Anke Korfage

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.

Five-year follow-up of oral functioning and quality of life in patients with oral cancer with implant-retained mandibular overdentures

The purpose of this prospective study was to assess the quality of life (QOL) and oral functioning of patients with oral cancer up to 5 years after prosthodontic rehabilitation with mandibular implant‐retained overdentures.

Recommendations for implant‐retained nasal prostheses after ablative tumor surgery: Minimal surgical aftercare, high implant survival, and satisfied patients

Nasal defects resulting from tumor resection are preferably rehabilitated with implant‐retained nasal prostheses. Aftercare, clinical outcome of the implants, and patients’ satisfaction with implant‐retained nasal prostheses were assessed.

Oral rehabilitation with implant-based prostheses of two adult patients treated for childhood rhabdomyosarcoma

BackgroundRhabdomyosarcoma is the most common malignant tumor in the nasal and paranasal sinus area at childhood. Multimodal treatment for this disorder has severe side effects due to normal tissue damage. As a result of this treatment, facial growth retardation and oral abnormalities such as malformation of teeth and microstomia can cause esthetic and functional problems.Case reportsTwo cases are presented of patients with severe midfacial hypoplasia and reduced oral function as a result of treatment of rhabdomyosarcoma of the nasopharyngeal and nasal–tonsil region. With a combined surgical (osteotomy, distraction osteogenesis, implants) and prosthetic (implant-based overdenture) treatment, esthetics and function were improved.

Dental implants in irradiated patients: which factors influence implant survival?

Dear Editor, We read the meta-analyses of Schiegnitz et al. [1] on survival of dental implants in irradiated patients with great interest. Although we underline their conclusion that dental implants are a valuable treatment option in oral cancer patients, we would like to make some critical remarks about their data entry and performing a meta-analysis. As such, we question the internal validity of this study. In Table 1, Schiegnitz et al. [1] provide an overview of the studies on dental implants they identified as eligible, and of which, some were included in their analyses. In our opinion, this table includes several errors. For instance, in the studies of Schoen et al. [2] and Korfage et al. [3], mandibular (and not both maxillary and mandibular as reported by Schiegnitz et al. [1]) implants were inserted immediately after the ablative surgery as well as that about two thirds of the patients received postoperative radiotherapy. Thus, the implants were inserted pre-irradiation in both studies (and not post-irradiation in the study of Schoen et al. [2] as stated in Table 1). Also, in the study of Schepers et al. [4], the implants were inserted preirradiation (and not post-irradiation as stated in Table 1). Furthermore, in the study of Klein et al. [5], implants were inserted post-irradiation instead of pre-irradiation as reported by Schiegnitz et al. [1]. Whether implants inserted before radiotherapy have a different survival than implants inserted post-radiotherapy remains unclear since most long-term studies on implant survival in irradiated jaws are on implants inserted post-irradiation. A major advantage of inserting implants before radiotherapy is that osseointegration takes place before the healing capacity of the bone is compromised by radiotherapy. Additionally, more patients can benefit from early oral rehabilitation as it has been shown that patients often are not in favour for implant surgery after completing their ablative surgery/radiotherapy trajectory because they are tired of any new treatment [6]. Schiegnitz et al. [1] state in their discussion that all six eligible studies published in 2007–2013 mention that the survival rate of implants placed in irradiated and non-irradiated bone is comparable, which is not correct. In this respect, it is important to add an analysis on the reasons why implants are lost in irradiated patients: due to loss of osseointegration, due to resection of recurrent tumour, due timing of implant placement (before or after radiotherapy), and/or due to implant placement in native or reconstructed bone?When taking these confounders into account, e.g. Korfage et al. [3] and Linsen et al. [7] report a significant lower survival rate for implants placed in irradiated native bone, while in the study of Klein et al. [5], 17 % of the implants were lost in reconstructed bone (22 out of 128) and only 5 % in native bone (3 out of 62). The meta-analysis of recent studies (2007–2013) on implants in irradiated and non-irradiated native jaws was, according to Schiegnitz et al. [1], performed on three studies with a minimal mean follow-up of 60 months. In the study of Linsen et al. [7], the mean follow-up was 42 months. It is not clear how the data of that study is included in the metaanalysis. Furthermore, the number of events in this metaanalysis (lost implants in irradiated versus non-irradiated A. Korfage (*) : P. U. Dijkstra : J. L. N. Roodenburg : H. Reintsema :G. M. Raghoebar :A. Vissink Department of Oral and Maxillofacial Surgery, University of Groningen, University Medical Center Groningen, P.O. Box 30.001, BB70, 9700 RB Groningen, The Netherlands e-mail: a.korfage@umcg.nl

Recommendations for implant-retained nasal prostheses after ablative tumor surgery

Nasal defects resulting from tumor resection are preferably rehabilitated with implant‐retained nasal prostheses. Aftercare, clinical outcome of the implants, and patients’ satisfaction with implant‐retained nasal prostheses were assessed.

Recommendations for implant-retained nasal prostheses after ablative tumor surgery: Minimal surgical aftercare, high implant survival, and satisfied patients: IMPLANT-RETAINED NASAL PROSTHESES

Nasal defects resulting from tumor resection are preferably rehabilitated with implant‐retained nasal prostheses. Aftercare, clinical outcome of the implants, and patients’ satisfaction with implant‐retained nasal prostheses were assessed.