Prosthodontic rehabilitation of oral function in head-neck cancer patients with dental implants placed simultaneously during ablative tumour surgery: an assessment of treatment outcomes and quality of life.

The aim of this prospective study was to assess treatment outcome and impact on quality of life of prosthodontic rehabilitation with implant-retained prostheses in head-neck cancer patients. Fifty patients were evaluated by standardized questionnaires and clinical assessment. All received the implants during ablative tumour surgery in native bone in the interforaminal area. About two-thirds of the patients (n=31) needed radiotherapy post-surgery. Both in irradiated and non-irradiated bone two implants were lost 18-24 months after installation. Peri-implant tissues had a healthy appearance. No cases of osteoradionecrosis occurred. In 15 patients no functional implant-retained lower dentures could be made for various reasons. The other 35 patients all functioned well, with an improvement in quality of life. Major improvement was observed in the non-irradiated patients. In the irradiated patients, less improvement in many functional items was observed, while items related to the oral sequelae of radiotherapy did not improve. Similar to the quality-of-life assessments, denture satisfaction was improved and tended to be higher in non-irradiated than irradiated patients. Implant-retained lower dentures can substantially improve the quality of life related to oral functioning and denture satisfaction in head-neck cancer patients. This effect is greater in non-irradiated than irradiated cancer patients.

The use of implant retained mandibular prostheses in the oral rehabilitation of head and neck cancer patients. A review and rationale for treatment planning.

Surgical treatment of malignancies in the oral cavity (tongue, floor of the mouth, alveolus, buccal sulcus, oropharynx) often results in an unfavourable anatomic situation for prosthodontic rehabilitation. The outcome is a severe disturbance of oral functioning despite the improved surgical techniques for reconstruction that are currently available. Radiotherapy, which often is applied postsurgically, worsens oral functioning in many cases. Main problems that may hamper proper prosthodontic rehabilitation of these patients include a severe reduction of the neutral zone, an impaired function of the tongue, and a very poor load-bearing capacity of the remaining soft tissues and mandibular bone. Many of these problems can, at least in part, be diminished by the use of endosseous oral implants. These implants can contribute to the stabilisation of the prostheses and intercept the main part of the occlusal loading. Surgical interventions after radiotherapy are preferably avoided because of compromised healing, which may lead to development of radionecrosis of soft tissues and bone as well as to increased implant loss. If surgical treatment after radiotherapy is indicated, measures to prevent implant loss and development of radionecrosis have to be considered e.g. antibiotic prophylaxis and/or pre-treatment with hyperbaric oxygen (HBO). To avoid this problem, implant insertion during ablative surgery has to be taken into consideration if postoperative radiotherapy is scheduled or possibly will be applied. This approach is in need of a thorough pre-surgical examination and multidisciplinary consultation for a well-established treatment planning. The primary curative intent of the oncological treatment and the prognosis for later prosthodontic rehabilitation have to be taken into account too.

[Dentoalveolar traumatology]. / Dentoalveolaire traumatologie.

The dentist will be confronted unexpectedly with a dentoalveolar trauma patient. This patient has to be seen immediately and has to be treated adequately. The risk of overlooking trauma-related signs when examining these patients, can be minimized by following a strict protocol. This article describes a protocol for examination and treatment of a patient with a dentoalveolar trauma. The prognosis after treatment of the trauma is discussed. Also some recommendations regarding aftercare and prevention are presented.

[Reconstructive preprosthetic surgery 1. Corrections of soft tissues and bone]. / Reconstructieve preprothetische chirurgie 1. Correcties van weke delen en bot.

The aim of reconstructive preprosthetic surgery is the creation of an environment of hard and soft tissue which is favourable to the function of an aesthetically optimal prosthesis, with or without oral implants. In this paper, various preprosthetic surgical treatments for correcting soft and hard tissues are discussed.

[Reconstructive preprosthetic surgery 2. Pre-implantologic surgery]. / Reconstructieve preprothetische chirurgie 2. Preïmplantaire chirurgie.

Reconstructive preprosthetic surgery is, amongst others, aimed at the creation of an environment which is favourable to the construction of an implant supported prosthesis. Not in all cases the pre-existent volume of bone is sufficient to place an implant in the planned position. In this paper various techniques to augment local bone defects for reliable implant placement are described.

[Dentoalveolar surgery for the dentist: removal of teeth and root tips]. / Dentoalveolaire chirurgie voor de tandarts: verwijdering van gebitselementen en wortelresten.

The indication for surgical removal of teeth or roottips is often made in dental practice. In some cases a general practitioner will decide to perform the surgical procedure himself, while in other cases he will refer the patient to an oral and maxillofacial surgeon. Level of difficulty of the treatment and the experience, the time available, the availability for postoperative care, and the personal interest of the dentist are factors involved in decision making. It is likely that with increased experience, the dentist will be able to perform more complicated treatments. This article supports this process. Surgical removal of teeth and roottips is systematically described, with emphasis on technical aspects. Presurgical management, removal of singlerooted and multirooted teeth, woundcare and postoperative management are the subjects covered.

[Dentoalveolar surgery for the dentist: removal of third molar]. / Dentoalveolaire chirurgie voor de tandarts: verwijdering van derde molaren.

In contrast to removal of other teeth and roottips, a third molar is mostly removed for preventive reasons. There is still debate about the correct indications for removal of third molars. As soon as the decision to remove a third molar surgically is made, the dentist has to decide between performing the surgical procedure himself or referring the patient to an oral and maxillofacial surgeon. Level of difficulty of the treatment and experience, available time, availability for postoperative care, and personal interest of the dentist are issues influencing this decision. This article describes systematically the indications, for instance using preoperative radiodiagnostics, the factors determining the technical surgical plan, as well as the practical surgical procedures.

Treatment outcome of bone-anchored craniofacial prostheses after tumor surgery.

BACKGROUND: Percutaneous endosseous implants have acquired an important place in the prosthetic rehabilitation of patients with craniofacial defects. The objective of this study was to evaluate the clinical outcome of the use of endosseous implants in the orbital and auricular region as well as to assess the satisfaction of patients with implant-retained craniofacial prostheses after tumor surgery. METHODS: The clinical outcome and patient satisfaction of implant-retained prostheses in the auricular and orbital region were evaluated in a group of 26 patients with facial defects after tumor surgery by using standardized questionnaires and a clinical assessment. Twelve patients (n = 31 implants) received the implants during ablative tumor surgery, from which 7 patients (n = 20 implants) were treated with radiation therapy after surgery (mean, 65 grays [Gy]). Fourteen patients (n = 44 implants) received the implants after the tumor surgery, from which 5 patients (n = 21 implants) were irradiated after ablative surgery (mean, 54.4 Gy), but before implant placement. RESULTS: No implants were lost in patients who had not undergone irradiation (100%), whereas 5 implants were lost in the irradiated group (87.8%). The overall implant survival rate was 93.3%. The peri-implant tissues had a healthy appearance, and no cases of osteoradionecrosis occurred. When compared with patients treated with conventional adhesive retained facial prostheses, satisfaction was higher in patients treated with implant-retained facial prostheses. CONCLUSIONS: From this study, it is concluded that implant-retained facial prostheses are better tolerated than adhesive retained prostheses and offer an improvement in the quality of life. Radiotherapy is not a contraindication for the use of osseointegrated implants in the maxillofacial region, but the loss of implants is higher than in nonirradiated sites.

The mandibular staple bone plate: a long-term retrospective evaluation.

PURPOSE: Clinical and radiographic parameters and denture satisfaction were evaluated in a long-term retrospective study of patients treated with the mandibular staple bone plate. PATIENTS AND METHODS: Fifty-six edentulous patients were treated with the mandibular staple bone plate to stabilize their lower denture. The mean evaluation period was 103 months (range, 84 to 139 months). Peri-implant mucosa and bone height were scored, together with quality of the prosthesis and prosthodontic maintenance care. Denture satisfaction was assessed by using two questionnaires. RESULTS: Four staple bone plates were removed during the evaluation period, and one appeared to be fractured. The remaining 51 staple bone plates were functional without any signs of major complications (survival rate, 91%). No further alveolar resorption in the interforaminal region of the mandible took place during the evaluation period. Patients were very satisfied with the prosthetic construction. CONCLUSIONS: The mandibular staple bone plate is a good modality to stabilize the lower denture. However, endosseous implant systems are preferred because of comparable success rates with a more simple operative procedure.

[Complaints and complications associated with removal of the mandibular third molar. A prospective clinical study]. / Nabezwaren en complicaties na verwijdering van de derde molaar in de onderkaak. Een prospectief klinisch onderzoek.

OBJECTIVE: To study the incidence of complaints and complications after removal of the mandibular third molar and to evaluate the influence of this procedure on functioning of the patient during the first post-surgical week. DESIGN: Prospective, clinical. SETTING: Department of Oral and Maxillofacial Surgery, University Hospital Groningen. METHODS: Patients referred for removal of a mandibular third molar were asked to return one week after the procedure and to keep a daily record of the use of pain medication, duration of the pain and intensity of the pain. RESULTS: Removal of mandibular third molars resulted in an overall complication rate of 12%. Pain medication was used more frequently and for a longer period by patients with post-surgical complications. Due to complaints following the removal of the mandibular third molar, the mean absence from work was one and a half day. Work was generally resumed with decreased perceived efficiency. CONCLUSION: After this commonly performed procedure in dento-alveolar surgery most of the patients were hampered as a result of pain during the first four post-surgical days. Over 10% of the patients developed complications leading to more frequently and prolonged use of pain medication. Removal of the mandibular third molar gave rise to complaints which influenced the patients relatively strong in their daily functioning.

A controlled clinical trial of implant-retained mandibular overdentures: clinical aspects.

In a controlled clinical trial, treatment effects of mandibular overdentures on two different implant-systems in edentulous patients were compared one year after insertion of the new dentures. The implant-systems used were the Brånemark system (Brå) and the IMZ-system. Treatment was randomly assigned to 60 patients according to a balanced allocation method. Evaluation included peri-implant and radiographical parameters. According to the Delphi method a clinical implant performance scale (CIP) was constructed based on all conceivable complications of the different implant systems. During the osseointegration period, five Brå- and one IMZ-implants were lost. The results of one of the peri-implant parameters and the radiographical score showed significant differences considering the (pseudo) pocket probing depth (Brå better than IMZ, P < 0.001) and the radiographic-score (IMZ better than Brå, P < 0.003). The results for the CIP-scale were less favourable for the Brå-group than for the IMZ-group; however, these differences were not significant.

Complications after mandibular third molar extraction.

The records of 1,797 patients were retrospectively examined to analyze the possible relationships between postoperative complications following mandibular third molar extraction and parameters such as age, sex, indication for surgery, position of the molar, surgical experience, surgical technique, and postoperative care. Older patients tended to suffer more often from complications. Surgery performed while there were signs of pericoronal inflammation also resulted in more complications. There was no statistically significant difference in the mean complication rate arising from surgery performed by staff members and the rate when surgery was performed by residents. There seems to be no reason for patients to return routinely for removal of resorbable sutures or other postoperative care because this practice does not result in a decrease in postoperative symptoms.

Computed tomography of palatine tonsillar carcinoma.

Twenty-five patients with surgically and histologically proven squamous cell carcinoma of the palatine tonsil were studied with computed tomography (CT) using a high dose intravenous contrast enhancement technique. With this technique, CT demonstrated the primary carcinoma within the palatine fossa as well as its contiguous spread to the base of the tongue, mobile tongue, lateral pharyngeal wall, supraglottic larynx, and nasopharynx and metastasis to local deep cervical lymph nodes.