Long-term results of endosseous implants as retention elements of orbital epitheses, reconstruction techniques, and aftercare after radical tumor resection.

PURPOSE: The aim of this study was to examine the long-term results of implants in orbital reconstruction after exenteration. MATERIALS AND METHODS: From 1998 to 2012, patients undergoing implant-supported rehabilitation after subtotal or total exenteration due to a tumor were included in a retrospective study. All the patients were evaluated for soft tissue reconstruction, irradiation, complications, abutments, hygiene index, implant mobility, and long-term success. RESULTS: Forty-eight patients (aged between 27 and 81 years) were selected. A total of 187 implants were inserted. All the patients were supplied with epitheses after implantation in the long term. Of the 187 implants, nine implants placed on five patients were lost. The mean follow-up period was 34 months (ranging from 6 to 144 months). The 5-year survival rate was 88%. CONCLUSION: On the basis of this retrospective study of 48 patients with 187 implants, the following observations were made: (1) The 5-year survival of implants in nonradiated bone was 92%, and (2) the 5-year survival of implants in radiated bone was 86%. Extraoral implants should be presented as an option in orbital rehabilitation after exenteration.

Immediate loading of mandibular implants in compromised patients: preliminary results.

To minimize the number of implant surgical procedures, a total of 72 single-stage, transgingival Frialoc implants (Friadent) were placed in the mandibles of 18 patients who required implant restoration. The patients' ability to undergo surgical implant treatment was restricted because of either poor general medical health or psychologic conditions. All implants were immediately loaded with a bar-retained overdenture. Only 4 of the 72 immediately loaded Frialoc implants (in one patient) failed over a control period of 29 months. The cumulative implant survival rate was 94.4%. Apart from an initial increase in bone resorption at two posterior implants supporting a cantilever bar (the cantilevers were removed 13 months after delivery of the prosthesis) and serious lip swelling in one patient, there were no further serious surgical, prosthetic, or general medical problems during the treatment period. The initial results of the study indicate that the single-stage Frialoc System allows fast prosthetic mandibular restorations. Because there is only one operation, the risk of local or general health complications in compromised patients is reduced.

Investigation of maxillary preprosthetic situations after oral tumor treatment.

In order to investigate the maxillary preprosthetic situation after oral tumor treatment and/or reconstructive surgery, based on the review of case history and the clinical records 47 cases were analyzed after oral tumor treatment and/or reconstruction, including residual maxillary bone, intermaxillary relationships, defection of maxilla and oral situation after radiation therapy. The results showed that the residual maxillary bone was useful for implantation in the front alveolar bone and zygoma area. The maxillary preprosthetic situation after tumor treatment and/or reconstructive surgery was difficult due to maxillary resection, intermaxillary relationships, unsuitable soft and hard tissue transfer and the irradiation. It is suggested that the maxillary preprosthetic situation after oral tumor treatment is getting worse not only due to maxillary resection and/or irradiation, but surprisingly also due to mandibular resection and/or irradiation.

Comparison of maxillary implant-supported prosthesis in irradiated and non-irradiated patients.

In order to investigate the influence of radiation therapy after the treatment of maxillary implant-supported prostheses, 27 patients received a total of 131 implants in maxilla after oral cancer treatment and/or reconstructive surgery. Among them, 25 received maxillary implant-supported prostheses. The cumulative survival rates of implants and prostheses were evaluated by the product-limit-estimates method according to Kaplan-Meier. The cumulative survival rate of implants and prostheses in irradiated patients was compared with that in non-irradiated patients by statistical Log-rank test. The results showed that 112 implants were observed after implant loading. The implants cumulative survival rate was approximately 65% for overall patients. The cumulative prosthesis successful rate was approximately 88% for all 25 patients. Log-rank test analysis revealed that there was a significant difference in cumulative implants survival rates between non-irradiated and irradiated maxillary bone (P < 0.01). It was concluded that the implants and prostheses in irradiated patients have significantly lower survival rates than in non-irradiated patients.