Dental implants in maxillofacial prosthodontics:An asset in head and neck cancer and Sjögren's syndrome patients

Maxillofaciale prothetiek is het vakgebied dat zich bezig houdt met het maken van protheses bij patiënten met een afwijking of aandoening in het hoofd-halsgebied. Deze protheses kunnen zowel gebitsprotheses zijn als gezichtsprotheses, waarbij bijvoorbeeld een neus, een oog of een oor wordt vervangen. Voor het bevestigen van de protheses kunnen tandheelkundige implantaten worden gebruikt. In het proefschrift is de toepassing van tandheelkundige implantaten beschreven in patiënten met een tumor in het hoofd-hals gebied en in patiënten met het syndroom van Sjögren. Het syndroom van Sjögren is een aandoening waarbij patiënten onder andere last hebben van een droge mond en droge ogen. In patiënten met een tumor in de mondholte worden de implantaten bij voorkeur geplaatst tijdens de tumoroperatie. Op deze wijze kan voor het merendeel van de patiënten snel na de behandeling van de tumor al een gebitsprothese worden gemaakt. Bovendien is de implantaatoverleving dan hoog. Ook voor vervanging van een neus zijn implantaten een uitkomst. Wanneer bijvoorbeeld twee implantaten in de neusbodem worden geplaatst, vormt dit een ideale uitgangspositie voor het bevestigen van een neusprothese. De patiënten zijn hier zeer tevreden over. Over de toepassing van implantaten bij patiënten met het syndroom van Sjögren was nog weinig bekend. Wij hebben 50 patiënten met het syndroom van Sjögren met implantaten onderzocht. De behandeluitkomst blijkt vergelijkbaar met die gezonde personen met implantaten. Geconcludeerd wordt dat zowel patiënten met een tumor in het hoofdhals gebied als patiënten met het syndroom van Sjögren veel baat hebben bij implantaatgedragen protheses

Outcome of implants placed to retain craniofacial prostheses - A retrospective cohort study with a follow-up of up to 30 years

OBJECTIVES: To retrospectively assess the treatment outcomes of endosseous implants placed to retain craniofacial prostheses. MATERIAL AND METHODS: Patients with craniofacial defects resulting from congenital disease, trauma, or oncologic treatment had implant retained prostheses placed in the mastoid, orbital, or nasal region and then assessed over a period of up to 30 years. Implant survival rates were calculated with the Kaplan-Meier method. Clinical assessments consisted of scoring skin reactions under the prosthesis and the peri-implant skin reactions. Possible risk factors for implant loss were identified. Patient satisfaction was evaluated using a 10-point VAS-scale. RESULTS: A total of 525 implants placed in 201 patients were included. The median follow up was 71 months (IQR 28-174 months). Implants placed in the mastoid and nasal region showed the highest overall implant survival rates (10-year implant survival rates of 93.7% and 92.5%, respectively), while the orbital implants had the lowest overall survival rate (84.2%). Radiotherapy was a significant risk factor for implant loss (HR 3.14, p < 0.001). No differences in implant loss were found between pre- and post-operative radiotherapy (p = 0.89). Soft tissue problems were not frequently encountered, and the patients were highly satisfied with their implant-retained prosthesis. CONCLUSION: Implants used to retain craniofacial prostheses have high survival and patient satisfaction rates and can thus be considered as a predictable treatment option. Radiation is the most important risk factor for implant loss

Linear and profilometric changes of the mucosa following soft tissue augmentation in the zone of aesthetic priority:A systematic review and meta-analysis

OBJECTIVES: To assess the outcomes of soft tissue augmentation, in terms of change in level and thickness of mid-buccal mucosa, at implants sites in the zone of the aesthetic priority. MATERIAL AND METHODS: MEDLINE, EMBASE and Cochrane Central Register of Controlled Trials databases were searched (last search on 1 June 2020). Inclusion criteria were studies reporting outcomes of different materials and timing of grafting in patients undergoing soft tissue augmentation at implant sites in the aesthetic zone with a follow-up of ≥1 year after implant placement. Outcome measures assessed included changes in level and thickness of mid-buccal mucosa, implant survival, peri-implant health and patients' satisfaction. RESULTS: Eighteen out of 2,185 articles fulfilled the inclusion criteria. Meta-analysis revealed a significant difference in vertical mid-buccal soft tissue change (0.34 mm, 95% CI: 0.13-0.56, p = .002) and mid-buccal mucosa thickness (0.66 mm, 95% CI: 0.35-0.97, p < .001) following immediate implant placement in favour of the use of a graft versus no graft. Mean difference in mid-buccal mucosa level following delayed implant placement (0.17 mm, 95% CI: 0.01-0.34, p = .042) was also in favour of the use of a graft versus no graft. With regard to mucosa thickness, the use of a graft was not in favour compared with no graft following delayed implant placement (0.22 mm, 95% CI: -0.04-0.47, p = .095). Observed changes remained stable in the medium term. CONCLUSION: Soft tissue augmentation in the zone of the aesthetic priority results in less recession and a thicker mid-buccal mucosa following immediate implant placement and less recession in mid-buccal mucosa following delayed implant placement compared with no graft

Mandibular dental implant placement immediately after teeth removal in head and neck cancer patients

BACKGROUND: Little is known about immediate implant placement in head and neck cancer patients. We studied implant survival and functional outcomes of overdentures fabricated on implants placed immediately after removal of the lower dentition during ablative surgery or preceding primary radiotherapy (RT). METHODS: Inclusion criteria were primary head and neck cancer, dentate lower jaw, and indication for removal of remaining teeth. Two implants to support a mandibular overdenture were placed immediately after extraction of the dentition during ablative surgery, or prior to starting primary radiotherapy. Standardized questionnaires and clinical assessments were conducted (median follow-up 18.5 months, IQR 13.3). RESULTS: Fifty-eight implants were placed in 29 patients. Four implants were lost (implant survival rate 93.1%). In 9 patients, no functional overdenture could be made. All patients were satisfied with their dentures. CONCLUSIONS: Combining dental implant placement with removal of remaining teeth preceding head neck oncology treatment results in a favorable treatment outcome

Prosthodontic rehabilitation of head and neck cancer patients-Challenges and new developments

Head and neck cancer treatment can severely alter oral function and aesthetics, and reduce quality of life. The role of maxillofacial prosthodontists in multidisciplinary treatment of head and neck cancer patients is essential when it comes to oral rehabilitation and its planning. This role should preferably start on the day of first intake. Maxillofacial prosthodontists should be involved in the care pathway to shape and outline the prosthetic and dental rehabilitation in line with the reconstructive surgical options. With the progress of three-dimensional technology, the pretreatment insight in overall prognosis and possibilities of surgical and/or prosthetic rehabilitation has tremendously increased. This increased insight has helped to improve quality of cancer care. This expert review addresses the involvement of maxillofacial prosthodontists in treatment planning, highlighting prosthodontic rehabilitation of head and neck cancer patients from start to finish

Dental implants in dentate primary and secondary Sjögren's syndrome patients:A multicenter prospective cohort study

Objectives: To prospectively assess the clinical performance and patient-reported outcomes of dental implants in dentate patients with primary and secondary Sjögren's syndrome (pSS and sSS, respectively) compared to patients without SS. Materials and Methods: Thirty-seven implants were placed in 17 patients with pSS/sSS and 26 implants in 17 non-SS patients to replace missing (pre)molars. Clinical performance, marginal bone-level changes, patient satisfaction, and oral health-related quality of life (OHRQoL) were assessed at 1 (T1), 6 (T6), 12 (T12), and 18 (T18) months after placement of the superstructure. Marginal bone-level changes were measured on standardized dental radiographs. Clinical parameters included implant and crown survival, plaque, bleeding and gingival indices, and probing depth. Patient satisfaction and OHRQoL were assessed with validated questionnaires. Results: Implant survival at T18 was 100% in the patients with pSS/sSS and 96.2% in the non-SS group. Mean marginal bone loss at T18 did not differ between patients with pSS/sSS and non-SS patients, 1.10 ± 1.04 and 1.04 ± 0.75 mm, respectively (p =.87). Clinical performance was good with no differences between the groups for all outcome measures (p >.05). OHRQoL in patients with pSS/sSS had improved significantly after placement of implant supported crowns at all measuring moments compared to baseline (p <.05). Nevertheless, patient satisfaction and OHRQoL remained significantly higher for patients without SS at all measuring moments (p <.05). Conclusion: Dental implants can be successfully applied in dentate patients with pSS/sSS and have a positive effect on OHRQoL

Oral rehabilitation with implant-based prostheses of two adult patients treated for childhood rhabdomyosarcoma

Background Rhabdomyosarcoma is the most common malignant tumor in the nasal and paranasal sinus area at childhood. Multimodal treatment for this disorder has severe side effects due to normal tissue damage. As a result of this treatment, facial growth retardation and oral abnormalities such as malformation of teeth and microstomia can cause esthetic and functional problems. Case reports Two cases are presented of patients with severe midfacial hypoplasia and reduced oral function as a result of treatment of rhabdomyosarcoma of the nasopharyngeal and nasal-tonsil region. With a combined surgical (osteotomy, distraction osteogenesis, implants) and prosthetic (implant-based overdenture) treatment, esthetics and function were improved

Patients' expectations of oral implants: a systematic review

Aim: Nowadays, oral implants are a leading concept in oral rehabilitation. Patient satisfaction with this treatment is high, but are the expectations of the patients met? The aim of this review was to systematically screen the literature on patients' expectations of implant-based therapy before treatment and to assess whether these expectations were being met. Materials and methods: A search strategy was developed for manuscripts dealing with patients' expectations of implant-based therapy to support different types of prosthodontics. Patients had an indication for implants, were seeking implants or had received implants. PubMed/MEDLINE, Ovid/ EMBASE and Cochrane/CENTRAL were searched to identify eligible studies. Two reviewers independently assessed the articles. Results: In total, 16 out of 3312 studies assessing patients' expectations of patients before implantbased therapy matched the inclusion criteria. A variety of methods were used in the studies. Patients had high expectations, with function followed by aesthetics being the most important expected improvements. Women had higher expectations than men. Costs were a major factor against implant-based therapy. The expectations that implants will last a lifetime and require no special needs of oral hygiene were of concern. Conclusion: Prior to treatment, patients have high expectations of implant therapy. In general, these expectations are met. Most studies revealed that women have higher expectations than men. The variety of applied study designs impaired comparability of results. Thus, standardised methods for measuring expectations of implant-based therapy are eagerly needed

Patients' expectations of oral implants:a systematic review

Aim: Nowadays, oral implants are a leading concept in oral rehabilitation. Patient satisfaction with this treatment is high, but are the expectations of the patients met? The aim of this review was to systematically screen the literature on patients' expectations of implant-based therapy before treatment and to assess whether these expectations were being met. Materials and methods: A search strategy was developed for manuscripts dealing with patients' expectations of implant-based therapy to support different types of prosthodontics. Patients had an indication for implants, were seeking implants or had received implants. PubMed/MEDLINE, Ovid/ EMBASE and Cochrane/CENTRAL were searched to identify eligible studies. Two reviewers independently assessed the articles. Results: In total, 16 out of 3312 studies assessing patients' expectations of patients before implantbased therapy matched the inclusion criteria. A variety of methods were used in the studies. Patients had high expectations, with function followed by aesthetics being the most important expected improvements. Women had higher expectations than men. Costs were a major factor against implant-based therapy. The expectations that implants will last a lifetime and require no special needs of oral hygiene were of concern. Conclusion: Prior to treatment, patients have high expectations of implant therapy. In general, these expectations are met. Most studies revealed that women have higher expectations than men. The variety of applied study designs impaired comparability of results. Thus, standardised methods for measuring expectations of implant-based therapy are eagerly needed