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Osseointegrated Implant Oral Rehabilitation in Head and Neck Cancer Patients
Sydney Chng, MD, PhD, FRACS, Jesse C. Selber, MD, MPH, Roman Skoracki, MD, FRCSC, FACS, Peirong Yu, MD, FACS, Matthew Hanasono, MD, FACS.
University of Texas M D Anderson Cancer Center, Houston, TX, USA.
Restoration of functional and cosmetic dentition is an integral part of reconstruction following treatment of head and neck cancer. Surgical ablation and/or radiotherapy to the oral cavity can change the contour of the floor of mouth and mandible affecting retention of conventional dental prostheses. Many head and neck cancer patients would therefore benefit from oral rehabilitation provided by osseointegrated implants (OI). Implant osseointegration in such patients is especially challenging due to compromised medical condition, poor oral hygiene, smoking, suboptimal free flap bone stock and radiotherapy.
Research in this field is limited by small cohort size and short follow-up periods. This study evaluates the success rate of mandibular and/or maxillary OI oral rehabilitation in a cohort of head and neck patients from 2005 to 2011. Primary endpoints include successful progression to implant-borne prosthesis fabrication, total complications, and implant-related complications.
A total of 249 consecutive patients (168 males and 81 females, median age 61 years) were identified. Data on demographics, co-morbidities, reconstructive surgery, dental oncology treatment and survival outcomes were retrospectively retrieved from a prospectively maintained database. A p-value of 0.05 was considered statistically significant.
A total of 1150 implants were placed in 249 patients, with an implant loss rate of 2.2%, at a median follow-up period of 22.8 months. OI were placed before/at time of surgical ablation in 63.5% (n=158) of patients, and delayed in 36.5% (n=91). Fifty-one (20.5%) patients had OI placed in their fibular free flaps. Of the 198 with OI in their native mandible and/or maxilla, 73 (29.3%) were reconstructed with a soft tissue free flap.
Eleven patients underwent subsequent dental rehabilitation elsewhere. 186 (78.2%) of the remaining 238 patients progressed to successful fabrication of a permanent prostheses. The median time interval between implant placement and fabrication of permanent prosthesis was 7.0 months. Disease recurrence was the most common reason (46%) for failure to progress to prosthesis fabrication. Complications were recorded in fifty-one patients (20.5%), of whom 29 (11.6%) were implant-related, including failure of implant integration (n=15), and osteoradionecrosis (n=14).
In 216 patients with an updated dietary record, 55.6% (n=120) of patients were consuming a regular diet, 26.4% (n=57) a soft diet, and 4.6% (n=10) a puree diet; 7.4% (n=16) were on full gastrostomy feeding, and 5.6% (n=12) needed supplementation with gastrostomy feeding at last follow-up.
Age, tobacco use, diabetes, chemotherapy and soft tissue free flap reconstruction did not preclude successful completion of OI oral rehabilitation, or significantly increase the occurrence of complications. Disease recurrence however was significantly associated with failure to complete OI oral rehabilitation (p<0.001). Implant-related complications were most common in patients who had OI placed following radiotherapy (20%), followed by those who had implants placed before radiotherapy (13.4%), and those who did not undergo radiotherapy (4.3%) (p=0.05).
Osseointegrated oral rehabilitation is feasible and desirable in head and neck cancer patients. Patient selection is important to optimize success for immediate OI placement. Disease recurrence and radiotherapy can be obstacles to OI dental rehabitation, and should be considered in planning treatment.
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