Including dental professionals in the multidisciplinary treatment team of head and neck cancer patients improves long-term oral health status.

OBJECTIVE: To assess in a cross-sectional study the impact of including dental professionals in the multidisciplinary treatment team of head and neck squamous cell carcinoma (HNSCC) patients on the long-term oral health status. MATERIALS AND METHODS: Oral health status, dental care behaviours, and oral health-related quality of life were assessed based on a clinical and radiographic examination, interview, and medical records in patients treated for HNSCC ≥ 6 months ago. This patient group ('cohort 2') was treated in a multidisciplinary treatment team including dental professionals and compared to a group of HNSCC patients previously treated at the same university, but without dental professionals included in the multidisciplinary treatment team ('cohort 1'). RESULTS: Cohort 2 consisted of 34 patients, who had received a dental check-up and if necessary, treatment by dental professionals prior to the initiation of cancer treatment. This cohort showed significantly improved oral hygiene habits and a better periodontal health status compared to cohort 1. However, cohort 2 still presented high demand for treatment due to active carious lesions; only a few, statistically insignificant improvements were detected compared to cohort 1. CONCLUSION: Including dental professionals in the multidisciplinary treatment team of HNSCC patients has a positive impact on patient oral health status-primarily in terms of periodontal disease-6 months and longer after finishing cancer therapy. CLINICAL RELEVANCE: A team-based approach including dental professionals specialised in head and neck cancer improves oral health status.

The use of onplants and implants in children with severe oligodontia: a retrospective evaluation.

OBJECTIVE: To evaluate a stable treatment concept for the oral rehabilitation of children with severe oligodontia. The treatment is intended to solve a specific problem caused by limited skeletal growth, multiple congenital missing teeth, underdeveloped bone volume and young age. MATERIAL AND METHODS: A surgical/prosthodontic approach was chosen for six patients with subtotal edentulism despite their young age. To support removable dentures the maxilla was treated with onplants (OnPlant), whereas dental rootform implants (NobelReplace, Nobel Biocare) were placed in the mandible. RESULTS: Eight onplants were placed in the hard palate of four patients for rehabilitating the maxilla and eight dental rootform implants were placed interforaminally in three patients to rehabilitate the mandible. While none of the rootform implants was lost, one onplant was lost and replaced with a stable outcome. The mean follow-up time of the onplants was 5 (±1) years vs. 3 (±2) years for the rootform implants. CONCLUSION: The evaluation showed the treatment concept described to ensure stable oral rehabilitation and recovery of the stomatognathic system even during the juvenile growth period.

Dental Management and Prosthetic Rehabilitation of Patients Suffering from Hypohidrotic Ectodermal Dysplasia: A Report of Two Case Histories.

The prosthetic restoration and dental long-term care of two oligodont male cousins suffering from X-linked hypohidrotic ectodermal dysplasia is described in two case histories. The first patient was three times supplied with removable dentures at an age from 5 to 12 years, and the second patient was restored twice by tooth- and implant-supported dentures within an observation period of 10 years. In both patients, implants were placed in the growing jaw (both arches) in order to enhance denture retention by single attachments and/or a palatinal bar. In one patient, loss of one maxillary implant occurred 3 years after implant exposure and 2 years after the provision of the implant-supported denture. In the second patient, after completion of growth and preceding bone augmentation, further implants facilitated an improved removable maxillary restoration. In both patients, an orthodontic alignment and reshaping of the conical anterior teeth by means of resin or full-ceramic crowns was applied to improve the esthetic appearance. Patients with HED require a consistent lifelong attendance comprised of oral hygiene, denture maintenance, and refitting. In oligo-/anodont children, the placement of implants in selected regions may be useful for the enhancement of denture retention. However, due to poor bone quality and volume, implant failure may occur.

Effectiveness of subperiosteal bone anchor (Onplant) placement in the anterior highly atrophic maxilla for cross-arch prosthetic rehabilitation: Results from a pilot study.

PURPOSE: The present prospective pilot study aimed to evaluate the feasibility of Onplants (Onplant Orthodontic System) off label use in the highly atrophic edentulous maxillae of adult patients to avoid bone grafting and conventional dental or zygomatic implants. MATERIAL AND METHODS: Two Onplants were placed subperiosteally in the anterior part of the hard palate in five adult patients presenting a highly atrophic edentulous maxilla, class V or VI, according to Cawood and Howell. After a healing period of 4 months the prosthetic procedures were started. Outcome measures were the survival rate of the Onplant system, complication rate and OHRQoL using a OHIP-G questionnaire at three different stages: before and after the Onplant placement and at the end of treatment. RESULTS: Unexpectedly, the present study had to be discontinued due to the early loss of all 10 Onplants at the time of prosthetic loading. In total, 16 patients were meant to participate, but the study was stopped after complete failures of the first five patients. While all inserted Onplants became unstable, no other complications like penetration of the nasal cavity, infections or fractures of the abutment screw were observed. The patient satisfaction and the oral health-related quality of life declined with the number of surgical interventions and finally with the Onplant failure. CONCLUSIONS: The anterior part of the adult hard palate apparently did not present adequate bone regenerative capacity to support Onplant-prosthetic rehabilitation. Off-label Onplant-supported prostheses are contraindicated for permanent maxillary rehabilitation in edentulous adult patients. Conflict-of-interest statement: The original manufacturer provided the materials free of charge in this investigator-sponsored research (code: 2011-1027). The authors declare no conflicts of interest in relation to this study.

Novel development for intraoral distraction osteogenesis by individually fabricated traction prostheses.

Modified fixed or removable partial dentures are used for intraoral distraction osteogenesis. These traction prostheses rest on teeth or endosseous implants and direct distraction forces to an endosseous implant in the osteotomy segment. This article explains the fabrication and function of custom-made traction prostheses for 1-, 2- and 3-dimensional distraction osteogenesis.

Use of an individual traction prosthesis and distraction osteogenesis to reposition osseointegrated implants in a juvenile with ectodermal dysplasia: a clinical report.

This article describes the use of distraction osteogenesis to reposition osseointegrated maxillary implants in an adolescent girl with ectodermal dysplasia and oligodontia. The distraction of 2 osteotomized segments was controlled by a prosthesis fabricated specifically for this purpose.

Computer-aided placement of endosseous oral implants in patients after ablative tumour surgery: assessment of accuracy.

The objective of this study was to evaluate the feasibility and accuracy of a novel surgical computer-aided navigation system for the placement of endosseous implants in patients after ablative tumour surgery. Pre-operative planning was performed by developing a prosthetic concept and modifying the implant position according to surgical requirements after high-resolution computed tomography (HRCT) scans with VISIT, a surgical planning and navigation software developed at the Vienna General Hospital. The pre-operative plan was transferred to the patients intraoperatively using surgical navigation software and optical tracking technology. The patients were HRCT-scanned again to compare the position of the implants with the pre-operative plan on reformatted CT-slices after matching of the pre- and post-operative data sets using the mutual information-technique. A total of 32 implants was evaluated. The mean deviation was 1.1 mm (range: 0-3.5 mm). The mean angular deviation of the implants was 6.4 degrees (range: 0.4 degrees - 17.4 degrees, variance: 13.3 degrees ). The results demonstrate, that adequate accuracy in placing endosseous oral implants can be delivered to patients with most difficult implantologic situations.