Oral prehabilitation for patients with head and neck cancer: getting it right - the Restorative Dentistry-UK consensus on a multidisciplinary approach to oral and dental assessment and planning prior to cancer treatment.

Historically, oral and dental issues for head and neck cancer patients were often not considered until after cancer treatment was complete. As a result, outcomes for oral rehabilitation were sometimes suboptimal. Inconsistencies in service delivery models and qualification, training and experience of staff delivering dental care often compounded this problem, making research and audit almost impossible. Collaborative working by consultants in restorative dentistry from all over the UK as part of a Restorative Dentistry-UK (RD UK) subgroup, renamed more recently as the RD-UK Head and Neck Cancer Clinical Excellence Network (CEN), has re-emphasised the importance of specialist restorative dentistry intervention at the outset of the head and neck cancer pathway to optimise outcomes of patient care. The CEN has driven several initiatives, reflecting Getting It Right First Time (GIRFT) principles aimed at reducing unwarranted variation. This improved consistency in approach and optimised collaborative working of the team now presents a better environment for multicentre audit and research. Ultimately, this should result in a continued improvement in patient and carer experience.

Dental loss after radiotherapy for head and neck cancer.

Introduction In radiotherapy (RT) for head and neck cancer (HNC), dental morbidity is significant and it may result in loss of the dentition following treatment.Aims The aim of this clinical study is to identify the incidence of tooth loss over time and correlate this to the RT dose and various risk factors in patients with HNC treated with radical RT.Design A retrospective observational study.Materials and methods The records of 1,118 patients with HNC treated with radical or adjuvant RT from January 2010 to December 2019 were analysed. After applying strict inclusion criteria, 78 patients with 1,566 individual tooth data were selected. RT dose mapping was performed for each tooth.Results A total of 253 teeth (16.2%) were extracted. The following risk factors were significant: gender (p = 0.0001), xerostomia (p <0.0001), RT dose (p <0.0001) and smoking (p <0.0001). Non-significant factors were age, RT delivery technique and the addition of cisplatin.Conclusion Detailed RT dose mapping was used to identify RT dose as a risk factor for dental loss. Careful pre-RT dental treatment and minimisation of RT dose to teeth and salivary glands is required to prevent or reduce the loss of dentition.

What is the optimal number of implants for fixed reconstructions: a systematic review.

OBJECTIVES: To assess the 5-year and 10-year survival and complication rates of implant-supported fixed reconstructions in partially and totally edentulous patients with regard to the optimal number and distribution of dental implants. MATERIAL AND METHODS: This review was designed as a systematic review of the literature. A search strategy was developed and executed using an electronic and selective hand search for English-language articles in Dental Journals limited to human clinical trials. Search terms were grouped into categories for "problem" - "intervention" - "outcome". For articles retrieved by this search, abstracts were screened by two reviewers based on the inclusion criteria. Selected articles were then obtained in full texts. Finally, the selection based on inclusion/exclusion criteria was repeated for the full-text articles. RESULTS: Of the 210 titles retrieved by the search, 51 were selected for full-text review based on the information given in the abstract. From the full-text articles, a total of nine studies were included for this systematic review. In meta-analysis, prosthetic survival rates over 5 and 10 years for partial Fixed Dental Prostheses (FDPs) on two to four implants were estimated as 98.9% (95% CI: 98.5-99.2%) and as 97.8% (95% CI: 96.9-98.4%) respectively. A survival rate for maxillary Full-Arch Fixed Dental Prostheses (FAFDPs) on four to six implants after 5 years was assessed as 97.5% (95% CI: 94.1-98.9%) and a survival rate after 10 years as 95.0% (95% CI: 88.5-97.9%). The result for the survival rates in case of mandibular FAFDPs on four to six implants after 5 years was 97.9% (95% CI: 96.3-98.8%) and after 10 years 95.9% (95% CI: 92.8-97.7%). Specific implant-to-replaced-unit-ratios were not available in any of the studies. CONCLUSION: For implant-supported FAFDPs, using 4-6 implants is a well-documented treatment option with high estimated 5-year survival of the construction. It is unclear whether three implants for supporting a FAFDP will achieve similar survival rates. The RCTs needed that report implant-to-replaced-units-ratios for partial FDPs and include 3 vs. 4-6 implants for supporting a FAFDP in the mandible.

EAO summer camp: a facilitated sharing experience.

AIM: The purpose of the EAO summer camp was to create visions and ideas for future developments in the field of implant dentistry. An additional goal was the installation of a young, strong and enduring network for scientific exchange among participants. SUMMER CAMP ACTIVITY: Forty participants younger than 40 years of age, from 16 different European countries, discussed potential future developments of implant dentistry in a professionally moderated workshop. Participants worked in a competitive manner over 3 days in small teams on four topics: future teaching and education, surgery in 2030, prosthetics in 2030 and futuristic tissue development related to the field of implantology. Various innovative conference and moderation techniques were applied to achieve a maximum output from the creative potential present. RESULTS: Plenum consensus was obtained for several key factors potentially influencing future development in implant dentistry. In particular, teaching and education will be improved by the establishment of curriculum standards and novel teaching technologies. Surgery in 2030 will benefit from an improved cost-effectiveness of new technologies and biomaterials. A more comprehensive knowledge on host susceptibility will have an impact on treatment planning and the predictability of implant therapy. A virtual patient concept and tissue engineering will influence Prosthodontics in 2030. Futuristic tissue development will set a "platinum standard" for tissue regeneration. SUMMARY: Visions on all four topics were generated and discussed intensively during the conference. "Future teaching and education" was voted unanimously as the winning team based on the presented ideas and the special interest this topic generated.

Local risk factors for implant therapy.

PURPOSE: The aim of this review was to determine the effect of several potential local risk factors on implant survival and success (primary outcomes) as well as on mucosal recession, bleeding on probing, and proximal marginal bone loss (secondary outcomes). MATERIALS AND METHODS: A comprehensive review of the literature was conducted. The selection of publications reporting on human clinical studies was based on predetermined inclusion criteria and was agreed upon by three reviewers. After title and abstract screening of 2,681 publications obtained from the search, 19 articles were deemed to be relevant to the topic and the search criteria. RESULTS: Limited data show that when an implant is placed within 3 mm of the neighboring tooth, proximal bone is at risk. The data regarding the placement of implants into infected sites are still insufficient, but studies have shown that this may be possible. Soft tissue thickness has not been shown to be a risk factor in implant survival. There is also no evidence to support a relationship between the width of keratinized tissue and implant survival. No studies were found that directly related bone density to implant survival. Implant stability was also difficult to examine due to the lack of validated stability measures. DISCUSSION AND CONCLUSION: One critical factor that faced the group during the review of the literature and interpretation of the data was the multifactorial nature of implant therapy. This makes isolation of specific risk factors difficult. Conclusions are limited by the current lack of quality clinical trials in this area.