Benefits of dental implants installed during ablative tumour surgery in oral cancer patients: a prospective 5‐year clinical trial

Objective: This prospective study assessed treatment outcome and patient satisfaction of oral cancer patients with a mandibular overdenture on implants up to 5 years after treatment. Materials and methods: At baseline, 50 consecutive edentulous oral cancer patients, in whom prosthetic problems were expected after oncological treatment, were evaluated by standardized questionnaires and clinical assessments. All implants were installed during ablative tumour surgery in native bone in the interforaminal area. About two‐thirds of the patients (n=31) had radiotherapy post‐surgery (dose >40 Gy in the interforaminal area). Results: At the 5‐year evaluation, 26 patients had passed away and four patients had to be excluded from the analyses, because superstructures were not present, due to persistent local irritation (n=2), loss of three implants (n=1) and the impossibility of making an overdenture related to tumour and oncological surgery‐driven anatomical limitations (n=1). In the remaining 20 patients, the prosthesis was still in function (76 implants). During the 5‐year follow‐up, total 14 implants were lost, 13 in irradiated bone (survival rate 89.4%, dose >40 Gy) and one in non‐irradiated bone (survival rate 98.6%). Peri‐implant tissues had a healthy appearance and remained healthy over time. Patients were satisfied with their dentures. Conclusions: It was concluded that oral cancer patients can benefit from implants installed during ablative surgery, with a high survival rate of the implants, a high percentage of rehabilitated patients and a high denture satisfaction up to 5 years after treatment. To cite this article:
Korfage A, Schoen PJ, Raghoebar GM, Roodenburg JLN, Vissink A, Reintsema H. Benefits of dental implants installed during ablative tumour surgery in oral cancer patients: a prospective 5‐year clinical trial.
Clin. Oral Impl. Res. 21 , 2010; 971–979.
doi: 10.1111/j.1600‐0501.2010.01930.x     

Immediate implant placement in edentulous oral cancer patients: a long-term retrospective analysis of 207 patients

Although the functional benefits of implants in the rehabilitation of edentulous cancer patients are well-known, most studies report on postponed implant placement. The outcome of immediate implant placement regarding successful rehabilitation, implant loading and survival is unclear. Two hundred and seven edentulous oral cancer patients that received implants during ablative surgery at the Radboud University Medical Centre between 2000 and 2011 were included. Data regarding the oncological treatment, implant placement, follow-up and prosthodontic rehabilitation were recorded retrospectively with a follow-up period of 5–17 years. Functioning implant-retained dentures were made in 73.9% of the patients. Of the surviving patients, 81.9% had functioning dentures after 2 years and 86.3% after 10 years. Patients with ASA score 1 and younger patients were rehabilitated more frequently. The median time of functioning denture placement was 336 days after surgery, with a negative influence of postoperative radiotherapy. Implant survival was 90.7%, and was lower when the implant was placed in a jaw involved in the tumour. Immediate implant placement during oral cancer surgery led to a high number of edentulous patients rehabilitated with implant-retained dentures, which are placed at an early time.     

Oral health‐related quality of life,oral aesthetics and oral function in head and neck cancer patients after oral rehabilitation

Head and neck cancer (HNC) is diagnosed in more than 500 000 patients every year worldwide with increasing prevalence. Oral rehabilitation is often needed after HNC treatment to regain oral function, aesthetics and oral health‐related quality of life (OHRQoL). The objectives were to evaluate OHRQoL, oral aesthetics and oral function after oral rehabilitation in HNC patients and compare it to that of non‐HNC patients. Eighteen patients treated for HNC who subsequently had oral rehabilitation (2014‐2017), and a control group of eighteen age‐ and gender‐matched non‐HNC patients treated with removable prostheses (2014‐2018) were included in a cross‐sectional study. The OHRQoL was assessed by the Oral Health Impact Profile 49 questionnaire (OHIP‐49), the oral aesthetics by the Prosthetic Esthetic Index (PEI) and the Orofacial Esthetic Scale (OES), and the oral function by the Nordic Orofacial Test‐Screening (NOT‐S). The HNC patients had worse oral function and OHRQoL than the control patients (mean NOT‐S score 4.56 vs 0.56, P < 0.01 and mean OHIP‐49 score 42.50 vs 20.94, P = 0.050). When including number of replaced teeth and type of prosthesis in the tests, no significant difference in OHRQoL was found between the groups. No difference was found in the overall aesthetic outcomes (mean PEI total score 32.28 vs 30.67, P = 0.367 and mean OES total score 48.78 vs 53.56, P = 0.321). Multiple regression analyses showed that being HNC patient compared to control patient impaired the oral function. Oral function is significantly impaired in HNC patients compared to non‐HNC patients after oral rehabilitation.     

Long-term success of dental implants in patients with head and neck cancer after radiation therapy

The purpose of this study was to analyze the long-term success and factors potentially influencing the success of dental implants placed in patients with head and neck cancer who underwent radiation therapy with a minimum total dose of 50 Gy during the years 1995–2010. Thirty-five patients (169 dental implants) were included in this study. Data on demographic characteristics, tumour type, radiation therapy, implant sites, implant dimensions, and hyperbaric oxygen therapy (HBOT) were obtained from the medical records and analyzed. Implant survival was estimated using Kaplan–Meier survival curves. Seventy-nine dental implants were placed in the maxilla and 90 in the mandible. The mean follow-up after implant installation was 7.4 years (range 0.3–14.7 years). The overall 5-year survival rate for all implants was 92.9%. Sex (P < 0.001) and the mode of radiation therapy delivery (P = 0.005) had a statistically significant influence on implant survival. Age, time of implantation after irradiation, implant brand and dimensions, and HBOT had no statistically significant influence on implant survival. Osseointegrated dental implants can be used successfully in the oral rehabilitation of patients with head and neck cancer with a history of radiation therapy. Risk factors such as sex and the mode of radiation therapy delivery can affect implant survival.     

Short dental implants in patients with oral lichen planus: a long-term follow-up

Oral lichen planus is associated with the Koebner phenomenon, and trauma may exacerbate oral lesions. Short dental implants, as alternatives to bony augmentation, would reduce the number of interventions and their morbidity. However, we know of no studies that have analysed the long-term outcomes of short implants in patients with oral lichen planus. We have therefore designed a retrospective study of such patients treated with short implants (≤ 8.5 mm long), with survival of implants as the main outcome. The secondary outcomes were marginal bone loss and the development of complications. We calculated the implants’ survival and compared the outcomes statistically between erosive and reticular oral lichen planus. Sixty-six short implants were placed in 23 patients with a mean (SD) age of 58 (7)?years. The mean (SD) peri-implant bone loss was 0.96 (0.89)?mm mesially and 0.99 (1.1)?mm distally. Sixty-five of the 66 implants survived with a mean (SD) follow-up of 68 (32) months, and there were no significant differences between erosive and reticular disease. Stable long-term outcomes can be expected for short implants placed in patients with oral lichen planus, and graftless rehabilitation of missing teeth could be possible in these patients if short implants were used.     

The effect of implant placement in patients with either Kennedy class II and III on oral health‐related quality of life: a prospective clinical trial

There is little evidence of the effect of implants restored with fixed partial dentures on oral health‐related quality of life (OHRQoL) in partially edentulous Kennedy class II and III patients. The aim of this study was to determine the change in OHRQoL in Kennedy classification II and III patients treated with a two‐implant‐supported fixed dental prosthesis (FDP). Kennedy class II and III patients received dental implants and an FDP. Oral health‐related quality of life was measured by administration of the Oral Health Impact Profile‐14 (OHIP‐14NL) questionnaire at intake (T1), 2 weeks after surgery (T2) and after 1 year of loading (T3). The mean OHIP score at T1 was 6·5 ± 1·2, 2·4 ± 1·0 at T2, and 0·9 ± 0·3 at T3. There was a statistically significant difference between T1 and T2 (P = 0·002) and T1 and T3 (P < 0·001) but not between T2 and T3 (P = 0·407). The OHIP score in Kennedy II patients decreased from 4·8 ± 3·2 at T1 to 1·5 ± 2·0 at T2 and 1·1 ± 1·8 at T3, and that in Kennedy III patients decreased from 8·9 ± 9·6 at T1 to 3·6 ± 8·9 at T2 and 0·8 ± 2·2 at T3. There were no statistically significant differences in the reductions in Kennedy II and III patients. Oral health‐related quality of life changed positively in patients treated with implants and an FDP in both groups. There was no change in OHRQoL between the times of implant placement and FDP placement.     

Effect of implant therapy on oral health‐related quality of life (OHIP‐49), health status (SF‐36), and satisfaction of patients with several agenetic teeth: Prospective cohort study

Background

Effect of fixed prosthodontics on patients with several agenetic teeth is not well understood.

Purpose

To assess the effect of implant‐based fixed prosthodontics on oral health‐related quality of life (OHRQoL), general health status, and satisfaction regarding dental appearance, ability to chew and speech in patients with several agenetic teeth.

Materials and Methods

For this prospective cohort study, all patients (≥18 years) with several agenetic teeth who were scheduled for treatment with fixed dental implants between September 2013 and July 2015 at our department were approached. Participants received a set of questionnaires before and 1 year after implant placement to assess OHRQoL (OHIP‐NL49), general health status (SF‐36), and satisfaction regarding dental appearance, ability to chew and speech.

Results

About 25 out of 31 eligible patients (10 male, 15 female; median age: 20 [19;23] years; agenetic teeth: 7 [5;10]) were willing to participate. Pre‐ and post‐treatment OHIP‐NL49 sum‐scores were 38 [28;56] and 17 [7;29], respectively (P < .001). Scores of all OHIP‐NL49 subdomains decreased tool, representing an improved OHRQoL (P < .05) as well as that satisfaction regarding dental appearance, ability to chew and speech increased (P < .001). General health status did not change with implant treatment (P > .05).

Conclusions

Treatment with implant‐based fixed prosthodontics improves OHRQoL and satisfaction with dental appearance, ability to chew and speech, while not affecting general health status.     

A prospective clinical study on titanium implants in the zygomatic arch for prosthetic rehabilitation of the atrophic edentulous maxilla with a follow-up of 6 months to 5 years

Background Prosthetic rehabilitation with implant‐supported prostheses in the atrophic edentulous maxilla often requires a bone augmentation procedure to enable implant placement and integration. However, a rigid anchorage can also be achieved by using so‐called zygomatic implants placed in the zygomatic arch in combination with regular implants placed in residual bone. Purpose The aim of the present study was to report on the clinical outcome of using zygomatic and regular implants for prosthetic rehabilitation of the severely atrophic edentulous maxilla. Materials and Methods Sixty‐nine consecutive patients with severe maxillary atrophy were, during a 5‐year period, treated with a total of 69 fixed full‐arch prostheses anchored on 435 implants. Of these, 131 were zygomatic implants and 304 were regular implants. Fifty‐seven bridges were screw‐retained and 12 were cemented. The screw‐retained bridges were removed at the examination appointments and each implant was tested for mobility. In addition, the zygomatic implants were subjected to Periotest^® (Siemens AG, Bensheim, Germany) measurements. The patients had at the time of this report been followed for at least 6 months up to 5 years in loading. Results Two regular implants failed during the study period giving a cumulative survival rate of 99.0%. None of the zygomatic implants was removed. All patients received and maintained a fixed full‐arch bridge during the study. Periotest measurements of zygomatic implants showed a decreased Periotest values value with time, indictating an increased stability. Three patients presented with sinusitis 14–27 months postoperatively, which could be resolved with antibiotics. Loosening of the zygomatic implant gold screws was recorded in nine patients. Fracture of one gold screw as well as the prosthesis occurred twice in one patient. Fracture of anterior prosthetic teeth was experienced in four patients. Conclusions The results from the present study show that the use of zygomatic and regular implants represents a predictable alternative to bone grafting in the rehabilitation of the atrophic edentulous maxilla.     

Immediate rehabilitation of the edentulous jaws with full fixed prostheses supported by four implants: interim results of a single cohort prospective study

Objectives: The purpose of this study was to prospectively evaluate the clinical and radiographic outcomes of immediately loaded full‐arch fixed prostheses supported by a combination of axially and non‐axially positioned implants in a large cohort of patients with completely edentulous jaws, up to 5 years of function. Materials and methods: One hundred and seventy‐three edentulous patients (80 males and 93 females) were enrolled according to specific selection criteria. Each patient received a full‐arch fixed prosthesis supported by two distal tilted implants and two anterior axially placed implants. The provisional functional acrylic prosthesis was delivered the same day as surgery in all cases. All cases were finalized 4–6 months later. The patients were scheduled for follow‐up at 6 and 12 months of function, and annually up to 5 years. At each follow‐up plaque and bleeding score was assessed and radiographic evaluation of marginal bone level was performed. Results: The overall follow‐up range was 4–59 months. A total of 154 immediately loaded prostheses (61 in the maxilla and 93 in the mandible) were in function for at least 1 year and were considered for the analysis. Four axially placed implants failed in the maxilla and one tilted implant in the mandible, all within 6 months of loading. No further implant failure occurred to date. Implant survival at 1 year was 98.36% and 99.73% for the maxilla and the mandible, respectively. Marginal bone loss at 1 year averaged 0.9±0.7 mm in the maxilla (204 implants) and 1.2±0.9 mm in the mandible (292 implants). No difference was found in marginal bone loss between axial and tilted implants. Plaque and bleeding scores progressively improved from 6 to 12 months. Fracture of the acrylic prosthesis occurred in 14% of total cases. Conclusions: The present preliminary results from a relatively large sample size suggest that the present technique can be considered a viable treatment option for the immediate rehabilitation of both mandible and maxilla. To cite this article:
Agliardi E, Panigatti S, Clericò M, Villa C, Malò P. Immediate rehabilitation of the edentulous jaws with full fixed prostheses supported by four implants: interim results of a single cohort prospective study.
Clin. Oral Impl. Res. 21 , 2010; 459–465.
doi: 10.1111/j.1600‐0501.2009.01852.x     

Survival of dental implants in irradiated head and neck cancer patients: a retrospective analysis

Purpose: To study the long‐term survival of dental implants placed in irradiated bone in subjects who received radiation for head and neck cancer. Materials and Method: A retrospective chart review was conducted for all patients who received dental implants following radiation treatment for head and neck cancer between May 1, 1987 through July 1, 2008. Only patients irradiated with a radiation dose of 50 Gy or greater and those who received dental implants in the irradiated field after head and neck radiation were included in the study. The associations between implant survival and patient/implant characteristics were estimated by fitting univariate marginal Cox proportional hazards models. Results: A total of 48 patients who had prior head and neck radiation had 271 dental implants placed during May 1987 to July 2008. The estimated survival at 1, 5, and 10 years was 98.9%, 89.9%, and 72.3%, respectively. Implants placed in the maxilla were more likely to fail than implants placed in the mandible (p = .002).There was also a tendency for implants placed in the posterior region to fail compared with those placed in the anterior region (p = .051). Conclusion: Dental implants placed in irradiated bone have a greater risk for failure. Survival is significantly influenced by the location of the implant (maxilla or mandible, anterior or posterior).     

A 5-year prospective multicenter clinical trial of non-submerged dental implants with a titanium plasma-sprayed surface in 200 patients

Background: Endosseous dental implants are a popular treatment to replace missing teeth. Although many advances have occurred and affected the macrogeometry and surface characteristics of dental implants, among other aspects, it is important to document how the implants perform in patients over time. Such evaluations are helpful not only to document the clinical survival of the implants but also patient satisfaction over an extended period. Methods: A formal prospective multicenter human clinical was performed at five centers involving 200 patients and 626 implants. Specific inclusion and exclusion criteria were used and detailed data collected at specified times using case report forms. An independent study monitor reviewed all study data before entry into the study database. Two implant designs were used in two different clinical indications. A non‐submerged titanium plasma‐sprayed (TPS) hollow cylindrical implant with a smooth transgingival collar was evaluated in the maxillary anterior sextant and a non‐submerged TPS solid screw implant with similar collar in the mandible. Results: Over the course of the 5‐year clinical trial, there was one early failure occurring before definitive prosthesis delivery. Three late failures were documented, one occurring at each of the 6, 12, and 18 months postoperative visits. Life table analysis at 5 years revealed a 99.4% survival rate and a 92.5% success rate. Patient satisfaction was rated as good to excellent for 96.1% of implants in regards to esthetics after 5 years; 98.8% for appearance; and 99.4% for prosthesis comfort, ability to chew and taste, fit, and general satisfaction. No serious adverse events were reported. Conclusions: Implant success and survival was over 92% and 99%, respectively, in a formal 5‐year prospective multicenter clinical trial involving 200 patients and 626 non‐submerged TPS implants. These implants included hollow cylinder implants in the anterior maxilla and solid screw implants placed in the mandible. These findings document the predictability and patient satisfaction of tooth replacement using a non‐submerged surgical technique involving a tissue‐level, rough surfaced endosseous dental implant.