Implant supported overdentures in Sjögren's disease patients: a multicentre prospective cohort study.

OBJECTIVES: To prospectively investigate patient-reported outcomes and clinical performance of implant supported overdentures in edentulous Sjögren's disease (SjD) patients compared to subjects without SjD. METHODS: 51 implants were placed in 12 patients with SjD and 50 implants in 12 non-SjD patients to support overdentures. Clinical performance, marginal bone-level changes, patient satisfaction and oral health related quality of life (OHRQoL) were assessed at 1 (T1), 6 (T6), 12 (T12) and 18 (T18) months after placement of the overdenture. Patient satisfaction, ability to chew and OHRQoL were assessed with validated questionnaires. Marginal bone-level changes were measured on standardised dental radiographs. Clinical parameters included implant and overdenture survival, plaque, bleeding and gingival indices, and probing depth. RESULTS: OHRQoL in patients with SjD improved significantly after placement of implant supported overdentures at all measuring moments compared to baseline (p<0.05). Nevertheless, ability to chew tough and hard food was significantly better for non-SjD patients at all timepoints after placement of an implant supported overdenture (p<0.05). Implant survival at T18 was 100% in the patients with SjD and 98% in the non-SS group. Mean marginal bone loss at T18 did not differ between patients with SjD and non-SS patients, 1.12±0.74 mm and 1.43±1.66 mm, respectively (p=0.58). Clinical performance was good with no differences between the groups for all outcome measures (p>0.05). CONCLUSIONS: Implant-supported overdentures have a positive effect on OHRQoL and dental implants can be successfully applied in edentulous patients with SjD with nearly similar outcomes as in non-SjD subjects.

Site-specific radiation dosage and implant survival in oral cancer patients: A cohort study.

OBJECTIVES: We assessed the radiation dosages (Dmean ) on implant regions to identify the threshold for implant loss in patients with an intraoral malignancy treated with dental implants to support a mandibular denture during ablative surgery before volumetric-modulated arc therapy (VMAT). MATERIALS AND METHODS: Data was collected prospectively from 28 patients treated surgically for an intraoral malignancy, followed by postoperative radiotherapy (VMAT) and analyzed retrospectively. Patients received 2 implants in the native mandible during ablative surgery. Implant-specific Dmean values were retrieved from the patients' files. Radiographic bone loss was measured 1 year after implant placement and during the last follow-up appointment. Implant survival was analyzed with the Kaplan-Meier method. Univariate logistic regression and Cox-regression analyses were performed to investigate the effect of increasing implant-specific radiation dosages on implant loss. RESULTS: Five out of 56 placed implants were lost during follow-up (median 36.0 months, IQR 39.0). Radiographically, peri-implant bone loss occurred in implants with a Dmean > 40 Gy. Implant loss occurred only in implants with a Dmean > 50 Gy. CONCLUSION: An implant-specific Dmean higher than 50 Gy is related to more peri-implant bone loss and, eventually, implant loss.

Dental implants in dentate primary and secondary Sjögren's syndrome patients: A multicenter prospective cohort study.

OBJECTIVES: To prospectively assess the clinical performance and patient-reported outcomes of dental implants in dentate patients with primary and secondary Sjögren's syndrome (pSS and sSS, respectively) compared to patients without SS. MATERIALS AND METHODS: Thirty-seven implants were placed in 17 patients with pSS/sSS and 26 implants in 17 non-SS patients to replace missing (pre)molars. Clinical performance, marginal bone-level changes, patient satisfaction, and oral health-related quality of life (OHRQoL) were assessed at 1 (T1), 6 (T6), 12 (T12), and 18 (T18) months after placement of the superstructure. Marginal bone-level changes were measured on standardized dental radiographs. Clinical parameters included implant and crown survival, plaque, bleeding and gingival indices, and probing depth. Patient satisfaction and OHRQoL were assessed with validated questionnaires. RESULTS: Implant survival at T18 was 100% in the patients with pSS/sSS and 96.2% in the non-SS group. Mean marginal bone loss at T18 did not differ between patients with pSS/sSS and non-SS patients, 1.10 ± 1.04 and 1.04 ± 0.75 mm, respectively (p = .87). Clinical performance was good with no differences between the groups for all outcome measures (p > .05). OHRQoL in patients with pSS/sSS had improved significantly after placement of implant supported crowns at all measuring moments compared to baseline (p < .05). Nevertheless, patient satisfaction and OHRQoL remained significantly higher for patients without SS at all measuring moments (p < .05). CONCLUSION: Dental implants can be successfully applied in dentate patients with pSS/sSS and have a positive effect on OHRQoL.

Linear and profilometric changes of the mucosa following soft tissue augmentation in the zone of aesthetic priority: A systematic review and meta-analysis.

OBJECTIVES: To assess the outcomes of soft tissue augmentation, in terms of change in level and thickness of mid-buccal mucosa, at implants sites in the zone of the aesthetic priority. MATERIAL AND METHODS: MEDLINE, EMBASE and Cochrane Central Register of Controlled Trials databases were searched (last search on 1 June 2020). Inclusion criteria were studies reporting outcomes of different materials and timing of grafting in patients undergoing soft tissue augmentation at implant sites in the aesthetic zone with a follow-up of ≥1 year after implant placement. Outcome measures assessed included changes in level and thickness of mid-buccal mucosa, implant survival, peri-implant health and patients' satisfaction. RESULTS: Eighteen out of 2,185 articles fulfilled the inclusion criteria. Meta-analysis revealed a significant difference in vertical mid-buccal soft tissue change (0.34 mm, 95% CI: 0.13-0.56, p = .002) and mid-buccal mucosa thickness (0.66 mm, 95% CI: 0.35-0.97, p < .001) following immediate implant placement in favour of the use of a graft versus no graft. Mean difference in mid-buccal mucosa level following delayed implant placement (0.17 mm, 95% CI: 0.01-0.34, p = .042) was also in favour of the use of a graft versus no graft. With regard to mucosa thickness, the use of a graft was not in favour compared with no graft following delayed implant placement (0.22 mm, 95% CI: -0.04-0.47, p = .095). Observed changes remained stable in the medium term. CONCLUSION: Soft tissue augmentation in the zone of the aesthetic priority results in less recession and a thicker mid-buccal mucosa following immediate implant placement and less recession in mid-buccal mucosa following delayed implant placement compared with no graft.

What is the optimal timing for implant placement in oral cancer patients? A scoping literature review.

BACKGROUND: Oral cancer patients can benefit from dental implant placement. Traditionally, implants are placed after completing oncologic treatment (secondary implant placement). Implant placement during ablative surgery (primary placement) in oral cancer patients seems beneficial in terms of early start of oral rehabilitation and limiting additional surgical interventions. Guidelines on the ideal timing of implant placement in oral cancer patients are missing. OBJECTIVE: To perform a scoping literature review on studies examining the timing of dental implant placement in oral cancer patients and propose a clinical practice recommendations guideline. METHODS: A literature search for studies dealing with primary and/or secondary implant placement in MEDLINE was conducted (last search December 27, 2019). The primary outcome was 5-year implant survival. RESULTS: Sixteen out of 808 studies were considered eligible. Both primary and secondary implant placement showed acceptable overall implant survival ratios with a higher pooled 5-year implant survival rate for primary implant placement 92.8% (95% CI: 87.1%-98.5%) than secondary placed implants (86.4%, 95% CI: 77.0%-95.8%). Primary implant placement is accompanied by earlier prosthetic rehabilitation after tumor surgery. CONCLUSION: Patients with oral cancer greatly benefit from, preferably primary placed, dental implants in their prosthetic rehabilitation. The combination of tumor surgery with implant placement in native mandibular bone should be provided as standard care.

Prosthodontic rehabilitation of head and neck cancer patients-Challenges and new developments.

Head and neck cancer treatment can severely alter oral function and aesthetics, and reduce quality of life. The role of maxillofacial prosthodontists in multidisciplinary treatment of head and neck cancer patients is essential when it comes to oral rehabilitation and its planning. This role should preferably start on the day of first intake. Maxillofacial prosthodontists should be involved in the care pathway to shape and outline the prosthetic and dental rehabilitation in line with the reconstructive surgical options. With the progress of three-dimensional technology, the pretreatment insight in overall prognosis and possibilities of surgical and/or prosthetic rehabilitation has tremendously increased. This increased insight has helped to improve quality of cancer care. This expert review addresses the involvement of maxillofacial prosthodontists in treatment planning, highlighting prosthodontic rehabilitation of head and neck cancer patients from start to finish.

Mandibular dental implant placement immediately after teeth removal in head and neck cancer patients.

BACKGROUND: Little is known about immediate implant placement in head and neck cancer patients. We studied implant survival and functional outcomes of overdentures fabricated on implants placed immediately after removal of the lower dentition during ablative surgery or preceding primary radiotherapy (RT). METHODS: Inclusion criteria were primary head and neck cancer, dentate lower jaw, and indication for removal of remaining teeth. Two implants to support a mandibular overdenture were placed immediately after extraction of the dentition during ablative surgery, or prior to starting primary radiotherapy. Standardized questionnaires and clinical assessments were conducted (median follow-up 18.5 months, IQR 13.3). RESULTS: Fifty-eight implants were placed in 29 patients. Four implants were lost (implant survival rate 93.1%). In 9 patients, no functional overdenture could be made. All patients were satisfied with their dentures. CONCLUSIONS: Combining dental implant placement with removal of remaining teeth preceding head neck oncology treatment results in a favorable treatment outcome.

Sjögren's syndrome is not a risk factor for periodontal disease: a systematic review.

OBJECTIVES: Sjögren's syndrome (SS) is an autoimmune disorder causing irreversible damage to the exocrine glands. Evidence whether SS patients are at a higher risk to develop periodontal disease is conflicting. Therefore, we systematically reviewed the literature on the prevalence of periodontal disease in patients with SS. METHODS: Searches were performed in MEDLINE and CENTRAL databases on prevalence of periodontal diseases in SS. Meta-analyses were performed for gingival index (GI), plaque index (PI), probing pocket depth (PPD), clinical attachment level (CAL), DMFT and DMFS (Decayed Missing Filled Teeth, respectively, Surfaces). RESULTS: Out of 512 studies, 10 studies were eligible for quantitative synthesis. Meta-analyses of the data indicated that in SS patients CAL, GI, PPD and PI are comparable to controls. DMFT and DMFS values were higher in SS patients than controls. CONCLUSIONS: No significant differences in the GI, PI, CAL, and PPD were observed in patients with SS compared to controls. These results indicate that there is no evidence of a higher risk for periodontal disease in patients with SS, while SS patients are more susceptible to caries compared to non-SS patients.

Outcome of implants placed to retain craniofacial prostheses - A retrospective cohort study with a follow-up of up to 30 years.

OBJECTIVES: To retrospectively assess the treatment outcomes of endosseous implants placed to retain craniofacial prostheses. MATERIAL AND METHODS: Patients with craniofacial defects resulting from congenital disease, trauma, or oncologic treatment had implant retained prostheses placed in the mastoid, orbital, or nasal region and then assessed over a period of up to 30 years. Implant survival rates were calculated with the Kaplan-Meier method. Clinical assessments consisted of scoring skin reactions under the prosthesis and the peri-implant skin reactions. Possible risk factors for implant loss were identified. Patient satisfaction was evaluated using a 10-point VAS-scale. RESULTS: A total of 525 implants placed in 201 patients were included. The median follow up was 71 months (IQR 28-174 months). Implants placed in the mastoid and nasal region showed the highest overall implant survival rates (10-year implant survival rates of 93.7% and 92.5%, respectively), while the orbital implants had the lowest overall survival rate (84.2%). Radiotherapy was a significant risk factor for implant loss (HR 3.14, p < 0.001). No differences in implant loss were found between pre- and post-operative radiotherapy (p = 0.89). Soft tissue problems were not frequently encountered, and the patients were highly satisfied with their implant-retained prosthesis. CONCLUSION: Implants used to retain craniofacial prostheses have high survival and patient satisfaction rates and can thus be considered as a predictable treatment option. Radiation is the most important risk factor for implant loss.

Oral rehabilitation with implant-based prostheses of two adult patients treated for childhood rhabdomyosarcoma.

BACKGROUND: Rhabdomyosarcoma is the most common malignant tumor in the nasal and paranasal sinus area at childhood. Multimodal treatment for this disorder has severe side effects due to normal tissue damage. As a result of this treatment, facial growth retardation and oral abnormalities such as malformation of teeth and microstomia can cause esthetic and functional problems. CASE REPORTS: Two cases are presented of patients with severe midfacial hypoplasia and reduced oral function as a result of treatment of rhabdomyosarcoma of the nasopharyngeal and nasal-tonsil region. With a combined surgical (osteotomy, distraction osteogenesis, implants) and prosthetic (implant-based overdenture) treatment, esthetics and function were improved.

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.

Patients' expectations of oral implants: a systematic review.

AIM: Nowadays, oral implants are a leading concept in oral rehabilitation. Patient satisfaction with this treatment is high, but are the expectations of the patients met? The aim of this review was to systematically screen the literature on patients' expectations of implant-based therapy before treatment and to assess whether these expectations were being met. MATERIALS AND METHODS: A search strategy was developed for manuscripts dealing with patients' expectations of implant-based therapy to support different types of prosthodontics. Patients had an indication for implants, were seeking implants or had received implants. PubMed/MEDLINE, Ovid/EMBASE and Cochrane/CENTRAL were searched to identify eligible studies. Two reviewers independently assessed the articles. RESULTS: In total, 16 out of 3312 studies assessing patients' expectations of patients before implant-based therapy matched the inclusion criteria. A variety of methods were used in the studies. Patients had high expectations, with function followed by aesthetics being the most important expected improvements. Women had higher expectations than men. Costs were a major factor against implant-based therapy. The expectations that implants will last a lifetime and require no special needs of oral hygiene were of concern. CONCLUSION: Prior to treatment, patients have high expectations of implant therapy. In general, these expectations are met. Most studies revealed that women have higher expectations than men. The variety of applied study designs impaired comparability of results. Thus, standardised methods for measuring expectations of implant-based therapy are eagerly needed.

Recommendations for implant-retained nasal prostheses after ablative tumor surgery: Minimal surgical aftercare, high implant survival, and satisfied patients.

BACKGROUND: Nasal defects resulting from tumor resection are preferably rehabilitated with implant-retained nasal prostheses. Aftercare, clinical outcome of the implants, and patients' satisfaction with implant-retained nasal prostheses were assessed. METHODS: Twenty-eight consecutive patients needing total rhinectomy because of tumor resection between 1998 and 2013 were treated according to a standardized protocol with 2 implants in the nasal floor. Surgical and prosthetic aftercare was scored using patient records. Finally in 2014, skin reaction, peri-implant bone loss, and patients' satisfaction were assessed in all 13 still living patients. RESULTS: In total, 56 implants were inserted (median follow-up, 35.1 months; interquartile range [IQR], 8.9-63.3). Implant survival was 96.4%. Implant survival was independent of radiotherapy. Peri-implant skin was healthy and patients' satisfaction high. Longevity of the prostheses was limited. CONCLUSION: Rehabilitation of nasal defects resulting from total rhinectomy with implant-retained nasal prostheses, according to our protocol, resulted in high patient satisfaction and favorable treatment outcome. © 2015 Wiley Periodicals, Inc. Head Neck 38: E-E, 2016.

Dental Implants in Patients with Sjögren's Syndrome.

BACKGROUND: Limited evidence is available for applying dental implants in Sjögren's syndrome (SS) patients. PURPOSE: This study aims to retrospectively assess clinical outcome of implant therapy in a cohort of well-classified patients with SS. MATERIALS AND METHODS: All SS patients attending the University Medical Center Groningen for follow-up (n = 406) were asked whether they had implants. In SS patients with implants peri-implant health and implant survival was recorded and compared with data from matched healthy controls. Patients' symptoms, health-related quality of life, oral functioning, and satisfaction were assessed using validated questionnaires. RESULTS: Of the responding SS patients (n = 335), 21% was provided with implants. Of these 69 SS patients, 50 SS patients were willing to join our study. In SS patients, peri-implant health was reasonably good with minor marginal bone loss and a peri-implantitis prevalence of 14%, comparable with healthy controls. Implant survival was 97% (median follow-up 46 months) [IQR 26;73], and overall patients' satisfaction was high. Oral functioning correlated negatively with dryness, patients' satisfaction, and chewing ability in SS patients. CONCLUSIONS: Implant therapy is common in our cohort of SS patients. In spite of shortcomings of our retrospective analysis, implants in SS patients seem to perform comparable with implants in healthy patients.

Overdentures on primary mandibular implants in patients with oral cancer: a follow-up study over 14 years.

We aimed to assess oral functioning, patients' satisfaction, condition of peri-implant tissues, and survival of implants up to 14 years after their insertion in patients with oral cancer who had had mandibular overdentures placed over primary implants. Endosseous dental implants were inserted prospectively in the interforaminal region of the mandible during resection of the tumour in 164/180 patients with oral cancer. All 58 patients were evaluated by questionnaires and clinical assessments during a final assessment in 2012. Implant-retained mandibular overdentures were inserted, and prosthetic rehabilitation and oral functioning were not associated with primary site or stage of the tumour, number or type of implants inserted, or the type of reconstruction. Over time the peri-implant mucosa was usually free of inflammation. More implants were lost in patients treated by radiotherapy (27/318, 8.5%) than in those not so treated (1/206, 0.5%). Patients who had been treated by irradiation reported more problems in oral functioning and less satisfaction than those who had not. Patients with an implant-retained mandibular overdenture reported fewer problems in oral functioning than patients without an overdenture. Primary insertion of an implant should be routinely incorporated in the surgical planning for patients with oral cancer, as oral functioning in those wearing mandibular overdentures improved considerably and peri-implant health was at least reasonable.

Five-year follow-up of oral functioning and quality of life in patients with oral cancer with implant-retained mandibular overdentures.

BACKGROUND: 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. METHODS: Fifty patients who had received implants during ablative surgery were evaluated by standardized questionnaires before and after oncological and prosthetic treatment. RESULTS: In 20 of 24 surviving patients, the dentures were functional after 5 years. In these survivors, oral function remained unchanged during this period. In the 6 patients with concurrent comorbidity, global health and QOL had deteriorated, while in the patients without comorbidity, global health and QOL were very high. Five-year survivors had a higher global health and better oral functioning at the 1-year evaluation than nonsurvivors. CONCLUSION: Oral function and denture satisfaction were high and did not change over time for survivors. Deterioration in overall global health and QOL was associated with concurrent comorbidity.

Analysis of translucency of skin by volume reflection for color formulation of facial prostheses.

PURPOSE: A facial prosthesis demands a good visual match with the adjacent skin. Skin color and translucency must be mimicked by the prosthesis. Translucency can be defined as allowing the passage of light, yet diffusing it so as not to render the bodies beyond clearly visible, therefore being semi-transparent. The translucency of skin hampers color measurements of color meters recommended by the Commission Internationale de l'Eclairage (CIE) due to edge loss. The aim of this study was to analyze the translucency of skin at different body sites by measuring volume reflection in a cohort of Caucasian individuals. MATERIALS AND METHODS: To analyze skin translucency, a volume reflection meter (VRM) was applied to the skin of the forehead, cheek, palm of the hand, and lower forearm. The VRM measures the volume reflection of a small incident light beam at three different distances from the incident beam. To describe the impact of translucency on skin color and the impact of volume reflection at different distances of an incident beam, the VRM spectra were converted into CIE L*a*b* coordinates. RESULTS: VRM measurements were carried out on a cohort of 48 individuals during spring. The mean age was 40.8 years (+/- 11.7 years). Statistically significant interactions between body site, distance from the light source, and L*, a*, and b* values were found. L* values decreased and a* and b* values increased at longer distances from the incident light beam since the light path was increased. CONCLUSION: Skin on the forehead, cheek, palm of the hand, and lower forearm each have their own specific volume reflection and thus, translucency, absorption, and scattering characteristics. These location-specific characteristics are due to known local differences in the skin's multilayered structure. For a good visual match between a facial prosthesis and the adjacent skin, volume reflection measurements of the skin close to the intended site of the prosthesis are necessary.