Maxillofacial Prosthetic Treatment Research Articles

A technique of speech aid adjustment with the assistance of nasalance values for non-nasal and nasal sounds

Evaluation of speech function is essential to maxillofacial prosthetic treatment. Measurement of nasalance with a nasometer is practical and typically done to detect hypernasality in maxillofacial defect patients. This case report describes a nasalance test used in the evaluation and rehabilitation of a patient who needed a speech aid. A 70-year-old man sought help at our clinic because his old speech aid had broken. Although a new speech aid was fabricated, he continued to have difficulty speaking and breathing. A nasalance test using nasal and non-nasal test words revealed hyponasality. The patient was satisfied with the speech aid after its adjustment in accordance with the nasalance test results. Nasalance testing that considers not only hypernasality but hyponasality helped the maxillofacial prosthodontist in the successful rehabilitation of this maxillofacial defect patient. (Int J Maxillofac Prosthetics 2020;3:23-27)

An Investigation of Quality of Life of Head-and-neck Cancer Patients after Tumor Resection and Subsequent Prosthetic Rehabilitation: A Clinical Study

ABSTRACT Background: Head-and-neck cancer and its treatment can decrease the quality of life (QoL) of patients in consequence of the loss of structural and functional integrity of the oro- and nasopharyngeal region. Maxillofacial prosthetic treatment is advised when anatomical structures of the head and neck are not replaceable by living tissue, when recurrence is likely, when radiotherapy is administered, or when fragment of fractured bones are severely displaced. The aim of the study was to examine whether prosthetic rehabilitation of maxillofacial defects affects the QoL of patients using the University of Washington (UW)-QoL. Materials and Methods: This was the prospective interventional study using pre- and post-design using a convenience sampling method. The prosthesis was fabricated as per the clinical situation using heat-polymerized polymethyl methacrylate, maxillofacial silicone, or a combination of both. Results: The overall mean composite QOL score before rehabilitation was 68.05 ± 16.98 and after rehabilitation, it was 73.22 ± 11.28. Chewing and saliva (dryness of the mouth) had the lowest scores (55 ± 9.2, 62 ± 8.6, respectively) among all domains, whereas pain and anxiety had the highest scores (93 ± 3.7, 95 ± 1.5, respectively). The domains of appearance, speech, swallowing, chewing, saliva, and overall QoL showed statistically significant improvements postprosthetic rehabilitation. Conclusions: In the present study and selected population, the subjective analysis using UW-QOL showed that despite altered anatomy following resection and reconstruction, compromised physiology following chemoradiation, the oral cancer patients coped well and adapted to near-normal oral status after prosthetic rehabilitation. This was evident from their improved QOL after 1 month of prosthetic rehabilitation.

Effects of maxillofacial prosthetic treatment on oral health-related quality of life and masticatory ability of patients with head and neck tumors.

Using multivariate analysis, this study investigated the effectiveness of maxillofacial prosthetic treatment in relation to oral health-related quality of life (OHR-QoL), masticatory ability (food intake status score and gum-jelly test score) and related factors in patients who had undergone surgery for head and neck tumors. The study cohort comprised 112 patients who underwent surgical resection and prosthetic treatment among 224 patients with head and neck tumors seen at the Maxillofacial Prosthetics Clinic of Tohoku University Hospital in a 2-year period. Correlations between OHR-QoL, food intake status score, and gum-jelly test score (criterion variables), and age, sex, maxillary defect, tongue/soft tissue defect, reconstructive surgery, and chemoradiotherapy (explanatory variables) were investigated, and the data were examined statistically. Maxillary defect, tongue and soft palate tissue defect, and chemoradiotherapy were identified as factors that hindered the effectiveness of maxillofacial prosthetic treatment for improvement of the OHR-QoL, food intake status score, and gum-jelly test score. On the other hand, reconstructive surgery was a factor that facilitated the improvement of OHR-QoL and masticatory ability with maxillofacial prosthetic treatment. The factors identified to be related to the success or failure of maxillofacial prosthetic treatment suggest the importance of combining prosthetic intervention with surgical reconstruction.

CAD-CAM for removable partial denture fabrication after marginal mandibulectomy based on a well-adjusted pre-existing denture.

This clinical report summarizes a workflow that introduces two approaches for fabricating a metal framework removable partial denture for a marginal mandibulectomy patient. First, the pre-existing denture was adjusted according to the piezographic technique to determine the optimal configuration for adhering to the available denture space. Second, computer-aided design-computer-aided manufacturing (CAD-CAM) technology was used to fabricate a new removable partial denture by digitally scanning the oral condition and the well-adjusted denture and then using the obtained data to design and fabricate the new denture. These two approaches can help to reduce chair time not only for maxillofacial prosthetic treatment but also for other denture cases.

Digital acoustic analysis of the first three formant frequencies in patients with a prosthesis after maxillectomy

Statement of problemProsthetic rehabilitation with an obturator can help to restore or improve the intelligibility of speech in patients after maxillectomy. The frequency of formants 1 and 2 as well as their ranges were initially reported in patients with maxillary defects in 2002, and the evaluation method that was used is now applied in clinical evaluation. However, the details of formant 3 are not known and warrant investigation because, according to speech science, formant 3 is related to the pharyngeal volume. Clarifying the formant frequency values of formant 3 in patients after maxillectomy would enable prosthodontists to refer to these data when planning treatment and when assessing the outcome of an obturator. PurposeThe purpose of this clinical study was to determine the acoustic characteristics of formant 3, together with those of formants 1 and 2, by using a digital acoustic analysis during maxillofacial prosthetic treatment. The utility of determining formant 3 in the evaluation of speech in patients after maxillectomy was also evaluated. Material and methodsTwenty-six male participants after a maxillectomy (mean age, 63 years; range, 20 to 93 years) were included, and the 5 Japanese vowels /a/, /e/, /i/, /o/, and /u/ produced with and without a definitive obturator prosthesis were recorded. The frequencies of the 3 formants were determined, and their ranges were calculated by using a speech analysis system (Computerized Speech Lab CSL 4400). The Wilcoxon signed rank test was used to compare the formants between the 2 use conditions (α=0.05). ResultsSignificant differences were found in the frequencies and ranges of all 3 formants between the use conditions. The ranges of all 3 formants produced with the prosthesis were significantly greater than those produced without it. ConclusionsBased on the findings, both the first 2 formants and the third formant were changed by wearing an obturator prosthesis. Because formant 3 is related to the volume of the pharynx, evaluation of this formant and its range can reflect the effectiveness of the prosthesis to seal the oronasal communication and help reduce hypernasality, suggesting the utility of formant 3 analysis in prosthodontic rehabilitation.

Awareness On Mastoid Implants Among Dental Students

Introduction: The goal of modern dentistry is to provide patients with good oral health in a predictable fashion. The edentulous patient may hoot have good masticatory function or aesthetics. When wearing a removable denture the efficiency is reduced to one sixth than natural dentition.An ideal prosthesis can bring back normal muscle activity thereby improving mastication. Implant Prosthetic options just do not rely on alveolar bone. There are many other options too. One such option is the mastoid implants.Our aim is to evaluate the awareness on mastoid implants among dental students.Materials and methods: A set of 10 questions were formulated and distributed among the undergraduate students to determine their awareness on mastoid implants All data were collected and analysis was done. The data were entered in an Excel sheet and were imported to SPSS software by IBM. Results: 80% of the participants were undergraduate students. Also 35% have ideas regarding mastoid implants and very few participants were trained in mastoid implants, only 3%. Almost 60 % of study participants agree that mastoid implants may be highly valued in the future.Conclusion: Within the limitations of the study it can be said that there is very little awareness about mastoid implants among the student population and conducting more educational programs and providing more hands-on training will motivate the upcoming dental professionals to be well aware of future prospects of maxillofacial prosthetic treatment.

Time and cost of maxillofacial prosthetic treatment: The need for assessment.

Time and cost of maxillofacial prosthetic treatment: The need for assessment.

Considered through Current Situation of “Maxillofacial Prosthetic Treatment in Hospital Dentistry”

Considered through Current Situation of “Maxillofacial Prosthetic Treatment in Hospital Dentistry”

Evaluation of the quality of life of patients with maxillofacial defects after prosthodontic rehabilitation: A cross-sectional study.

Oral cancer surgery leads to hard- and soft-tissue loss which can affect the quality of life of the individuals. Maxillofacial prosthodontics focuses on optimizing the disrupted oral function of individuals whose rehabilitation will serve as a psychosocial therapy. The aim of this study was to assess the oral health-related quality of life (OHRQoL) after the maxillofacial prosthetic rehabilitation following cancer resection surgery. The sample comprised 15 oral cancer patients who agreed to maxillofacial prosthesis (MFP) after surgery. Oral function and OHRQoL were evaluated pre- and postmaxillofacial prosthetic rehabilitation. The masticatory function, swallowing function, and articulatory function were evaluated. The OHRQoL was evaluated by OHIPJ-14 questionnaire. Descriptive methods such as frequency, percentage, mean, and standard deviation were calculated. Descriptive statistics was used to analyze the results. A statistically significant difference was observed between prescores and postscores of dysphagia score (P = 0.05) and OHIP-J14 score (P = 0.00). No statistically significant differences were evident in perceived chewing ability (P = 0.29) and intelligibility score (P = 0.43). A statistically significant difference was evident in the prescore and postscore of OHIP-J14 subscales: functional limitations (P < 0.05), physical pain (P < 0.05), psychological discomfort (P < 0.05), physical disability (P < 0.05), psychological disability (P < 0.05), and handicap (P < 0.05), before and after maxillofacial prosthetic treatment except for social disability (P > 0.05). OHRQoL significantly improved with maxillofacial prosthetic rehabilitation.

Difficulties and Future Prospects for the Maxillofacial Prosthetic Treatment in the Department of Dentistry and Oral Surgery of the Regional Core Hospital

Difficulties and Future Prospects for the Maxillofacial Prosthetic Treatment in the Department of Dentistry and Oral Surgery of the Regional Core Hospital

Use of an occlusal ramp for rehabilitation after a mandibulectomy and its effects on mastication

Statement of problemPatients with a mandibular defect can develop mandibular deviation, resulting in a loss of or reduction in occlusal contact and ultimately loss of function. The occlusal ramp is a prosthesis used to help restore the masticatory function of such patients and is used particularly in the maxillofacial rehabilitation of patients with masticatory dysfunction resulting from mandibular deviation. The occlusal ramp is usually attached to a mandibular denture or worn as an independent device placed on the palate corresponding to the mandible that produces the offset. However, evidence of the effects of its use is sparse. PurposeThe purpose of this clinical study was to investigate the effects of occlusal ramp use in functional rehabilitation. Materials and methodsThis study included 10 patients who had received mandibulectomies (5 men and 5 women; mean age 76.7 years, range 67 to 90 years) with deviation of the mandible. An occlusal ramp was fabricated for each participant as part of their maxillofacial prosthetic treatment. Masticatory performance was evaluated before and after the treatment by measuring glucose extraction while masticating a piece of gummy jelly. The Wilcoxon signed-rank test was used for statistical analysis (α=.05). ResultsThe median masticatory performance score, represented as glucose concentration (mg/dL), was 82.45 before treatment and 115.45 after treatment, with an overall improvement of 33.00. Scores differed significantly before and after treatment (P=.005). Masticatory performance for each participant improved in the range of 17.7 to 103.3, highlighting the role that the occlusal ramp played in mastication, although with differing effects in each participant. ConclusionsMasticatory performance in participants with mandibular deviation after a mandibulectomy was significantly improved with an occlusal ramp. This suggests the effectiveness of using occlusal ramps in maxillofacial prosthetic treatment for the recovery of masticatory function in patients with mandibular deviation.

Nutrition assessment of an elderly patient with recurrent advanced carcinoma of the maxilla: A case report

Maxillectomy patients require a maxillofacial prosthesis for improving quality of life from the preoperative period to the stage of palliative care. This case report describes maxillofacial prosthetic treatment from the aspect of nutrition by following the condition of a 69-year-old woman who received surgery for a right-side carcinoma of the maxilla. After the initial treatment, metastatic disease was found, and her nutritional status worsened steadily. Although the prognosis may be poor, maxillofacial prosthodontic treatment should be given in order to maintain nutritional status and quality of life and to achieve optimal function for the patient as palliative care. (Int J Maxillofac Prosthetics 2020;3:28-31)

Oral health-related quality of life and oral hygiene condition in patients with maxillofacial defects: A retrospective analysis

PurposeThe purpose of this study was to evaluate the effect of oral rehabilitation (maxillofacial prosthetic intervention and oral hygiene instruction) on oral health-related Quality of Life (OHRQoL) and oral hygiene condition in patients with maxillofacial defects and to explore the correlation between them in these patients. MethodsTwenty-five patients with maxillofacial defects who had been treated since April 2016 to March 2018 were included in this study. The scores of the Oral Health Impact Profile (OHIP) and O’Leary’s Plaque Control Record (PCR) were also identified as the scores of OHRQoL and oral hygiene condition, respectively. Statistical analyses were performed to compare between the scores of “pre” and “post” prosthetic treatment and to evaluate patient-related factors influencing these variables (age, the number of residual teeth and occlusal supports, and occlusal units (OUs)). The effect of combined chemo-radiotherapy (CRT) on each score was also assessed statistically. Furthermore, the correlation of OHIP and PCR scores was explored statistically. ResultsBoth oral rehabilitations could significantly improve OHIP and PCR scores. Significant correlations of the change of OHIP scores with age and OUs were detected. CRT had no significant effect on OHIP and PCR scores. No correlations between OHIP and PCR were observed. ConclusionsAlthough oral rehabilitation such as maxillofacial prosthetic treatment and oral hygiene instruction would be highly effective for improvement of OHRQoL and oral hygiene condition in patients with maxillofacial defects, there was no correlation between them.

Clinical survey over the past 35 years at the clinic for maxillofacial prosthetics Tokyo Medical and Dental University

PurposeThe purpose of this survey was to examine the overview of maxillofacial prosthetic treatment at our department, in order to ascertain the actual status of patients and discuss future needs. MethodsSubjects were all patients who visited Clinic for Maxillofacial Prosthetics, Dental Hospital, Tokyo Medical and Dental University (TMDU) in the period from January 1, 1980 to December 31, 2014. Using medical records of the Clinic for Maxillofacial Prosthetics, Dental Hospital, TMDU, patients’ data including sex, address, referring institution, and primary condition were analyzed throughout the period. ResultsThe number of patients over 35 years was 6219, with a man-to-woman ratio of 6:4. The number of patients in their 60s, 70s, and 80s showed an increasing trend. Patients with tumors accounted for about 50 % of cases in 1980–1984 and increased to 80 % in 2010–2014. ConclusionsThe survey showed an increasing number of elderly patients and patients with tumors. This suggests that more awareness and education about maxillofacial prosthetics are needed.

Maxillofacial prosthetic treatment factors affecting oral health-related quality of life after surgery for patients with oral cancer

Statement of problemAfter oral cancer surgery, tissue defects can cause deformity and limited mobility, complicating many essential functions. For patients with mandibular, tongue, and oral floor defects, evidence regarding the effects of maxillofacial prosthetics on their oral health-related quality of life (OHRQoL) is lacking. Therefore, maxillofacial prosthetic reconstruction has been implemented with no clear treatment goals. PurposeThe purpose of this clinical study was to identify factors affecting the improvement of OHRQoL by using maxillofacial prosthetic treatment after surgery to repair maxillary, mandibular, tongue, and oral floor defects. Material and methodsAll individuals who agreed to maxillofacial prosthetics after surgery for oral cancer were enrolled. Oral function and OHRQoL were evaluated before maxillofacial prosthesis placement and 1 month after final adjustments. The oral functions evaluated included masticatory function, swallowing function, and articulatory function. The Oral Health Impact Profile (OHIP-J54) was used to evaluate OHRQoL. Factors affecting changes in the OHIP-J54 score for participants’ background and oral functions before and after treatment were analyzed through logistic regression analysis (stepwise method). ResultsParticipants included 34 men and 16 women with an average age of 72.4 ±8.7 years. “Psychological discomfort” was correlated with the patient’s sex and masticatory function. “Physical disability” was related to articulatory function. “Handicap” was related to the swallowing function. “Additional Japanese questions” were related to the patient’s sex. ConclusionsParticipants’ sex and their oral functions, including masticatory, swallowing, and articulatory functions, were associated with improved OHRQoL because of maxillofacial prosthetics after surgery for oral cancer.

Maxillofacial prosthetics training and practice profiles in the United States

Statement of problemThe motivation of maxillofacial prosthodontists to go into fellowship training and specific procedures in maxillofacial prosthetics practice once they have completed training has not been previously evaluated. PurposeThe purpose of this study was to survey maxillofacial prosthodontists in the United States to investigate their reasons for pursuing maxillofacial prosthetic training and their practice profiles. Material and methodsIn June 2015, a survey was sent to all US maxillofacial prosthodontists asking for descriptive demographics, their reasoning as to what prompted entrance into a maxillofacial prosthetic program, and their practice pattern. Frequencies, percentages, means, and standard deviations were calculated and reported. ResultsThe survey response rate was 60.4%. The main reason for pursuing maxillofacial training was primarily personal satisfaction, prosthodontic residency exposure, and mentorship rather than media exposure and compensation. The time spent in prosthodontic practice varied among practitioners, with the majority of practice time spent accomplishing standard prosthodontic procedures (65.59%) versus maxillofacial (25.53%) or surgical procedures (9.67%). Of 12 clinical maxillofacial procedures inquired about, the most prevalent were obturators, dental oncology, and mandibular resections. ConclusionsThis study reveals that personal satisfaction, mentorship, and prosthodontic residency exposure were the reasons most prosthodontists pursued an additional year of maxillofacial prosthetic fellowship. Most were very satisfied with their training and chosen career path and would recommend an additional year of training. The majority of maxillofacial prosthodontists provided maxillofacial prosthetic treatment for approximately one fourth of their practice time. The most common procedures performed were obturators, dental oncology, and mandibular resections.

顎顔面補綴治療の成功のポイント

超高齢社会に突入し，頭頸部癌罹患率が上昇している今，顎顔面補綴学の専門的知識の共有が必要とされている．今後，一般補綴歯科医も頭頸部腫瘍症例への対処が求められ，顎顔面補綴治療を行う状況が増加することを想定し，本稿では顎顔面補綴治療の成功のポイントを「動き」と「機能」という観点から述べる．顎顔面補綴治療は決して一般補綴治療から逸脱した特殊な治療ではない．一般補綴治療における知識に基づいて，各ステップを省略せずに丁寧に行う必要がある治療であるという概念を共有できれば幸いである．

Analysis of maxillofacial prosthetics at university dental hospitals in the capital region of Korea.

PURPOSEThe purpose of this study was to investigate the demographic patterns of maxillofacial prosthetic treatment to identify the characteristics and geographic distribution of patients with maxillofacial prosthetics in the capital region of Korea.MATERIALS AND METHODSThis retrospective analytical multicenter study was performed by chart reviews. This study included patients who visited the department of prosthodontics at four university dental hospitals for maxillofacial prosthetic rehabilitation. Patients with facial and congenital defects or with insufficient medical data were excluded. The patients were classified into three categories based on the location of the defect. Patients' sex, age, and residential area were analyzed. Pearson's chi-square test with a significance level of 0.05 was used to analyze the variables.RESULTSAmong 540 patients with maxillofacial prosthetics, there were 284 (52.59%) male patients and 256 (47.41%) female patients. The number of the patients varied greatly by hospital. Most patients were older than 70, and the most common defect was a hard palate defect. Chi-square analysis did not identify any significant differences in sex, age, and distance to hospital for any defect group (P>.05).CONCLUSIONThe results of this study indicated that there was imbalance in the distribution of patients with maxillofacial prosthetic among the hospitals in the capital region of Korea. Considerations on specialists and insurance policies for the improvement of maxillofacial prosthetics in Korea are required.

Management of Velopharyngeal Disorders. A Case Series

Patients with acquired defects or congenital malformations of the palate exhibit disturbances in speech, including hypernasality, nasal emission, and decreased intelligibility of speech. Maxillofacial prosthetic treatment can reestablish the palatopharyngeal integrity to provide the potential for acceptable speech. This article describes a case series of patients with palatopharyngeal disorders and their treatment approaches.

Evaluation of hardness and surface roughness of two maxillofacial silicones following disinfection

The purpose of this study was to evaluate the Shore A hardness and surface roughness of two silicones for maxillofacial prosthetic treatment, under the influence of chemical disinfection and storage. Twenty-eight specimens were obtained, half of which were made of Silastic MDX 4-4210 silicone and, the other half were made of Silastic 732 RTV silicone. The specimens were divided into four groups: Silastic 732 RTV and MDX 4-4210 with disinfection 3 times a week with Efferdent tablets and the same materials without disinfection. The hardness of the materials was analyzed with a Shore A Durometer. The surface roughness was established by a digital portable roughness tester, initially and 2 months after the confection of the specimens. A variance test was applied (2-way ANOVA), followed by Tukey test (the level of significance was set at 1%). The storage time factor statistically influenced (p < 0.01) the materials' properties of hardness and roughness. MDX 4-4210 (28.59 Shore A, 0.789 Ra) presented higher values than Silastic 732 RTV (18.08 Shore A, 0.656 Ra) for both properties. Regarding the disinfection period, there was no significant difference in any of the materials tested.