Prosthetic rehabilitation of a maxillary defect with a bone anchored prosthesis: A clinical report.

Mucormycosis is an opportunistic fungal infection that frequently infects sinuses, brain, or lungs and arises mostly in immunocompromised patients. Although its occurrence in the maxilla is rare, debridement and resection of the infected and necrotic area is often the best treatment but usually results in an extensive maxillary defect. Protocols for prosthetic obturation versus microvascular reconstruction have been established and used effectively in tertiary institutions for patients with such large defects. Aramany Class VI defects involving more than half of the palatal surface can be managed effectively by surgical reconstruction using microvascular free flaps as a platform for supporting bone-anchored prostheses. Providing fixed prostheses may offer advantages over a conventional obturator prosthesis in terms of hygiene, function, and esthetics. Nonetheless, fixed prostheses retained by endosseous implants in patients with reconstructive osteomyocutaneous flaps often require a sequential team approach by the surgeon and prosthodontist. This clinical report describes the reconstruction of a maxilla by using a scapular free flap with subsequent prosthetic rehabilitation in a patient with maxillary sinus infection secondary to mucormycosis.

Risk of Dental Implant Failure Associated With Medication Use.

PURPOSE: The probability of achieving important clinical outcomes is an increasingly important factor for patients considering various treatment options for tooth loss. For oral reconstruction involving dental implants, the patient-specific risks of implant failure may be influenced by the patient's medication profile. The purpose of this study was to identify associations between dental implant failure and medication use in a consecutive series of patients seen from October 1983 through December 2014 at the Department of Dental Specialties, Mayo Clinic (Rochester, Minnesota). MATERIALS AND METHODS: In this patient-level analysis, demographic, implant-specific, and medical profile data were abstracted from a prospective clinical database and individual medical records and used to determine the time to first implant failure. Implant failure-free survival at the patient level was estimated using the Kaplan-Meier method. Associations of demographic characteristics and medication use with implant failure were evaluated by using Cox proportional hazards regression models and summarized with hazard ratios and 95% confidence intervals. RESULTS: In the 31-year study period, 6358 patients received their first dental implant (median age, 53 years). The median follow-up duration of the 5645 patients whose implants did not fail was 5.8 years, and 713 patients had implant failure (median, 0.6 years). All associations were adjusted for age, sex, and era of implantation because these features strongly influence medication use and implant failure. After adjustment, no medication increased the risk of implant failure in the cohort; specifically, medication use at the time of implant placement or starting a medication after implant placement did not increase the risk of implant failure. Among the medications used at the time of implant placement, corticosteroids were associated with a reduced risk of implant failure (hazard ratio, 0.82; 95% CI, 0.67-0.99; p = 0.04). This association was not seen when corticosteroids were started after implant placement. CONCLUSION: In the population studied, medication use was not associated with an increased risk of dental implant failure.

Association of Systemic Conditions with Dental Implant Failures in 6,384 Patients During a 31-Year Follow-up Period.

PURPOSE: Outcome research has become an increasingly important form of clinical evidence for making health care decisions, including oral health considerations in the field of dentistry. In oral reconstruction involving dental implants, the risk of implant failure may be influenced by a patient's underlying medical condition. To identify associations, implant failure and systemic conditions or diseases were studied in a consecutive series of patients who received dental implants from October 1, 1983, to December 31, 2014, in the Department of Dental Specialties at Mayo Clinic in Rochester, Minnesota. MATERIALS AND METHODS: Data were abstracted from a prospective clinical database and electronic health records for patients' demographic, implant-specific, and medical profiles to determine time to first implant failure. Survival free of implant failure at the patient level was estimated by using the Kaplan-Meier method. Associations of demographic and systemic characteristics with implant failure were evaluated by using Cox proportional hazards regression models and summarized with hazard ratios and 95% confidence intervals. RESULTS: The patient cohort consisted of 6,358 patients with a median age of 53 years at placement of the first implant. A total of 713 patients experienced implant failure at a median of 0.6 years. Among the 5,645 patients who did not experience implant failure, the median duration of follow-up was 5.8 years. More than 20 systemic diseases or conditions were identified for assessment, of which 15 comprised more than 50 patients and five comprised more than 500 patients. All associations were adjusted for age, sex, and era of implant, given the strong influence of these features on implant failure. After adjustment, no systemic disease or condition was shown to increase the risk for implant failure in the population and setting studied. CONCLUSION: Patients considering oral reconstruction involving implants in the medical setting studied do not appear to risk implant loss because of systemic conditions or diseases.