OP012: Outcome of dental implants in maxillectomy patients

Abstract

Head and neck cancer patients’ quality of life is improved (1) by the surgical reconstruction of resection defects and (2) by the dental rehabilitation with an implant-supported prosthesis. Understanding the implant behavior in these compromised situations may improve treatment planning. Therefore, the survival rates of dental implants inserted in maxillectomy patients were estimated. In addition, treatment modalities such as the type of radiotherapy, the type of surgical reconstruction and the type of prosthetic rehabilitation were tried to identify as risk factors for implant failure. After tumor staging and unilateral or bilateral maxillectomy, followed by adjunctive chemo/radiotherapy, the dental rehabilitation was performed by the same prosthodontist (St.S.). Afterwards, patients were regularly followed up in an oncological and dental recall system. Implant failure (uncensored) was defined as explantation, loss of osseointegration or failed use for prosthetic reconstruction. Implant survival was estimated by applying Kaplan–Meier analysis. Cox models were used to evaluate any association between implant failure and medical treatment modality. 156 dental implants in 39 cancer patients were placed in 40 resected maxillae. Overall, 14 out of 156 implants in 8 patients were lost. The 1-year implant survival rate was 92.7% (±2.1% Std.Err) and the 4-year implant survival rate was 90.3% (±2.5% Std.Err), respectively. Sixteen resected maxillae were surgically reconstructed followed by insertion of 60 implants, resulting in 9 implant failures. 23 resected maxillary defects remained open and received 96 implants for oral rehabilitation, ending up with 5 implant losses. Unsplinted implants showed a non-statistically significant higher risk for failures (Logrank, P -value < 0.05). If considering the clinical challenge by the oral rehabilitation of maxillectomy patients, the 4-year implant survival rate was surprisingly high. A larger sample size and a longer observation time are needed to identify risk factors for implant failures.