics, Liverpool University Hospitals NHS Foundation Trust, Liverpool, UK
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11
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Buurman DJM, Speksnijder CM, Engelen BHBT, Kessler P. Masticatory performance and oral health-related quality of life in edentulous maxillectomy patients: A cross-sectional study to compare implant-supported obturators and conventional obturators. Clin Oral Implants Res 2020; 31:405-416. [PMID: 31944417 PMCID: PMC7319476 DOI: 10.1111/clr.13577] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2019] [Revised: 12/05/2019] [Accepted: 01/08/2020] [Indexed: 10/28/2022]
Abstract
OBJECTIVE The aim of this cross-sectional study was to compare the masticatory performance and oral health-related quality of life (OHRQoL) of edentulous maxillectomy patients with and without implant-supported obturator prostheses. MATERIAL AND METHODS Nineteen edentulous maxillectomy patients with completed prosthetic obturator treatment in the upper jaw participated in this study. In nine patients, the obturator prosthesis was supported by implants in the remaining bone of the midface and/or skull base to improve retention. Masticatory performance was measured objectively by the mixing ability test (MAT) and subjectively by three OHRQoL questionnaires: (a) the Oral Health Impact Profile for EDENTulous people (OHIP-EDENT), (b) the Obturator Function Scale (OFS), and (c) the Dutch Liverpool Oral Rehabilitation Questionnaire version 3 (LORQv3-NL). The independent t test and the Mann-Whitney U test were used to test for differences in outcomes of patients with and without implant-retention of their obturator prostheses. RESULTS Patients with implant-supported obturator prostheses had significantly better masticatory and oral function, reported fewer chewing difficulties, and had less discomfort during food intake than did patients with a conventional obturator. CONCLUSION Supporting prosthetic obturators after maxillectomy with implants improve oral functioning, chewing, and eating comfort. This treatment modality is a viable technique to improve the functionality of prosthetic rehabilitation in patients who have undergone maxillectomy.
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Affiliation(s)
- Doke J M Buurman
- Department of Cranio-Maxillofacial Surgery, Maastricht University Medical Center, Maastricht, The Netherlands.,GROW School for Oncology and Developmental Biology, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Caroline M Speksnijder
- Department of Cranio-Maxillofacial Surgery, Maastricht University Medical Center, Maastricht, The Netherlands.,Department of Head and Neck Surgical Oncology, University Medical Center Utrecht Cancer Center, Utrecht University, Utrecht, The Netherlands.,Julius Center Sciences, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands.,Department of Oral and Maxillofacial Surgery and Special Dental Care, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Britt H B T Engelen
- Department of Cranio-Maxillofacial Surgery, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Peter Kessler
- Department of Cranio-Maxillofacial Surgery, Maastricht University Medical Center, Maastricht, The Netherlands.,GROW School for Oncology and Developmental Biology, Maastricht University Medical Centre, Maastricht, The Netherlands
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12
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Hämmerle CHF, Tarnow D. The etiology of hard- and soft-tissue deficiencies at dental implants: A narrative review. J Periodontol 2019; 89 Suppl 1:S291-S303. [PMID: 29926950 DOI: 10.1002/jper.16-0810] [Citation(s) in RCA: 54] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2016] [Revised: 11/07/2017] [Accepted: 12/11/2017] [Indexed: 01/19/2023]
Abstract
OBJECTIVE The objective of the present paper was to review factors and conditions that are associated with hard and soft-tissue deficiencies at implant sites. IMPORTANCE Hard- and soft-tissue deficiencies at dental implants are common clinical findings. They can lead to complications and compromise implant survival and, hence, may require therapeutic interventions. It is, therefore, important to understand the etiology of hard and soft-tissue deficiencies. Based on this understanding, strategies should be developed to correct hard and soft-tissue deficiencies with the aim of improving clinical outcomes of implant therapy. FINDINGS A large number of etiological factors have been identified that may lead to hard and soft-tissue deficiencies. These factors include: 1) systemic diseases and conditions of the patients; 2) systemic medications; 3) processes of tissue healing; 4) tissue turnover and tissue response to clinical interventions; 5) trauma to orofacial structures; 6) local diseases affecting the teeth, the periodontium, the bone and the mucosa; 7) biomechanical factors; 8) tissue morphology and tissue phenotype; and 9) iatrogenic factors. These factors may appear as an isolated cause of hard and soft-tissue defects or may appear in conjunction with other factors. CONCLUSIONS Hard- and soft-tissue deficiencies at implant sites may result from a multitude of factors. They encompass natural resorption processes following tooth extraction, trauma, infectious diseases such as periodontitis, peri-implantitis, endodontic infections, growth and development, expansion of the sinus floor, anatomical preconditions, mechanical overload, thin soft tissues, lack of keratinized mucosa, malpositioning of implants, migration of teeth, lifelong growth, and systemic diseases. When more than one factor leading to hard and/or soft-tissue deficiencies appear together, the severity of the resulting condition may increase. Efforts should be made to better identify the relative importance of these etiological factors, and to develop strategies to counteract their negative effects on our patient's wellbeing.
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Affiliation(s)
- Christoph H F Hämmerle
- Chairman of the Clinic of Fixed and Removable Prosthodontics and Dental Material Science, Center of Dental Medicine, University of Zurich, Switzerland
| | - Dennis Tarnow
- Director of Implant Education, Columbia University College of Dental Medicine, New York, NY, USA
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13
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Hämmerle CHF, Tarnow D. The etiology of hard- and soft-tissue deficiencies at dental implants: A narrative review. J Clin Periodontol 2019; 45 Suppl 20:S267-S277. [PMID: 29926502 DOI: 10.1111/jcpe.12955] [Citation(s) in RCA: 41] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2016] [Revised: 11/07/2017] [Accepted: 12/11/2017] [Indexed: 01/01/2023]
Abstract
OBJECTIVE The objective of the present paper was to review factors and conditions that are associated with hard and soft-tissue deficiencies at implant sites. IMPORTANCE Hard- and soft-tissue deficiencies at dental implants are common clinical findings. They can lead to complications and compromise implant survival and, hence, may require therapeutic interventions. It is, therefore, important to understand the etiology of hard and soft-tissue deficiencies. Based on this understanding, strategies should be developed to correct hard and soft-tissue deficiencies with the aim of improving clinical outcomes of implant therapy. FINDINGS A large number of etiological factors have been identified that may lead to hard and soft-tissue deficiencies. These factors include: 1) systemic diseases and conditions of the patients; 2) systemic medications; 3) processes of tissue healing; 4) tissue turnover and tissue response to clinical interventions; 5) trauma to orofacial structures; 6) local diseases affecting the teeth, the periodontium, the bone and the mucosa; 7) biomechanical factors; 8) tissue morphology and tissue phenotype; and 9) iatrogenic factors. These factors may appear as an isolated cause of hard and soft-tissue defects or may appear in conjunction with other factors. CONCLUSIONS Hard- and soft-tissue deficiencies at implant sites may result from a multitude of factors. They encompass natural resorption processes following tooth extraction, trauma, infectious diseases such as periodontitis, peri-implantitis, endodontic infections, growth and development, expansion of the sinus floor, anatomical preconditions, mechanical overload, thin soft tissues, lack of keratinized mucosa, malpositioning of implants, migration of teeth, lifelong growth, and systemic diseases. When more than one factor leading to hard and/or soft-tissue deficiencies appear together, the severity of the resulting condition may increase. Efforts should be made to better identify the relative importance of these etiological factors, and to develop strategies to counteract their negative effects on our patient's wellbeing.
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Affiliation(s)
- Christoph H F Hämmerle
- Chairman of the Clinic of Fixed and Removable Prosthodontics and Dental Material Science, Center of Dental Medicine, University of Zurich, Switzerland
| | - Dennis Tarnow
- Director of Implant Education, Columbia University College of Dental Medicine, New York, NY, USA
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Butterworth CJ. Primary vs secondary zygomatic implant placement in patients with head and neck cancer-A 10-year prospective study. Head Neck 2019; 41:1687-1695. [PMID: 30664292 DOI: 10.1002/hed.25645] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2018] [Revised: 09/23/2018] [Accepted: 12/10/2018] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND Zygomatic implants can provide excellent remote anchorage to support the prosthetic rehabilitation of patients treated for maxillary and midfacial tumors. METHODS Patients who underwent zygomatic implant placement by the author between 2006 and 2016 as part of their oncology treatment were followed prospectively. RESULTS Forty-nine consecutively treated patients received 131 zygomatic implants of which 9 failed and were removed from 4 patients; 24 patients (49%) received radiotherapy either before or after implant insertion. The overall 12-month survival estimate was 94% and the 60-month estimate was 92%. CONCLUSIONS The use of zygomatic implants in the management of maxillary and midfacial malignancy is a predictable prosthetic treatment modality to support complex oral and facial prostheses. Their use with or without free tissue transfer can provide effective prosthetic rehabilitation with high implant survival irrespective of the timing of placement or the need for adjuvant radiotherapy. CLINICAL SIGNIFICANCE Zygomatic Implants provide an excellent platform for the restoration of the dentition and facial structures affected by maxillary and midfacial malignant disease.
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Affiliation(s)
- Chris J Butterworth
- Department of Oral and Maxillofacial Surgery, Aintree University Hospital NHS Foundation Trust, Liverpool, UK.,Department of Clinical and Molecular Cancer Medicine, University of Liverpool, Liverpool, UK
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Edher F, Nguyen CT. Short dental implants: A scoping review of the literature for patients with head and neck cancer. J Prosthet Dent 2017; 119:736-742. [PMID: 28927926 DOI: 10.1016/j.prosdent.2017.06.003] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2017] [Revised: 06/06/2017] [Accepted: 06/08/2017] [Indexed: 10/18/2022]
Abstract
STATEMENT OF PROBLEM Dental implants can be essential in the rehabilitation of various cancer defects, but their ideal placement can be complicated by the limited dimensions of the available host bone. Surgical interventions developed to increase the amount of bone are not all predictable or successful and can sometimes be contraindicated. Short dental implants have been suggested as an alternative option in sites where longer implants are not possible. Whether they provide a successful treatment option is unclear. PURPOSE The purpose of this study was to review the literature on short dental implants and assess whether they are a viable definitive treatment option for rehabilitating cancer patients with deficient bone. MATERIAL AND METHODS A scoping review of the literature was performed, including a search of established periodontal textbooks for articles on short dental implants combined with a search of PubMed, MEDLINE, EMBASE, Web of Science, and Cochrane Database of Systematic Reviews. A search for all literature published before June 2016 was based on the following keywords: ['dental implants' OR 'dental implantation, endosseous' OR 'dental prosthesis, implant supported'] AND [short]. RESULTS The minimum acceptable implant length has been considered to be 6 mm. The survival rates of short implants varied between 74% and 96% at 5 years, depending on factors such as the quality of the patient's bone, primary stability of the implant, clinician's learning curve, and implant surface. Short implants can achieve results similar to those of longer implants in augmented bone and offer a treatment alternative that could reduce the need for invasive surgery and associated morbidity and be safer and more economical. CONCLUSIONS Short dental implants (6 mm to 8 mm) can be used successfully to support single or multiple fixed reconstructions or overdentures in atrophic maxillae and mandibles. The use of short dental implants lessens the need for advanced and complicated surgical bone augmentation procedures, which reduces complications, costs, treatment time, and morbidity. Short implants could be an alternative in the rehabilitation of patients with cancer.
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Affiliation(s)
- Faraj Edher
- Graduate student, Faculty of Dentistry, University of British Columbia, Vancouver, British Columbia, Canada
| | - Caroline T Nguyen
- Assistant Professor, Department of Oral Health Sciences, University of British Columbia; and Provincial Practice Leader in Prosthodontics, Department of Oral Oncology and Dentistry, British Columbia Cancer Agency, Vancouver, British Columbia, Canada.
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Salvatori P, Mincione A, Rizzi L, Costantini F, Bianchi A, Grecchi E, Garagiola U, Grecchi F. Maxillary resection for cancer, zygomatic implants insertion, and palatal repair as single-stage procedure: report of three cases. Maxillofac Plast Reconstr Surg 2017; 39:13. [PMID: 28603707 PMCID: PMC5443715 DOI: 10.1186/s40902-017-0112-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2017] [Accepted: 04/01/2017] [Indexed: 12/26/2022] Open
Abstract
Background Oronasal/antral communication, loss of teeth and/or tooth-supporting bone, and facial contour deformity may occur as a consequence of maxillectomy for cancer. As a result, speaking, chewing, swallowing, and appearance are variably affected. The restoration is focused on rebuilding the oronasal wall, using either flaps (local or free) for primary closure, either prosthetic obturator. Postoperative radiotherapy surely postpones every dental procedure aimed to set fixed devices, often makes it difficult and risky, even unfeasible. Regular prosthesis, tooth-bearing obturator, and endosseous implants (in native and/or transplanted bone) are used in order to complete dental rehabilitation. Zygomatic implantology (ZI) is a valid, usually delayed, multi-staged procedure, either after having primarily closed the oronasal/antral communication or after left it untreated or amended with obturator. The present paper is an early report of a relatively new, one-stage approach for rehabilitation of patients after tumour resection, with palatal repair with loco-regional flaps and zygomatic implant insertion: supposed advantages are concentration of surgical procedures, reduced time of rehabilitation, and lowered patient discomfort. Cases presentation We report three patients who underwent alveolo-maxillary resection for cancer and had the resulting oroantral communication directly closed with loco-regional flaps. Simultaneous zygomatic implant insertion was added, in view of granting the optimal dental rehabilitation. Conclusions All surgical procedures were successful in terms of oroantral separation and implant survival. One patient had the fixed dental restoration just after 3 months, and the others had to receive postoperative radiotherapy; thus, rehabilitation timing was longer, as expected. We think this approach could improve the outcome in selected patients.
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Affiliation(s)
- Pietro Salvatori
- Department of Otorhinolaryngology-H&N Surgery, Humanitas San Pio X Hospital, Via F. Nava 31, 20159 Milan, Italy
| | - Antonio Mincione
- Department of Otorhinolaryngology, Ospedale Civile, Via Papa Giovanni Paolo II, 20025 Legnano, MI Italy
| | - Lucio Rizzi
- Department of Otorhinolaryngology, Ospedale Civile, Via Papa Giovanni Paolo II, 20025 Legnano, MI Italy
| | - Fabrizio Costantini
- Department of Otorhinolaryngology-H&N Surgery, Humanitas San Pio X Hospital, Via F. Nava 31, 20159 Milan, Italy
| | - Alessandro Bianchi
- Department of Otorhinolaryngology-H&N Surgery, Humanitas San Pio X Hospital, Via F. Nava 31, 20159 Milan, Italy
| | - Emma Grecchi
- Department of Oral Surgery, IRCCS Fondazione Ca' Granda, Ospedale Maggiore Policlinico, Via F. Sforza 35, 20122 Milan, Italy
| | - Umberto Garagiola
- Biomedical Surgical and Dental Sciences Department, Maxillo-Facial and Odontostomatology Unit, Fondazione Cà Granda IRCCS Ospedale Maggiore Policlinico, University of Milan, Milan, Italy
| | - Francesco Grecchi
- Department of Maxillo-Facial Surgery, Istituto Ortopedico Galeazzi, Via R. Galeazzi 4, 20161 Milan, Italy
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Chrcanovic BR, Albrektsson T, Wennerberg A. Survival and Complications of Zygomatic Implants: An Updated Systematic Review. J Oral Maxillofac Surg 2016; 74:1949-64. [PMID: 27422530 DOI: 10.1016/j.joms.2016.06.166] [Citation(s) in RCA: 121] [Impact Index Per Article: 15.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2016] [Revised: 06/01/2016] [Accepted: 06/08/2016] [Indexed: 12/29/2022]
Abstract
PURPOSE To assess the survival rate of zygomatic implants (ZIs) and the prevalence of complications based on previously published studies. MATERIALS AND METHODS An electronic search of 3 databases was performed in December 2015 and was supplemented by manual searching. Clinical series of ZIs were included. Interval survival rate and cumulative survival rate (CSR) were calculated. The untransformed proportion of complications (sinusitis, soft tissue infection, paresthesia, oroantral fistulas) was calculated by considering the prevalence reported in the studies. RESULTS Sixty-eight studies were included, comprising 4,556 ZIs in 2,161 patients with 103 failures. The 12-year CSR was 95.21%. Most failures were detected within the 6-month postsurgical period. Studies (n = 26) that exclusively evaluated immediate loading showed a statistically lower ZI failure rate than studies (n = 34) evaluating delayed loading protocols (P = .003). Studies (n = 5) evaluating ZIs for the rehabilitation of patients after maxillary resections presented lower survival rates. The probability of presenting postoperative complications with ZIs was as follows: sinusitis, 2.4% (95% confidence interval [CI], 1.8-3.0); soft tissue infection, 2.0% (95% CI, 1.2-2.8); paresthesia, 1.0% (95% CI, 0.5-1.4); and oroantral fistulas, 0.4% (95% CI, 0.1-0.6). However, these numbers might be underestimated, because many studies failed to mention the prevalence of these complications. CONCLUSION ZIs present a high 12-year CSR, with most failures occurring at the early stages postoperatively. The main observed complication related to ZIs was sinusitis, which can appear several years after ZI installation surgery.
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Affiliation(s)
- Bruno Ramos Chrcanovic
- PhD student, Department of Prosthodontics, Faculty of Odontology, Malmö University, Malmö, Sweden.
| | - Tomas Albrektsson
- Retired Professor and former Department Head, Department of Biomaterials, Göteborg University, Göteborg; Guest Professor, Department of Prosthodontics, Faculty of Odontology, Malmö University, Malmö, Sweden
| | - Ann Wennerberg
- Professor and Department Head, Department of Prosthodontics, Faculty of Odontology, Malmö University, Malmö, Sweden
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Wu Y, Huang W, Zhang Z, Zhang Z, Zou D. Long-term success of dental implant-supported dentures in postirradiated patients treated for neoplasms of the maxillofacial skeleton: a retrospective study. Clin Oral Investig 2016; 20:2457-2465. [PMID: 26907545 DOI: 10.1007/s00784-016-1753-z] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2015] [Accepted: 02/11/2016] [Indexed: 11/29/2022]
Abstract
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.
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Affiliation(s)
- Yiqun Wu
- Department of Oral Implants, School of Medicine, Ninth People's Hospital affiliated with Shanghai Jiao Tong University, Shanghai, China
| | - Wei Huang
- Department of Oral Implants, School of Medicine, Ninth People's Hospital affiliated with Shanghai Jiao Tong University, Shanghai, China
| | - Zhiyong Zhang
- Department of Oral Implants, School of Medicine, Ninth People's Hospital affiliated with Shanghai Jiao Tong University, Shanghai, China
| | - Zhiyuan Zhang
- Department of Oral and Maxillofacial Surgery, School of Medicine, Ninth People's Hospital affiliated with Shanghai Jiao Tong University, Shanghai, China
| | - Duohong Zou
- Department of Implants Dentistry, School of Medicine, Ninth People's Hospital affiliated with Shanghai Jiao Tong University, Shanghai, China.
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Wang F, Huang W, Zhang C, Sun J, Qu X, Wu Y. Functional outcome and quality of life after a maxillectomy: a comparison between an implant supported obturator and implant supported fixed prostheses in a free vascularized flap. Clin Oral Implants Res 2016; 28:137-143. [PMID: 26725478 DOI: 10.1111/clr.12771] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/12/2015] [Indexed: 11/29/2022]
Affiliation(s)
- Feng Wang
- Department of Oral Implantology; Ninth People's Hospital; School of Medicine; Shanghai Key Laboratory of Stomatology; Shanghai Jiao Tong University; Shanghai China
| | - Wei Huang
- Department of Oral Implantology; Ninth People's Hospital; School of Medicine; Shanghai Key Laboratory of Stomatology; Shanghai Jiao Tong University; Shanghai China
| | - Chenping Zhang
- Department of Oral and Maxillofacial-Head and Neck Oncology; Ninth People's Hospital; School of Medicine; Shanghai Key Laboratory of Stomatology; Shanghai Jiao Tong University; Shanghai China
| | - Jian Sun
- Department of Oral and Maxillofacial-Head and Neck Oncology; Ninth People's Hospital; School of Medicine; Shanghai Key Laboratory of Stomatology; Shanghai Jiao Tong University; Shanghai China
| | - Xingzhou Qu
- Department of Oral and Maxillofacial-Head and Neck Oncology; Ninth People's Hospital; School of Medicine; Shanghai Key Laboratory of Stomatology; Shanghai Jiao Tong University; Shanghai China
| | - Yiqun Wu
- Department of Oral Implantology; Ninth People's Hospital; School of Medicine; Shanghai Key Laboratory of Stomatology; Shanghai Jiao Tong University; Shanghai China
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Wu Y, Wang XD, Wang F, Huang W, Zhang Z, Zhang Z, Kaigler D, Zou D. Restoration of Oral Function for Adult Edentulous Patients with Ectodermal Dysplasia: A Prospective Preliminary Clinical Study. Clin Implant Dent Relat Res 2015; 17 Suppl 2:e633-42. [PMID: 25728861 DOI: 10.1111/cid.12296] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
BACKGROUND Therapy with zygomatic implants (ZIs) or conventional implants (CIs) has proven to be an effective method to restore oral function for systemically healthy patients. However, it is still a major challenge to fully restore oral function to edentulous adult patients with ectodermal dysplasia (ED). PURPOSE The aim of this study was to determine an effective treatment protocol for restoring oral function using ZIs and CIs to edentulous adult ED patients. MATERIALS AND METHODS Ten edentulous adult ED patients were treated in this study. The treatment protocol involved the following: (1) bone augmentation in the region of the anterior teeth; (2) placement of two ZIs and four CIs in the maxilla, and four CIs in the mandible; (3) fabrication of dental prosthesis; and (4) psychological and oral education. Following treatment of these patients, implant success rates, biological complications, patient satisfaction, and psychological changes were recorded. RESULTS Although there was evidence of bone graft resorption in the maxilla, bone augmentation of the mandible was successful in all patients. Nine CIs in the maxilla failed and were removed. All ZIs were successful, and the CIs success rates were 77.50% in the maxilla and 100% in the mandible, with a mean of 88.75%. The mean peri-implant bone resorption for the CIs ranged from 1.3 ± 0.4 mm to 1.8 ± 0.6 mm, and four cases exhibited gingival hyperplasia in the maxilla and mandible. One hundred percent of the patients were satisfied with the restoration of their oral function, and >50% of the patients exhibited enhanced self-confidence and self-esteem. CONCLUSIONS This study demonstrates that oral function can be restored in edentulous adult ED patients using a comprehensive and systematic treatment protocol involving psychological and oral education, bone augmentation, implant placement, and denture fabrication. Despite these positive outcomes, bone augmentation remains challenging in the anterior region of the maxilla for edentulous adult ED patients.
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Affiliation(s)
- Yiqun Wu
- Department of Oral Implant, School of Medicine, Ninth People's Hospital Affiliated with Shanghai Jiao Tong University, Shanghai, China
| | - Xu Dong Wang
- Department of Oral and Maxillofacial Surgery, School of Medicine, Ninth People's Hospital Affiliated with Shanghai Jiao Tong University, Shanghai, China
| | - Feng Wang
- Department of Oral Implant, School of Medicine, Ninth People's Hospital Affiliated with Shanghai Jiao Tong University, Shanghai, China
| | - Wei Huang
- Department of Oral Implant, School of Medicine, Ninth People's Hospital Affiliated with Shanghai Jiao Tong University, Shanghai, China
| | - Zhiyong Zhang
- Department of Oral Implant, School of Medicine, Ninth People's Hospital Affiliated with Shanghai Jiao Tong University, Shanghai, China
| | - Zhiyuan Zhang
- Department of Oral and Maxillofacial Surgery, School of Medicine, Ninth People's Hospital Affiliated with Shanghai Jiao Tong University, Shanghai, China
| | - Darnell Kaigler
- Department of Periodontics and Oral Medicine, Department of Biomedical Engineering, Michigan Center for Oral Health Research, University of Michigan, Ann Arbor, MI, USA
| | - Duohong Zou
- Department of Dental Implant Centre, Stomatologic Hospital & College, Key Laboratory of Oral Diseases Research of Anhui Province, Anhui Medical University, Hefei, China
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Vega LG, Gielincki W, Fernandes RP. Zygoma implant reconstruction of acquired maxillary bony defects. Oral Maxillofac Surg Clin North Am 2013; 25:223-39. [PMID: 23642670 DOI: 10.1016/j.coms.2013.02.007] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The reconstruction of acquired maxillary bony defects after pathologic ablation, infectious debridement, avulsive trauma, or previously failed reconstructions with zygoma implants represents a treatment alternative that is safe, predictable, and cost-effective. Still the single most important factor for treatment success of these complex reconstructions is the implementation of a team approach between the surgeon and the restorative dentist. The focus of this article is to review the surgical and prosthetic nuances to successfully reconstruct acquired maxillary defects with zygoma implants.
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Affiliation(s)
- Luis G Vega
- Oral and Maxillofacial Residency Program, Health Science Center at Jacksonville, University of Florida, Jacksonville, FL 32209, USA.
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