Extraoral prostheses using extraoral implants

The aim of this study was to evaluate extraoral prostheses and the use of extraoral implants in patients with facial defects. 10 cases were treated utilizing maxillofacial prostheses employing extraoral implants in five cases. 16 extraoral implants were installed. Seven implants were placed in irradiated sites in the orbital regions. Six implants were placed in mastoid regions and three in a zygoma region that was irradiated. Two implants failed before initial integration was achieved in irradiated areas. Using 14 extraoral implants as anchors, five extraoral prostheses were set. The other five cases were treated with extraoral prostheses without using extraoral implants due to cost and patient-related factors. The data included age, sex, primary disease, implant length, implant failure, prosthetic attachment, radiation therapy, and peri-implant skin reactions. The use of extraoral implants for the retention of extraoral prostheses has simplified the placement, removal, and cleaning of the prosthesis by the patient. The stability of the prostheses was improved by anchors. Clinical and technical problems are presented with the techniques used for their resolution. Using extraoral implants resulted in a high rate of success in retaining facial prostheses and gave good stability and aesthetic satisfaction.     

Implant-Supported Facial Prostheses Provided by a Maxillofacial Unit in a U.K. Regional Hospital: Longevity and Patient Opinions

PURPOSE: The aim of this study was to acquire information on the types and longevity of implant-retained facial prostheses and the opinions of patients on several factors related to their prostheses. MATERIALS AND METHODS: A survey of 75 maxillofacial prosthetic patients currently under treatment and review at the Maxillofacial Unit, Morriston Regional Hospital was conducted through a 23-question postal questionnaire. These patients were selected as representative of a group of individuals receiving treatment or under review for the fabrication of maxillofacial prostheses. RESULTS: Of the prosthetic replacements, 83% were ear prostheses, 8% nose, 6% eye, and 2% combination prostheses. Of the 47 respondents, 8 (17%) reported that they were currently wearing their original prostheses. The remaining 39 (83%) respondents had all been provided with at least 1 replacement prosthesis. The mean lifetime of the prostheses was found to be 14 months (range: 4-36 months). The majority of replacement prostheses in this study were provided as a result of color fade or wear of the silicone material of the previous prosthesis. Individuals with no previous experience wearing a prosthesis had an unrealistic expectation of their prosthesis longevity, with a mean value of 17.8 months. In comparison, individuals with previous experience had reduced expectations, with a mean of 14.4 months. In terms of the patients' opinions of the overall quality of their prostheses, the results demonstrated that a large number of patients were satisfied. Thirty-five patients rated their prostheses as excellent and 9 as good. At 7-12 months, 4 patients rated their prostheses as excellent and 8 as good. At 13 months, 4 patients rated their prostheses as excellent and 5 as good. CONCLUSIONS: It is important that advice be given to patients on the expected average longevity of their prostheses, together with information on factors affecting the longevity (i.e., environmental staining, cosmetics, and cleaning regimes). In this study, 26% of the replacement prostheses were provided due to color fading of the original prosthesis. This highlights the need for continuing research in the development of materials used for the construction of facial prostheses with improved properties, and in particular, improved color stability.     

Clinical applications of visible light-cured resin in maxillofacial prosthetics. Part II: Tray material

As an alternative to autopolymerizing acrylic resin, visible light-cured resin for custom-made impression trays is advocated. This new system facilitates chairside tray fabrication for custom-made impressions and benefits maxillofacial prosthetic patients needing intraoral or extraoral prosthetic rehabilitation.     

Impact of prosthetic rehabilitation type on satisfaction of completely edentulous patients. A 5-year prospective study

Abstract

Objective. The aim of this study was to evaluate the satisfaction of rehabilitated edentulous patients in relation to implant prosthetic type. Materials and methods. This prospective cohort study included 40 completely edentulous patients wearing conventional prostheses. They were divided into two study groups: Group A contained 20 patients rehabilitated with implant-supported fixed prostheses and Group B contained 20 patients with overdentures. Subjects were evaluated by means of a specially designed questionnaire before treatment and after 1, 3 and 5 years. Results. Group A exhibited better results in terms of esthetics, function and personal satisfaction, although without statistically significant differences. However, statistically significant differences were found within parameters of oral hygiene after 1 year in favor of Group B. Conclusions. Overall satisfaction was seen to increase after implant rehabilitation, regardless of the type of prosthesis used. The satisfaction of edentulous patients differs depending on prosthetic type. Patients rehabilitated with fixed prostheses obtain a generally higher level of satisfaction than patients wearing overdentures.     

Myofunctional therapy as an aid to prosthodontic treatment after hemiglossectomy: a clinical report

Although several reports describe the prosthetic management of patients after hemiglossectomy, the techniques are related to the fabrication of the prostheses, no reports on maximizing the functional potential of the remaining tongue musculature and surrounding tissues were identified by the authors. This clinical report describes the use of myofunctional therapy as an aid to the maxillofacial prosthodontic rehabilitation of an edentulous patient who was diagnosed with invasive squamous cell carcinoma of the tongue and underwent hemiglossectomy. Myofunctional therapy was introduced before, during, and after the fabrication of conventional maxillary and mandibular complete dentures. Muscle exercises were devised to improve the posture and muscular tonus of the remaining tongue, and thus help with mastication and adaptation to the mandibular denture. Myofunctional therapy improved the posture and function of the remaining tongue, providing acceptable mastication and increased stability of the mandibular denture.     

Survey of Currently Used Materials for Fabrication of Extraoral Maxillofacial Prostheses in North America,Europe, Asia,and Australia

Purpose: The purpose of this survey was to review the extraoral maxillofacial materials currently used as well as the advantages and disadvantages of the materials in the fabrication of facial prostheses. Results of this survey will enhance scientific knowledge, generate research study ideas, and possibly lead to production of alternative or new maxillofacial materials. Material and Methods: A 47‐question survey was delivered via e‐mail to all members (combined total of 260 members) of the American Anaplastology Association (AAA) and American Academy of Maxillofacial Prosthetics (AAMP) for evaluation of personal preference involving maxillofacial prosthetic materials (intrinsic/extrinsic silicone elastomers and pigments/colorants used, polymerization/curing process, advantages and disadvantages of the most often used materials, most important characteristic of material/technique used). Results: The views of 43 (16%) respondents indicated that the majority surveyed were using room temperature‐vulcanized (RTV) silicone products. Silicone pigments for intrinsic and silicone pastes for extrinsic coloring were favored over artist's oil colors and dry earth pigments. The polymerization process and/or curing times and temperatures for the same silicone material varied between users. The top five advantages of most often used materials were good esthetics, ease of coloring, easy manipulation, thin margins possible, and adhesive compatibility. The top five disadvantages were discoloration over time, technique‐sensitivity, lack of repairability, extrinsic colors peel/fade, and lack of longevity. Nontoxic/nonallergenic materials with high edge strength and color stability were the most important features when choosing a maxillofacial prosthetic material/technique. Conclusions: The responses to this survey indicate that the majority of AAA and AAMP members are using or have used a variety of RTV silicones, pigments, and colorants in the quest to provide the best possible facial prosthetic service. Further research is needed to further refine and improve extraoral maxillofacial materials/techniques based on the results of this study.     

Implant-supported mandibular telescopic prostheses in oral cancer patients: an up to 9-year retrospective study

PURPOSE: The aim of this retrospective study was to present the results of implant-supported telescopic prostheses in the mandible after removal of malignant tumors. MATERIALS AND METHODS: Between 1991 and 2000, 24 patients with squamous cell carcinoma (16 irradiated, eight nonirradiated) underwent mandibular rehabilitation with implant-supported telescopic prostheses. A total of 111 dental implants were placed. Treatment complications were observed. The cumulative survival rates of the implants and prostheses were evaluated by lifetable analysis. RESULTS: Within a mean follow-up period of 30 months (1 to 108 months), only three implants failed. All other implants are still in function. Of 24 patients, 23 were satisfied with their implant-supported telescopic restorations. Soft tissue, implant, or prosthetic complications occurred very rarely. The cumulative implant survival rate was about 97% and the cumulative prosthesis survival rate was about 95% at 9 years. CONCLUSION: Implants and implant-supported telescopic maxillofacial prostheses can successfully remain in function over a long period. Increased implant and prosthetic complications should not be expected. Therefore, telescopic implant attachments seem to be very useful as a treatment option for prosthetic restoration of the mandible in tumor patients.     

Oral rehabilitation by prosthetic restoration after maxillectomy for malignant tumors.

In maxillectomy patients, speech intelligibility between before and after insertion of prostheses has been reviewed by many investigators. Speech intelligibility was not related to the size of the defect, but rather to the defect region. Speech intelligibility was considerably improved by the use of prostheses. A great difference could not be found in escape rate from the nasal cavity between before and after insertion of prostheses, but there was a remarkable change in the spirometer. Postmaxillectomy functions are also easily restored by prosthetic oral rehabilitation, necessary to aid surgical procedure.     

Facial defects restored with extraoral implant-supported prostheses

A facial defect results in cosmetic, functional, and psychologic problems and acts as a difficult and challenging procedure for the maxillofacial surgeon and the prosthodontist. Retention of a facial prosthesis is an important key in the patient's satisfaction and acceptance. The introduction of extraoral implant applications have been accepted as an advanced retention method. The purpose of this article is to report the results from our clinical experience with patients wearing facial prostheses anchored to extraoral ITI implants (Straumann, AG, Basel, Switzerland).     

Implant-retained auricular prostheses: an assessment of implant success and prosthetic complications

The aims of this study were to evaluate the success rates and peri-implant soft tissue responses of auricular implants, to assess prosthetic complications, and to calculate the survival rate of silicone auricular prostheses. Twenty-nine extraoral implants were placed in 10 patients with 11 auricular defects. Implant failure was defined as clinically detectable implant mobility, and a 5-point scale was used to record the health of peri-implant soft tissues. Prosthetic complications were assessed, and the survival rate of silicone auricular prostheses was calculated using Kaplan-Meier analysis. The implant success rate was 100%. A few soft tissue problems were noted. The overall cumulative survival rate for the first prostheses of the patients was 70% after 18 months. The mean survival time was 17 months. Extraoral implants had a very high success rate in the mastoid region. Prosthetic assessment indicated that although experience with wearing prostheses reduces retention degradation, discoloration and reduced quality of fit at the prosthesis edge over time remain the major problems in maxillofacial prosthetics.     

Magnet-retained facial prosthesis combined with an implant-supported edentulous maxillary obturator: a case report

The prosthetic rehabilitation of maxillofacial defects is especially challenging when the patient is edentulous. Although dental implants are used to enhance the retention and stability of both facial and maxillary prostheses, combining facial and maxillary prostheses is extremely difficult. This article describes the prosthetic treatment of an edentulous patient with a large maxillary and facial defect. After placing dental implants in the remaining maxilla, a maxillary obturator prosthesis supported by a milled bar attachment was fabricated. The facial prosthesis was retained by a magnetic attachment to the maxillary obturator prosthesis. As the obturator prosthesis was supported securely by this sturdy attachment, the facial prosthesis was stable during mastication and facial movement. The patient reported improvement in prosthesis retention and stability. Both the masticatory and the speech functions of the patient improved.     

Self-perceived changes in oral health-related quality of life after receiving different types of conventional prosthetic treatments: A cohort follow-up study

Objectives

To evaluate the changes in oral health-related quality of life (OHRQoL) reported by subjects treated with conventional prostheses.

Methods

A consecutive sample of 153 patients seeking prosthodontic rehabilitation was recruited. Socio-demographic and prosthetic-related factors (Eichner Index; number of occlusal, aesthetic, and lost units) were registered. Baseline impacts on OHRQoL were collected using the OHIP-14 questionnaire. One month after treatment, the participants answered whether the prostheses had generated better, equal, or poorer effects within the 14 items of a retrospective scale (Post-OHIP). The study patients were compared with the reference population (P-population; n = 123) in terms of OHRQoL. Such P-population consisted of Spanish adults wearing conventional dental prostheses who were not seeking any dental treatment. The reliability and validity of the tests applied and the factor structure of the Post-OHIP were investigated. A Poisson regression model was calculated to predict what items would change favourably after treatment.

Results

Four prosthetic cohorts were established according to the types of rehabilitations performed: 1-FDPs: metal–ceramic fixed dental prostheses; 2-M-RPDs: metal-based removable partial dentures; 3-ADs: acrylic partial dentures and 4-CDs: complete dentures. Both tests confirmed adequate psychometric properties. Most items of the Post-OHIP consistently loaded on a single factor. Patients requiring ADs or CDs reported significantly lower baseline OHRQoL than those needing M-RPDs or FDPs. Pain/discomfort was the only hampering issue subsequent to removable rehabilitation. M-RPDs are expected to provide the significantly highest therapeutic improvements.

Conclusions

Patients perceived benefits in chewing ability, aesthetics and satisfaction with their mouth after receiving conventional dental prostheses.

Clinical significance

Conventional prosthetic therapy enhances patients’ overall well-being although it can cause discomfort and chewing dysfunction in more than 20% of subjects. Metal-based removable partial dentures are the most predictable in terms of patient satisfaction. The higher the clinical impairment felt by patients, the higher the increase in OHRQoL after rehabilitation.     

Food selection and perceptions of chewing ability following provision of implant and conventional prostheses in complete denture wearers

The loss of natural teeth compromises chewing efficiency, and edentulous patients often have a diet that is deficient in fibre and vitamins. Prostheses that are retained on implants offer the possibility of overcoming some of the limitations of conventional dentures in terms of chewing efficiency. The aim of this study was to test the hypothesis that improvement in satisfaction with oral prostheses would result in improved food selection in edentulous patients. This prospective study involved three groups, namely (i) subjects who requested and received implants to stabilise a complete fixed or removable prosthesis (IG, n = 26), (ii) edentulous subjects who requested implant prostheses, but received conventional dentures (CDG1, n = 22), and (iii) edentulous subjects who requested and received conventional dentures (CDG2, n = 35). Data were collected using validated questionnaires pre- and postoperatively. Prior to treatment, all subjects were asked whether they ate a variety of hard and soft foods, to indicate the degree of difficulty they experienced when chewing these foods, and to rate their satisfaction with various aspects of their maxillary and mandibular complete dentures. Following the completion of treatment, subjects completed the questionnaires again. Pre- and postoperative data were compared. Subjects who received implant prostheses reported significant improvement in chewing hard and soft foods. CDG2 subjects also reported improvement, but CDG1 subjects reported no change or even deterioration following treatment. Despite reported improvement in satisfaction with comfort and ability to chew food, 30-50% of IG and CDG2 subjects still avoided eating foods such as carrot and apple. This suggests that, in the absence of tailored dietary advice, apparently successful prosthetic rehabilitation does not necessarily result in a satisfactory diet.     

Maxillofacial prosthetic rehabilitation of a midfacial defect complicated by microstomia: a clinical report

Severe limitation in the oral opening, though an uncommon clinical presentation, makes gaining access to the oral cavity difficult for any dental procedure. This article describes the maxillofacial prosthetic management of a patient with a midfacial defect complicated by postsurgical microstomia. Intraoral and extraoral prostheses restored the patient's speech, dental articulation, mastication, lip support, esthetics, and anterior oral seal.     

咬合重建相关病例回顾及修复流程研究

目的根据咬合异常的不同临床表现，应用不同的修复方法进行咬合重建，评价临床效果，讨论与咬合重建相关疾病的临床诊断及修复设计流程。方法64例咬合异常患者按照修复前检查-诊断-修复设计-咬合重建修复-修复后评价的临床步骤，进行固定修复、固定-可摘局部义齿修复及可摘局部义齿修复咬合重建，于修复前后分别检查颞颌关节健康状况、义齿使用情况与咀嚼效能。结果咬合重建修复1年后，30例颞颌关节紊乱病患者中的25例治愈，对关节区疼痛与关节弹响的疗效差异有统计学意义：全部患者对咬合重建修复的临床效果满意，与可摘局部义齿修复相比较，固定修复、固定-可摘局部义齿修复在义齿舒适度（X^2=5．25，P〈0．05）和对发音影响（X^2=10．86，P〈0．05）等方面的满意度较高，差异有统计学意义；不同种类修复之间及选用不同种类修复咬合重建修复前（F=9．248，P〈0．05）和修复后（F=4．858，P〈0．05），患者咀嚼效能的差异有统计学意义。总结和制定与咬合重建相关疾病的临床诊断流程及修复设计流程。结论运用系统化的临床诊断流程及修复设计流程，能保障获得准确的诊断与针对性的修复设计，保证咬合重建诊疗修复取得成功。     

Clinical outcome of removable prostheses supported by mini dental implants. A systematic review

Introduction: For many years, edentulous patients have had no other option than conventional dentures to reestablish their oral function. To avoid the need for bone graft surgery, some professionals have suggested the use of mini dental implants (MDIs) to support prostheses. The MDIs are narrow implants, ranging approximately from 1.8 to 2.9?mm in diameter. Recently, the promising results of mini implants regarding osseointegration and patient satisfaction have led clinicians to accept them as a definitive treatment option. Objective: Therefore, the proposition of this systematic review was to assess information on the outcomes of MDIs supporting removable prostheses. Methods:The PubMed and Cochrane databases were searched for articles published before September 2017, which yielded a total of 774 studies for analysis. After exclusion and inclusion criteria, 22 prospective studies were included in this systematic review. Results: Most mini implants were placed in a flapless single-stage surgery and loaded immediately. Most studies reported failures in the first year and prosthetic complications. The mean survival rate of the selected studies was 95.6%, and mean follow-up was 22.8 months. Conclusion: The MDI-supported removable prostheses successfully improved patients’ chewing and speaking ability, quality of life, and satisfaction, suggesting that MDIs are a viable and safe option to support removable prostheses in the mandibular arch.     

Treatment outcomes of fixed or removable implant-supported prostheses in the edentulous maxilla. Part I: patients' assessments

STATEMENT OF PROBLEM: Distinct clinical parameters determine whether fixed or removable implant-supported prostheses are indicated to restore the edentulous maxilla. However, there is a strong belief that fixed implant prostheses meet with greater patient acceptance and satisfaction, but this may differ from the patients' perceptions, their psychological responses to treatment, and their assessments of the treatment outcome. PURPOSE: This prospective clinical study compared the treatment outcomes of fixed and removable implant-supported restorations in the edentulous maxilla with the main emphasis on the patient's point of view.Material and methods: Twenty patients who requested an implant-supported superstructure to restore the edentulous maxilla were asked to complete a questionnaire measuring their satisfaction with the present situation and the psychologic impact of their oral health status with their responses marked on a Visual Analog Scale (VAS). Ten patients were treated with a fixed, screw-retained implant prosthesis (group 1), and 10 were treated with a removable, implant-supported and bar-retained overdenture (group 2). Six months after prosthetic rehabilitation, patients were again given the questionnaire to assess their psychologic well-being and satisfaction with the implant-supported restoration. RESULTS: Both prosthesis designs were associated with significant improvements in comfort and retention, function, esthetics and appearance, taste, speech, and self-esteem. No difference was found between the 2 groups with respect to how the patients assessed the implant therapy. However, the results indicated that patients in group 2 experienced greater differences between pretreatment and posttreatment scores for the parameters esthetics, taste, and speech. Treatment costs per unit were significantly higher in group 1 than in group 2. CONCLUSION: Patients in groups 1 and 2 were similarly satisfied with their implant-supported prostheses in the edentulous maxilla with regard to their well-being and the cost-utility, irrespective of whether the restoration was fixed or removable.     

Subjective assessment of chewing function of obturator prosthesis wearers

PURPOSE: Assessments of masticatory performance and occlusal force for wearers of obturator prostheses were performed as clinical objective assessments and reported in an earlier study. The purpose of the present study was to evaluate clinically the chewing function of obturator prosthesis wearers by self-evaluations and to examine their relationship to the objective assessments. MATERIALS AND METHODS: Twenty patients with maxillofacial obturator prostheses who were having a periodic checkup at the maxillofacial rehabilitation clinic in Kyushu University Hospital were recruited for this study. Chewing function was evaluated by 3 assessment tools: a self-assessment mastication scale, a chewing function score, and a mastication score. In addition, correlations among these assessments and objective tests--ie, masticatory performance and maximum occlusal force--were analyzed by the Spearman rank correlation coefficient. RESULTS: The mean self-assessment mastication scale was 63.2 (SD 31.8), the chewing function score was 54.0 (SD 30.2), and the mastication score was 51.4 (SD 33.3). There was no statistically significant relationship between the self-assessment mastication scale and each objective test. However, there were significant correlations between each semisubjective score--the chewing function score and the mastication score--and masticatory performance. There was no relationship between each semisubjective score and maximum occlusal force. CONCLUSION: A self-assessment mastication scale was not always in agreement with objective assessments, and assessments made by patients should be taken into consideration when arranging maxillofacial rehabilitation. Conversely, both chewing function and mastication scores corresponded with masticatory performance, and these would be useful as screening tests before performing objective tests.     

Restoration with implants in patients with recessive dystrophic epidermolysis bullosa and patient satisfaction with the implant-supported superstructure

PURPOSE: The use of endosseous implants in the prosthetic restoration of edentulous patients with recessive dystrophic epidermolysis bullosa (RDEB) may provide improved outcomes when compared with traditional prosthetic methods. The aim of this study was to evaluate the feasibility of placing endosseous implants in patients with RDEB and to compare the treatment outcomes of fixed and removable implant-supported restorations in the edentulous maxilla or mandible with the main emphasis on patient response. MATERIALS AND METHODS: Six patients with RDEB were treated with implants. All patients were completely edentulous in either the maxilla or mandible and had marked oral involvement, with alterations in the soft and hard tissues in all cases. Three patients were treated with fixed, screw-retained implant-supported prostheses, and 3 were treated with removable implant-supported prostheses. Six months after prosthetic restoration, patients were given a questionnaire to assess their psychologic well-being and satisfaction with the implant-supported restoration marked on a visual analog scale. RESULTS: A total of 38 dental implants (21 maxillary, 17 mandibular) were placed in 6 patients. The implant success rate was 97.9%. The average follow-up from implant placement was 5.5 years (range, 1 to 9). The fixed and removable implant-supported prostheses were associated with improvements in comfort and retention, function, esthetics and appearance, taste, speech, and self-esteem. The level of satisfaction was slightly higher in patients with a fixed prosthesis. CONCLUSION: These findings suggest that endosseous implants can be successfully placed and provide support for prostheses in patients with RDEB. Patients with fixed prostheses and overdentures were satisfied with their implant-supported prostheses in the edentulous maxilla and mandible.