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

PJ Schoen*, H Reintsema, GM Raghoebar, A Vissink, JLN Roodenburg

*Corresponding author for this work

Research output: Contribution to journalReview articlepeer-review

86 Citations (Scopus)

Abstract

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 heating, which may lead to development of radionecrosis of soft tissues and bone as well as to increased implant toss. If surgical treatment after radiotherapy is indicated, measures to prevent implant toss 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 muttidisciptinary consultation for a well-estabtished treatment planning. The primary curative intent of the oncotogical treatment and the prognosis for later prosthodontic rehabilitation have to be taken into account too. (C) 2003 Elsevier Ltd. All rights reserved.

Original languageEnglish
Pages (from-to)862-871
Number of pages10
JournalOral Oncology
Volume40
Issue number9
DOIs
Publication statusPublished - Oct-2004

Keywords

  • oncology
  • radiotherapy
  • mandible
  • tongue
  • implants
  • prosthodontics
  • ADJUNCTIVE HYPERBARIC-OXYGEN
  • OSSEOINTEGRATED IMPLANTS
  • DENTAL IMPLANTS
  • ENDOSSEOUS IMPLANTS
  • OROMANDIBULAR RECONSTRUCTION
  • FREE FLAPS
  • IRRADIATED BONE
  • CLINICAL-EVALUATION
  • ENDOSTEAL IMPLANTS
  • TUMOR SURGERY

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