Harry Reintsema

Augmentation of localized defects of the anterior maxillary ridge with autogenous bone before insertion of implants

PURPOSE This study evaluated the applicability of intraorally harvested autogenous bone grafts for the augmentation of the narrow maxillary alveolar ridge to enable insertion of implants for single tooth replacement. MATERIALS AND METHODS Local defects of the anterior maxilla were reconstructed in 27 patients with autogenous bone grafts from the mandibular symphysis (n = 12), maxillary tuberosity (n = 8), or mandibular retromolar area (n = 7). Three months after grafting, either Branemark (n = 23) or ITI Bonefit implants (n = 8) were inserted. RESULTS At the time of implantation, all grafted sites showed sufficient bone volume for insertion of the implants. Twenty-four to 68 months after insertion, all implants were functioning well. CONCLUSION Augmentation of local alveolar defects in the maxilla with intraorally harvested autogenous bone grafts appears to be a reliable method to enable implant placement.

Fully 3‐dimensional digitally planned reconstruction of a mandible with a free vascularized fibula and immediate placement of an implant‐supported prosthetic construction

Reconstruction of craniofacial defects becomes complex when dental implants are included for functional rehabilitation. We describe a fully 3‐dimensional (3D) digitally planned reconstruction of a mandible and immediate prosthetic loading with a fibula graft in a 2‐step surgical approach.

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.

Oral Rehabilitation Outcomes Network-ORONet

The published literature describing clinical evidence used in treatment decisionmaking for the management of tooth loss continues to be characterized by a lack of consistent outcome measures reflecting not only clinical performance but also a range of patient concerns. Recognizing this problem, an international group of clinicians, educators, and scientists with a focus on prosthodontics formed the Oral Rehabilitation Outcomes Network (ORONet) to promote strategies for improving health based on comprehensive, patient-centered evaluations of comparative effectiveness of therapies for oral rehabilitation. An initial goal of ORONet is to identify outcome measures for prosthodontic therapies that represent multiple domains with patient relevance, are amenable to utilization in both institutional and practice-based environments, and have established validity. Following a model used in rheumatology, the group assessed the prosthodontic literature, with an emphasis on implantbased therapies, for outcomes related to longevity and functional, psychologic, and economic domains. These systematic reviews highlight a need for further development of standardized outcomes that can be integrated across clinical and research environments.

Predictors for trismus in patients receiving radiotherapy

Abstract Background: Trismus, a restricted mouth opening in head and neck cancer patients may be caused by tumor infiltration in masticatory muscles, radiation-induced fibrosis or scarring after surgery. It may impede oral functioning severely. The aims of our study were to determine: (1) the incidence of trismus at various time points; and (2) the patient, tumor, and treatment characteristics that predict the development of trismus after radiotherapy in head and neck cancer patients using a large database (n = 641). Methods: Maximal mouth opening was measured prior to and 6, 12, 18, 24, 36, and 48 months after radiotherapy. Patient, tumor, and treatment characteristics were analyzed as potential predictors for trismus using a multivariable logistic regression analysis. Results: At six months after radiotherapy, 28.1% of the patients without trismus prior to radiotherapy developed trismus for the first time. At subsequent time points the incidence declined. Over a total period of 48 months after radiotherapy, the incidence of trismus was 3.6 per 10 person years at risk. Patients who had tumors located in the oral cavity, oropharynx or nasopharynx, and the salivary glands or ear, and who had a longer overall treatment time of radiotherapy, were more likely to develop trismus in the first six months after radiotherapy. Maximal mouth opening was a predictor for developing trismus at all time points. Conclusion: Incidence of trismus is 3.6 per 10 person years at risk. Tumor localization and overall treatment time of radiotherapy are predictors for developing trismus the first six months after radiotherapy. Maximal mouth opening is a significant predictor for developing trismus at all time points. Regular measurements of maximal mouth opening are needed to predict trismus.

Paradigm shift in head and neck oncology patient management

ObjectiveThis article describes a paradigm shift in what is considered to be good care for patients living with and after (head and neck) cancer. HNO patients often experience severe and difficult physical and psychosocial problems due to the nature and location of the disease. Many disciplines are involved in their treatment, so their voice is only one amongst many others in the decision making process. For this patient group it seems complicated to put the concept of Shared Decision Making into practice. As a step in this direction, patient reported outcomes which ask patients to select the disconcerting issues and symptoms can be used as a basis for referral, supportive care and treatment decision making. We need to provide more tailored and personalized information that is specific to individual circumstances, preferences and concerns and focuses more on the impact of treatment and access to help and support. Follow up of these patients should be concentrated on both medical and emotional aspects.Practice implicationsA shift in the way caregivers provide their information contributes to a more profound involvement of patients in treatment decisions.

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

Maxillofacial Prosthodontics Practice Profile: A Survey of Non-United States Prosthodontists

BackgroundThis study surveyed non-United States maxillofacial prosthodontists (MFP) to determine their practice profile and rationale for pursuing an MFP career.MethodsEmail addresses for the MFP were obtained from the International Society for Maxillofacial Rehabilitation, American Academy of Maxillofacial Prosthetics, and International Academy for Oral Facial Rehabilitation. Emails with a link to the electronic survey program were sent to each participant. Chi-square and Mann–Whitney-U tests were used to investigate the influence of formal MFP training on professional activities and type of treatments provided.ResultsOne hundred twelve respondents (response rate 39%) from 33 nationalities returned the survey. The top three reasons for pursuing an MFP career were personal satisfaction, prosthodontics residency exposure, and mentorship. The predominant employment setting was affiliation with a university (77%). There were significant differences between respondents with and without formal MFP training regarding provision of surgical treatments (P = 0.021) and dental oncology (P = 0.017). Most treatments were done together with otolaryngology, oral surgery (68%) and head and neck surgery (61%). Practitioners not affiliated with a university spent significantly more time in clinical practice (P = 0.002), whereas respondents affiliated with universities spent significantly more time in teaching/training (P = 0.008) and funded research (P = 0.015).ConclusionsPersonal satisfaction is the most important factor in a decision to choose an MFP career. Most of the MFPs work at a university and within a multidisciplinary setting. There were differences regarding type of treatments provided by respondents with and without formal MFP training.