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1.
Artículo en Inglés | MEDLINE | ID: mdl-33151192

RESUMEN

Oral cancer treatment involving the maxilla and/or mandible often results in esthetic and functional deficits that can diminish the patient's quality of life. As a result, expeditious reconstruction of the defect and dental rehabilitation is desirable. Dental rehabilitation shortly after reconstruction with an osteocutaneous free flap and resection prosthesis is a persistent challenge for patients with oncologic defects where immediate dental rehabilitation is not a possibility. Additionally, conventional prosthesis fabrication techniques are impractical or impossible due to postoperative anatomical changes and limitations in clinical armamentarium. To address these limitations, a technique and a novel implant-supported prosthetic workflow for the oncologic patient were developed to provide interim dental rehabilitation for such clinical situations. This article describes the prosthesis fabrication technique, reports short-term outcomes, and evaluates patient-reported quality-of-life outcomes using the FACE-Q Head and Neck Cancer Module.


Asunto(s)
Implantes Dentales , Colgajos Tisulares Libres , Reconstrucción Mandibular , Implantación Dental Endoósea , Prótesis Dental de Soporte Implantado , Peroné/cirugía , Humanos , Calidad de Vida
2.
Spec Care Dentist ; 40(3): 315-319, 2020 May.
Artículo en Inglés | MEDLINE | ID: mdl-32396249

RESUMEN

INTRODUCTION: A definitive maxillary obturator prosthesis can be used to rehabilitate a maxillary defect with the aim of improving speech, deglutition, and elimination of oronasal regurgitation. The aims of this study were (1) to determine the time required to fabricate a definitive maxillary obturator prosthesis and (2) to compare the fabrication and follow-up times between a patient's first and second definitive maxillary obturator prosthesis. MATERIALS AND METHODS: A retrospective review was completed of patients that had maxillary definitive obturators fabricated following head and neck surgery from 2002 to 2018 (n = 173). Demographics, clinical data, date of surgery, start date of fabrication, follow-up dates, and prosthesis follow-up data were collected. RESULTS: The median time to delivery of the patient's first definitive maxillary obturator prosthesis from the date of surgery was 7.7 months for nonradiated patients and 9.6 months for radiated patients (P ≤ .05). Additionally, there was a significant difference in the median number of appointments to fabricate the 1st definitive maxillary obturator prosthesis as compared to the 2nd prosthesis (6 vs 5; P ≤ .05). CONCLUSION: Fabrication timelines differed based on history of radiotherapy and patient experience. This data is helpful to set expectations for patients and practitioners regarding the process for prosthesis fabrication and follow-up.


Asunto(s)
Neoplasias Maxilares , Obturadores Palatinos , Estudios de Seguimiento , Humanos , Maxilar , Estudios Retrospectivos
3.
Clin Case Rep ; 8(2): 278-282, 2020 Feb.
Artículo en Inglés | MEDLINE | ID: mdl-32128173

RESUMEN

This clinical report describes the expeditious treatment of a geriatric patient with squamous cell carcinoma of the nose treated with total rhinectomy, craniofacial implant placement, and a nasal prosthesis.

4.
Int J Prosthodont ; 32(5): 448-450, 2019.
Artículo en Inglés | MEDLINE | ID: mdl-31486818

RESUMEN

Leiomyosarcoma is a rare malignant condition occurring in the maxillofacial region in which the mandible may be affected. Management of this tumor in the mandible may include segmental mandibulectomy, osteocutaneous fibula free-flap reconstruction, endosseous implants, and postoperative radiotherapy. Posttreatment malocclusion can be managed with an overpartial mandibular resection prosthesis. The purpose of this report is to describe the expeditious oral rehabilitation of an oncologic patient with posttreatment malocclusion, demonstrating the utility of an overpartial mandibular resection prosthesis.


Asunto(s)
Colgajos Tisulares Libres , Leiomiosarcoma , Maloclusión , Neoplasias Mandibulares , Reconstrucción Mandibular , Procedimientos Quirúrgicos Reconstructivos , Trasplante Óseo , Humanos , Mandíbula , Prótesis e Implantes , Colgajos Quirúrgicos
5.
J Indian Prosthodont Soc ; 19(3): 221-224, 2019.
Artículo en Inglés | MEDLINE | ID: mdl-31462860

RESUMEN

Aim: The aim of this study is to retrospectively, observe a consecutive series of patients with segmental mandibulectomy defects reconstructed with fasciocutaneous free flaps and mandibular resection prostheses, and to review treatment concepts for the management of such patients. Settings and Design: Observational study done at Memorial Sloan Kettering Cancer Center, New York, NY, USA. Materials and Methods: Records were reviewed of all patients who had fasciocutaneous free-flap reconstruction and fabrication of mandibular resection prostheses following segmental mandibulectomy between 2000 and 2017 at a tertiary cancer center. Mandibular resection prosthesis fabrication interval data, as well as follow-up interval data, were recorded. Statistical Analysis Used: Descriptive statistics. Results: Twenty-one consecutive patients had mandibular resection prostheses fabricated following segmental mandibulectomy and fasciocutaneous free-flap reconstruction during the study. The median time for mandibular resection prosthesis delivery following surgery was 9 months (range 4-41 months). There was a median of two-follow-up visits (range 0-4) within the first 90 days of mandibular resection prosthesis delivery. Conclusions: Oral rehabilitation with mandibular resection prosthesis following segmental mandibulectomy and fasciocutaneous free-flap reconstruction is an attainable treatment goal for the oncologic patient. Reviewing the proposed course of care is helpful for patient management.

6.
Int J Prosthodont ; 32(3): 241-247, 2019.
Artículo en Inglés | MEDLINE | ID: mdl-31034537

RESUMEN

PURPOSE: To report the feasibility of oral rehabilitation in patients who had undergone marginal mandibulectomy and to describe the factors that impact the selection of a mandibular resection prosthesis. MATERIALS AND METHODS: A retrospective review of patients who had undergone marginal mandibulectomy over a 14-year period at a tertiary care cancer center was undertaken. Measurements of the vertical height and width of the mandible and the distance between the alveolar crest and mandibular canal were measured after marginal mandibulectomy. The feasibility and success of tooth-borne or implant-supported resection prostheses were measured. RESULTS: Following marginal mandibulectomy, the median heights between the alveolar crest and lower border of the mandible were 21.8 mm, 17.7 mm, and 14.3 mm in the anterior, premolar, and molar regions, respectively. However, the median distances between the alveolar crest and the mandibular canal in the premolar and molar regions were only 3.98 and 3.4 mm, respectively. These residual bone measurements are not satisfactory for implant-supported mandibular resection prostheses, which can be considered only in the anterior region of the mandible. Patients with marginal mandibulectomy in the premolar and molar regions can only be rehabilitated with removable dentures, provided they have remaining stable teeth to clasp and anchor the removable denture. CONCLUSION: Implant-supported resection prostheses after marginal mandibulectomy are feasible only in the anterior segment of the mandible and are not possible in the premolar and molar regions.


Asunto(s)
Implantes Dentales , Osteotomía Mandibular , Proceso Alveolar , Diente Premolar , Prótesis Dental de Soporte Implantado , Humanos , Mandíbula , Estudios Retrospectivos
7.
Clin Implant Dent Relat Res ; 21(5): 873-878, 2019 Oct.
Artículo en Inglés | MEDLINE | ID: mdl-30884091

RESUMEN

BACKGROUND: We hypothesized that crestal bone loss (CBL) and peri-implant soft tissue inflammation are increased when conventionally-loaded dental implants are placed in cigarette and waterpipe smokers compared to nonsmokers. PURPOSE: The present 8-years' follow-up retrospective clinical study evaluated the stability of the conventionally-loaded dental implants placed in cigarette- and waterpipe (narghile) smoking and nonsmoking population group. MATERIALS AND METHODS: Self-reported cigarette-smokers, waterpipe users along with never-smokers have been included. Data pertaining to gender, age, duration and frequency of cigarette-smoking, and usage of waterpipe were collected using a preformed questionnaire. Probing depth (PD), bleeding on probing (BOP), and peri-implant plaque index (PI) were recorded measuring mesial and distal CBL on digital bitewing radiographs. Study power estimated with group comparisons performed using the Kruskal-Wallis and Bonferroni post-hoc adjustment tests. Statistically significant P-values of less than 0.05 were considered. RESULTS: Forty-one cigarette-smokers, forty waterpipe-users, and forty-two never-smokers with mean ages of 44.5 ± 4.3, 41.2 ± 4.7, 43.3 ± 2.8 years, respectively, were included. The mean duration of smoking habit and duration of each session of cigarette-smoking was 5.5 ± 0.3 years and 7.7 ± 1.2 minutes, respectively. The mean period of waterpipe use and time of each session of was 10.6 ± 0.8 years and 20.2 ± 3.1 minutes, respectively. Among cigarette-smokers, waterpipe-users and never-smokers, the implants had been in function for 8.5 ± 0.3, 8.6 ± 0.3, and 8.5 ± 0.5 years, respectively. PD, CBL, and peri-implant PI were positively more among cigarette and waterpipe smoking users (P < 0.05) than with never-smokers. Peri-implant bleeding on probing was significant among never-smokers (P < 0.05) compared to waterpipe-users and cigarette-smokers. There was no difference in Peri-implant PI, PD, and CBL in cigarette-smokers and waterpipe-users. CONCLUSIONS: Cigarette-smokers and waterpipe users are vulnerable to peri-implant soft tissue inflammation and CBL than never-smokers. There is no variation in the severity of peri-implant soft tissue inflammation and CBL in waterpipe and cigarette users.


Asunto(s)
Pérdida de Hueso Alveolar , Implantes Dentales , Pipas de Agua , Fumar en Pipa de Agua , Adulto , Estudios de Seguimiento , Humanos , Persona de Mediana Edad , Estudios Retrospectivos , Fumadores
8.
J Prosthet Dent ; 122(1): 82-87, 2019 Jul.
Artículo en Inglés | MEDLINE | ID: mdl-30782457

RESUMEN

STATEMENT OF PROBLEM: Treatment and timing considerations for patients seeking oral rehabilitation after marginal or segmental mandibulectomy (with osseous reconstruction) are not well understood. PURPOSE: The purpose of this retrospective review study was to report the type and timing of oral rehabilitation for mandibular defects without discontinuity and to describe additional treatment considerations for rehabilitation. MATERIAL AND METHODS: The records were reviewed of all patients who received a mandibular resection prosthesis after marginal mandibulectomy, marginal mandibulectomy with fasciocutaneous free-flap reconstruction, and segmental mandibulectomy with fibula free-flap reconstruction between 2000 and 2017 in the tertiary cancer care institution. Patients not treated by the Dental Service in the institution were excluded. The specific type of rehabilitation was noted, as was the time interval between primary surgery and prosthesis delivery. RESULTS: During the study period, 111 consecutive patients were treated by the Memorial Sloan Kettering Cancer Center Dental Service for mandibular rehabilitation. Forty-three patients underwent marginal mandibulectomy, 9 patients underwent marginal mandibulectomy with fasciocutaneous free-flap reconstruction, and 59 patients underwent segmental mandibulectomy with fibula free-flap reconstruction. Most patients in all 3 groups received mandibular resection prostheses without the use of endosseous implants. Only 4 (8%) patients who had undergone marginal mandibulectomy underwent endosseous implant placement, all of which followed marginal mandibulectomy in anterior mandibular segments without free-flap reconstruction. Patients who underwent marginal mandibulectomy with fasciocutaneous free-flap reconstruction were only restored with removable mandibular resection prostheses, and none had endosseous implants. In patients who underwent segmental mandibulectomy, 13 (22%) were rehabilitated with endosseous implants. The majority in this cohort (>50%) received radiation therapy as part of their treatment. The median time to oral rehabilitation was 8 months after marginal mandibulectomy, 14 months after marginal mandibulectomy with fasciocutaneous free-flap reconstruction, and 12 months after segmental mandibulectomy with fibula free-flap reconstruction. CONCLUSIONS: Timing for oral rehabilitation may differ depending on the treatment modality followed for mandibular tumors in the patient with oral cancer. However, most patients in this cohort underwent rehabilitation with removable mandibular resection prostheses regardless of the timing of care. Endosseous implants were used infrequently, but research is needed to better understand their potential role and indication in the patient with oral cancer.


Asunto(s)
Colgajos Tisulares Libres , Neoplasias Mandibulares , Reconstrucción Mandibular , Trasplante Óseo , Peroné , Humanos , Mandíbula , Osteotomía Mandibular , Prótesis e Implantes , Estudios Retrospectivos , Resultado del Tratamiento
9.
Photodiagnosis Photodyn Ther ; 25: 456-459, 2019 Mar.
Artículo en Inglés | MEDLINE | ID: mdl-30753923

RESUMEN

BACKGROUND: The aim of the present study was to comprehensively review indexed literature regarding the potential role of antimicrobial photodynamic therapy (aPDT) in Orthodontics. METHODS: Indexed databases were searched up to and including January 2019 using the following key words: (a) antimicrobial photodynamic therapy; (b) antimicrobial photodynamic chemotherapy; (c) orthodontic; and (d) orthodontics. Original (clinical and experimental) studies, case-reports, and case-series were included. Letters to the Editor, commentaries and review articles were excluded. RESULTS: Out of the 29 studies identified in the initial search, 4 studies were processed for data extraction. Three studies were randomized clinical trials performed in humans and 1 study was experimental. Results from 2 studies showed that aPDT is effective in the treatment of gingival inflammation in patients undergoing orthodontic therapy (OT). One study showed that oral decontamination can be successfully performed using aPDT among patients undergoing OT. Results of the experimental study showed that aPDT helps in surface decontamination of orthodontic instruments. CONCLUSION: There is insufficient evidence in indexed literature to justify the potential role of aPDT in OT. Hence, further studies are required in this regard.


Asunto(s)
Infecciones Bacterianas/tratamiento farmacológico , Gingivitis/tratamiento farmacológico , Aparatos Ortodóncicos Fijos/efectos adversos , Fotoquimioterapia/métodos , Infecciones Bacterianas/etiología , Gingivitis/etiología , Humanos , Fármacos Fotosensibilizantes/uso terapéutico , Ensayos Clínicos Controlados Aleatorios como Asunto
10.
Quintessence Int ; 50(1): 40-48, 2019.
Artículo en Inglés | MEDLINE | ID: mdl-30411093

RESUMEN

Successful intraoral rehabilitation for patients with head and neck cancer can be extremely challenging to both the patient and the physician due to anatomical, functional, and esthetic changes from the cancer and its treatment. The measures with optimal oral hygiene to prevent or minimize the sequelae of cancer treatments are fundamental to preservation of function and avoidance of complications of therapy. In patients with loss of teeth, endosseous (dental) implants offer an option to improve intraoral rehabilitation. This review presents the indications, problems, and relevant issues pertaining to the use of endosseous implants in a head and neck oncologic population. The problems associated with the traditional approaches for cancer treatment including surgery, radiotherapy, and chemotherapy, as well as those with antiresorptive medications are discussed as they relate to consideration for endosseous implants. This information can aid dental practitioners to select appropriate candidates for implant surgery, minimize postoperative complications, and maximize the successful oral rehabilitation of this patient population.


Asunto(s)
Implantación Dental Endoósea/métodos , Implantes Dentales , Neoplasias de Cabeza y Cuello/complicaciones , Neoplasias de Cabeza y Cuello/rehabilitación , Rehabilitación Bucal/métodos , Diseño de Prótesis Dental , Prótesis Dental de Soporte Implantado , Estética Dental , Humanos , Higiene Bucal
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