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

• Published in: Oral oncology Vol. 40; no. 9; pp. 862 - 871
• Main Authors: Schoen, P.J., Reintsema, H., Raghoebar, G.M., Vissink, A., Roodenburg, J.L.N.
• Format: Journal Article
• Language: English
• Published: Oxford Elsevier Ltd 01-10-2004; Elsevier
• Subjects: Biological and medical sciences; Dental Implantation, Endosseous - methods; Dental Prosthesis, Implant-Supported; Female; Head and Neck Neoplasms - radiotherapy; Head and Neck Neoplasms - surgery; Humans; Implants; Male; Mandible; Mandibular Prosthesis; Medical sciences; Middle Aged; Oncology; Otorhinolaryngology (head neck, general aspects and miscellaneous); Otorhinolaryngology. Stomatology; Prosthodontics; Radiation Injuries - complications; Radiotherapy; Tongue; Tumors; Oncology; Mandible; Tongue; Radiotherapy; Prosthodontics; Implants; Human; Implant; Prosthesis; Stomatology; Review; Cancerology; Treatment; ENT disease; Head and neck cancer; Treatment planning
• ISSN: 1368-8375; 1879-0593
• DOI: 10.1016/j.oraloncology.2003.08.024

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 healing, which may lead to development of radionecrosis of soft tissues and bone as well as to increased implant loss. If surgical treatment after radiotherapy is indicated, measures to prevent implant loss 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 multidisciplinary consultation for a well-established treatment planning. The primary curative intent of the oncological treatment and the prognosis for later prosthodontic rehabilitation have to be taken into account too.