Abstract
Purpose of the StudyPatients undergoing ablative tumor surgery of the midface are faced with functional and esthetic issues. Various reconstructive strategies, such as implant-borne obturator prostheses or microvascular tissue transfer, are currently available for dental rehabilitation. The present study shows the first follow-up of patients treated with patient-specific implants (IPS Implants® Preprosthetic) for the rehabilitation of extended maxillary defects following ablative surgery.Patients and MethodsAll patients treated with patient specific implants due to postablative maxillary defects were included. 20 implants were placed in the 19 patients (bilateral implants were placed in one of the cases). In 65.75% of the cases, resection was performed due to squamous cell carcinoma. In addition to the primary stability, the clinical implant stability, soft tissue management, successful prosthodontic restoration, and complications were evaluated at a mean follow-up period of 26 months.ResultsAll patient-specific implants showed primary stability and were clinically stable throughout the observation period. Definitive prosthodontic restorations were performed in all patients. No implant loosening was observed. Major complications occurred only in previously irradiated patients with insufficient soft tissue conditions (p = 0.058). Minor complications such as exposure of the underlying framework or mucositis were observed, but they never led to failure of restorations or implant loss.ConclusionsTreatment of postablative maxillary defects with patient-specific implants offers a safe alternative with predictable results for full and rapid dental rehabilitation, avoiding time-consuming augmentation procedures and additional donor-site morbidity.
Highlights
Ablative tumor surgery of the midface often leads to esthetic and functional limitations that burden patients physically as well as psychologically [1]
The most technically advanced concept to achieve this goal was introduced by Dennis Rohner and Beat Hammer by combining the idea of immediate dental rehabilitation following a prosthodontic backwards planning protocol with the insertion of conventional dental implants into the fibula; prelaminating the perimplant soft tissues around the fibula with skin grafts and in a second stage, harvesting of the fibula bone flap using patient-specific cutting guides to accomplish the backwards-planned design; and mounting the individual prostheses onto the osseointegrated dental implants with plate fixation of the microvascular bone flap and into the maxillary defect site [9, 10]
In the area of the soft tissue surrounding the implant posts that penetrate into the oral cavity, an inflammatory reaction in the form of mucositis was observed in some cases
Summary
All patients treated with patient specific implants due to postablative maxillary defects were included. 20 implants were placed in the 19 patients (bilateral implants were placed in one of the cases). All patients treated with patient specific implants due to postablative maxillary defects were included. 20 implants were placed in the 19 patients (bilateral implants were placed in one of the cases). In 65.75% of the cases, resection was performed due to squamous cell carcinoma. In addition to the primary stability, the clinical implant stability, soft tissue management, successful prosthodontic restoration, and complications were evaluated at a mean follow-up period of 26 months
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