Pathways for the rehabilitation of resection defects in the maxilla.

Oral rehabilitation of head and neck cancer patients is an integral component of the care pathway. Maxillectomy procedures can cause significant defects, such as oronasal fistulas, loss of support for the cheek and lip, aesthetic defects in the middle third of the face and functional impairments. Orofacial rehabilitation plays a fundamental role in restoring aesthetics and functional capabilities, such as speech, mastication and deglutition.Rehabilitation of maxillectomy patients poses a challenge for both clinicians and patients. This paper utilises case examples to demonstrate the treatment options for the oral rehabilitation of these patients. We will summarise the treatment pathways for conventional obturators, delayed (secondary) implant retained fixed rehabilitation following composite free flap and early rehabilitation using a zygomatic implant perforated flap technique. This paper aims to highlight the challenges in treatment planning and the importance of a multidisciplinary approach in improving patient outcomes.

Modern partial dentures - part 2: a review of novel metal-free materials and innovations in polymers.

New materials are continuously being developed and advanced for the provision of partial dentures. However, the rate at which they are developing makes it hard for the clinician to discern which would be worth adopting into their practice.This paper looks at some of those materials, including the earlier alternatives to conventional acrylic resins, polyamides and acetal resin, followed by a review of the newer novel polymers that are currently in use, including aryl-ketone-polymers and the polymer group polyaryletherketones.The newer polymers have many similarities, in both properties and aesthetics, such as increased elasticity that allows the dentures to engage deeper undercuts, while maintaining high strength. A significant benefit of the novel polymers is in their ability to fit into a digital workflow. Computer-aided design and manufacture confer a high degree of consistency, efficiency and accuracy in the prosthesis. The ability to use precise digital tools to create frameworks and clasps of accurate parameters limits the introduction of technical error that has the potential to be introduced in the construction of a conventional cobalt-chrome framework.The novel high-performance polymers show great promise. Research is needed on these materials investigating the effects on oral health, longevity and survival of the appliances, as well as studies looking at patient satisfaction and the impact on quality of life.

Modern partial dentures - part 1: novel manufacturing techniques.

While the conventional fabrication of removal partial dentures through the lost-wax technique is a time-tested technique, it is recognised as a 'complicated, error-prone, time-consuming and expensive process'. This has financial implications and can lead to increased chair time for the patient and dentist, resulting from low precision and ill-fitting frameworks. The use of computer-aided design and computer-aided manufacture brings removable prosthodontics into the digital era and opens up a host of benefits to the practitioner and laboratory technician. This paper introduces the benefits and downsides to adopting a digital workflow, and looks at the various alternative manufacturing techniques, which allow the clinician and technician to streamline their processes and make use of novel denture materials.