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Zaid W, Amin D, Carlson ER. Obturating the Maxillary Defect: Surgical and Prosthetic Considerations. Atlas Oral Maxillofac Surg Clin North Am 2024; 32:81-90. [PMID: 39059877 DOI: 10.1016/j.cxom.2023.12.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/28/2024]
Affiliation(s)
- Waleed Zaid
- Department of Oral and Maxillofacial Surgery, Louisiana State University, School of Dentistry, 7777 Hennessy Boulevard / Suite 306 Medical Plaza 1, Baton Rouge, LA 70808, USA
| | - Dina Amin
- Department of Oral and Maxillofacial Surgery, University of Rochester Schools of Medicine and Dentistry, 601 Elmwood Avenue, Suite 4.0241A, Rochester, NY 14642, USA
| | - Eric R Carlson
- Department of Oral and Maxillofacial Surgery, University of Tennessee Graduate School of Medicine, 1930 Alcoa Highway, Suite 335, Knoxville, TN 37920, USA.
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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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Sharma S, Kumar Upadhyay A, Prakash A, Singodia P, Ravi Kiran S, Shankar R. Treatment Complications of Head and Neck Cancers and Rehabilitation Measures: A Narrative Review. Cureus 2024; 16:e61173. [PMID: 38933634 PMCID: PMC11204137 DOI: 10.7759/cureus.61173] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/27/2024] [Indexed: 06/28/2024] Open
Abstract
Head and neck cancers (HNCs) are malignant tumors mainly from squamous cells in the head and neck tissues. Treatment involves a multidisciplinary approach with surgery, radiotherapy, and chemotherapy. However, the long-term prognosis for patients with advanced-stage tumors is guarded, with a median survival time of approximately 24 months. HNC patients have very high rates of depression and anxiety and the highest suicide rate among all cancers due to the intense and challenging nature of the treatment, underscoring the importance of our collective efforts. Rehabilitation success depends on various factors, including tumor, patient, and treatment-related factors. Patients may require post-treatment oral rehabilitation measures, including implants, obturators, and flexible dentures. These measures are crucial, but they often need to be more utilized. Patients may face challenges in maintaining oral hygiene and managing mucositis. Additionally, it is essential to address other intricacies such as trismus, xerostomia, gustatory dysfunctions, neuropathy, speech impairments, and psychological disturbances. Unfortunately, there is little literature on post-treatment rehabilitative measures. Despite its crucial role in improving patients' quality of life, rehabilitation often receives inadequate attention compared to treatment. Our narrative review, which covers various factors that affect rehabilitation, including oral rehabilitation measures and post-treatment complications, is anticipated to deliver practical insights to professionals and inspire positive changes in their regular practice.
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Affiliation(s)
- Swati Sharma
- Prosthodontics, Crown and Bridge & Oral Implantology, Tata Main Hospital, Jamshedpur, IND
| | | | | | | | - Sarat Ravi Kiran
- Oral and Maxillofacial Surgery, Tata Main Hospital, Jamshedpur, IND
| | - Rama Shankar
- Oral and Maxillofacial Surgery, Tata Main Hospital, Jamshedpur, IND
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Saadellaoui I, Bekri S, Labidi A, Yaala MB, Mabrouk Y, Mansour L. Combination of CAD/CAM technologies and conventional processing in the fabrication of a maxillary obturator prosthesis: a clinical report. J Med Life 2024; 17:375-380. [PMID: 39044932 PMCID: PMC11262598 DOI: 10.25122/jml-2024-0017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2024] [Accepted: 04/10/2024] [Indexed: 07/25/2024] Open
Abstract
Soft and hard tissue defects resulting from resective surgeries for carcinomas located in the maxillary arches can cause functional, esthetic, and psychological damage. A removable obturator prosthesis offers several advantages, restoring oral functions and improving patients' quality of life. Technological advancements, such as the use of intraoral scanning and computer-aided design (CAD) and manufacturing, reduce laboratory working time, eliminate the risk of impression material aspiration, and address challenges related to whole tissue undercut impression. Here, we report the case of a partially edentulous female patient with a velo-palatal defect for whom a rigid maxillary obturator prosthesis was fabricated. Digital impressions were taken and the standard tessellation language files of the scans were sent to the laboratory. Using dental CAD software, the maxillary metallic framework was designed and manufactured using selective laser melting technology. The obturators and artificial teeth were conventionally processed, with acrylic resin used for the rigid obturators. The resulting obturator prosthesis made it possible to close the oro-nasal communication and to improve swallowing, speaking, and chewing.
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Affiliation(s)
- Ines Saadellaoui
- Department of Removable Prosthodontics, Approche Biologique et Clinique Dento-Faciale (LR12ES10) Laboratory, Faculty of Dental Medicine, University of Monastir, Monastir, Tunisia
| | - Sana Bekri
- Department of Removable Prosthodontics, Approche Biologique et Clinique Dento-Faciale (LR12ES10) Laboratory, Faculty of Dental Medicine, University of Monastir, Monastir, Tunisia
| | - Amel Labidi
- Department of Removable Prosthodontics, Approche Biologique et Clinique Dento-Faciale (LR12ES10) Laboratory, Faculty of Dental Medicine, University of Monastir, Monastir, Tunisia
| | - Mohamed ben Yaala
- Department of Removable Prosthodontics, Approche Biologique et Clinique Dento-Faciale (LR12ES10) Laboratory, Faculty of Dental Medicine, University of Monastir, Monastir, Tunisia
| | - Yosra Mabrouk
- Department of Removable Prosthodontics, Approche Biologique et Clinique Dento-Faciale (LR12ES10) Laboratory, Faculty of Dental Medicine, University of Monastir, Monastir, Tunisia
| | - Lamia Mansour
- Department of Removable Prosthodontics, Approche Biologique et Clinique Dento-Faciale (LR12ES10) Laboratory, Faculty of Dental Medicine, University of Monastir, Monastir, Tunisia
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Grande F, Cesare PM, Mochi Zamperoli E, Gianoli CM, Mollica F, Catapano S. Evaluation of Tension and Deformation in a Mandibular Toronto Bridge Anchored on Three Fixtures Using Different Framework Materials, Abutment Systems, and Loading Conditions: A FEM Analysis. Eur J Dent 2023; 17:1097-1105. [PMID: 36696917 PMCID: PMC10756777 DOI: 10.1055/s-0042-1758785] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023] Open
Abstract
OBJECTIVE The aim of this study was to investigate by finite element method analysis the behaviour of a three-implant mandible Toronto framework made by three different materials, with two abutment systems and two loading conditions. MATERIALS AND METHODS Three implants were virtually inserted in a mandible model in positions 3.6, 4.1, and 4.6. Three prosthetic framework bars with the same design and dimension (4.8 × 5.5 mm) were projected. The variables introduced in the computer model were the framework materials (glass fiber reinforced resin, Co-Cr, TiAl6V4), the abutment systems (Multi-Unit-Abutment [MUA]/OT-Bridge), and the loading conditions (500 N vertical load on all the framework area and 400 N on a 7-mm distal cantilever). The computer was programmed with physical properties of the materials as derived from the literature. Maximum tension and deformation values for each variable were registered at framework, screws, and abutment level and then compared. RESULTS Metal frameworks Cr-Co and TiAl6V4 resulted in lower deformation than glass fiber-reinforced resin frameworks while presenting higher tension values. The OT-Bridge exhibited lower maximum tension and deformation values than the MUA system. The first loading condition reached higher tension and deformation values than the second and it resulted in more uniformly distributed load on all the framework area, especially with the OT-Bridge system. CONCLUSION More rigid materials and OT-Bridge system decrease the deformation on the prosthetic components. Tension stresses are more uniformly distributed with glass fiber-reinforced resin, in the OT-Bridge system and avoiding cantilever loading.
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Affiliation(s)
- Francesco Grande
- Department of Mechanical and Aerospace Engineering, Politecnico di Torino, Turin, Italy
| | | | | | | | | | - Santo Catapano
- Department of Prosthodontics, University of Ferrara, Ferrara, Italy
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Hu Y, Liu J, Wu W, Wang Z. Immediate reconstruction of defects after a partial maxillectomy with a digitally planned, prefabricated, 3-dimensionally printed, esthetic obturator prosthesis. J Prosthet Dent 2023:S0022-3913(23)00064-1. [PMID: 36841709 DOI: 10.1016/j.prosdent.2023.01.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2022] [Revised: 01/05/2023] [Accepted: 01/06/2023] [Indexed: 02/26/2023]
Abstract
A digital workflow was used to design and prefabricate a 3-dimensionally printed, esthetic obturator prosthesis for immediate placement after a partial maxillectomy. The approach involved simultaneous reciprocation and support of the maxillary defect during the surgery and minimized the incidence of cicatricial contracture of the soft tissue, preventing permanent facial deformity and dysfunction.
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Affiliation(s)
- Yongjie Hu
- Professor, Department of Oral and Maxillofacial-Head and Neck Oncology, Shanghai Ninth People's Hospital, College of Stomatology, Shanghai Jiaotong University School of Medicine; National Clinical Research Center for Oral Diseases; Shanghai Key Laboratory of Stomatology & Shanghai Research Institute of Stomatology, Shanghai, PR China
| | - Jiannan Liu
- Associate Professor, Department of Oral and Maxillofacial-Head and Neck Oncology, Shanghai Ninth People's Hospital, College of Stomatology, Shanghai Jiaotong University School of Medicine; National Clinical Research Center for Oral Diseases; Shanghai Key Laboratory of Stomatology & Shanghai Research Institute of Stomatology, Shanghai, PR China
| | - Wenyan Wu
- Resident, Department of Stomatology, Ruijin Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, PR China
| | - Zhen Wang
- Assistant Professor, Department of Oral and Maxillofacial-Head and Neck Oncology, Shanghai Ninth People's Hospital, College of Stomatology, Shanghai Jiaotong University School of Medicine; National Clinical Research Center for Oral Diseases; Shanghai Key Laboratory of Stomatology & Shanghai Research Institute of Stomatology, Shanghai, PR China.
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N P, KS A, S MK, Natarajan S. Maxillary Defect Rehabilitation Using a Hollow Bulb Obturator. Cureus 2022; 14:e31326. [DOI: 10.7759/cureus.31326] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/10/2022] [Indexed: 11/12/2022] Open
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Comparison of the Accuracy between Denture Bases Produced by Subtractive and Additive Manufacturing Methods: A Pilot Study. PROSTHESIS 2022. [DOI: 10.3390/prosthesis4020015] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
Abstract
Today, two different types of CAD-CAM fabrication methods for complete denture bases are available besides the conventional protocols: a subtractive milling process from a prepolymerized block of polymethylmethacrylate and an additive manufacturing process that built the denture base using a light-cured liquid in a VAT-polymerization process. The aim of this study was to evaluate and to compare the accuracy and precision of denture prosthetic bases made with subtractive and additive manufacturing technologies and to compare them with a denture base with the conventional method in muffle. From the results obtained, 3D printing dentures show a statistically significant higher accuracy than milled prosthetic bases. Milled prosthetic bases have similar accuracy than conventional fabricated dentures.
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