Primary insertion of osseointegrated dental implants into fibula osteoseptocutaneous free flap for mandible reconstruction

Twelve patients with segmental mandibular defects were reconstructed with fibula osteoseptocutaneous flaps and simultaneous placement of osseointegrated implants. Decision to perform this procedure was based on the facts that all patients had benign diseases, did not require postoperative radiotherapy, were in good general and oral conditions, and were psychologically motivated. A total of 34 fixtures was inserted in the first stage. Eight patients underwent second stage surgery, which consisted of connection of the implant abutments to the fixtures and the use of palatal mucosal grafts around the implants. Final dental prostheses were fixed 1 month later in seven patients, at this time. All flaps survived after surgery, and no implant failure was observed after a mean follow-up period of 25 months. Only one fixture was not used during the subsequent stage and was left as a sleeper. Fixed dental prostheses were used in five patients and removable overlay prostheses in the other two. Chewing function was recovered between 4 and 6 weeks after the start using the definitive dental prosthesis. In contrast to previous results, we conclude that excellent results can be achieved when this combined procedure is used in carefully selected patients. In addition, it is confirmed that the fibula osteoseptocutaneous flap is a versatile, reliable composite tissue that facilitates primary placement of osseointegrated dental implants during mandible reconstruction, thus allowing full oral rehabilitation in a shorter period of time.     

Papillon-Lefèvre syndrome. Reappraisal of etiology, clinical features and treatment. II. Oral rehabilitation using osseointegrated implants

A brief review of aetiological aspects, clinical features and treatment of Papillon-Lefèvre syndrome, is mentioned. A case is reported of a girl having typical features of syndrome. In part II of this article we include oral rehabilitation of these patients using osseointegrated implants.     

Implant reconstruction of the jaws and craniofacial skeleton

Full oral rehabilitation with a high degree of success is now possible with osseointegrated implants. Osseointegration is a direct connection between living bone and the titanium implant at the level of the light microscope. Osseointegrated implants are currently used to replace single teeth, support fixed bridges and stabilize full dentures. These implants can also be placed extraorally for attachment of facial prosthesis. The surgical technique used to place implants intraorally into jaws or facial skeleton is performed in two stages using a local anesthetic and/or conscious sedation. During stage I surgery, holes are placed into the jaw using a series of gradually larger diameter burs until the desired diameter and depth of the bony preparation is achieved. The implant is then placed. The implant must remain undisturbed for 4 months for osseointegration to take place. Stage II surgery is then required to remove the mucosa over the implant and place the transmucosal abutment. After 1-2 weeks of healing, the restorative dentist can take an impression and fabricate the prosthesis. On occasion, it is necessary to augment the height and width of the atrophic jaw with autogenous or allogeneic bone grafts prior to implant placement. Bone grafts are sometimes placed on the floor of the nose or the floor of the maxillary sinus. Guided tissue regeneration is a technique used to generate bone within bony defects adjacent to implants. With long-term rates of success (5 years) of 99% for implants placed in the mandible and 95% for those placed in the maxilla, reconstruction of the jaws and cranial facial skeleton with osseointegrated implants has become the treatment of choice.     

Regional epidemiological features of lip, oral cavity, and oropharyngeal cancer

Lip, oral cavity, and oropharyngeal cancer are among the most common forms of the disease in the world. These types of cancer display significant geographic, ethnic, and socioeconomic variations. We examined the cases of cancer of the lip, oral cavity, and oropharynx diagnosed in the Department of Otolaryngology at the University of Uluda? School of Medicine during the last 5 years, July 1990 to June 1995, and recorded the epidemiological features of these tumors. The Department of Otolaryngology treated a total of 26,225 in- and outpatients during the 5-year period. 320 of these patients (1.2%) were seen for head and neck cancer. 42 of the 320 patients (13.1%) were diagnosed with cancer of the lip, oral cavity, and oropharrynx. After the larynx, this was the second most frequent location of malignant head and neck tumors. We discovered the following epidemiological and pathological features: (1) The incident rate was highest in patients between 41 and 60 years of age. (2) 70% of the patients were male, and 76% of them had a history of tobacco/alcohol use. (3) Occupation had no apparent relevance (four of the patients were farmers). (4) Approximately one third of the patients had undergone medical therapy prior to diagnosis. (5) One third of the patients had initially seen a dentist for treatment, and approximately half had poor dental and oral hygiene. (6) The most frequent symptom was ulceration. (7) Histopathological examination revealed squamous cell carcinoma in 88% of the cases. (8) The cancer was localized to the lip in 31% of cases, oral cavity, 50%, and oropharynx, 19%. (9) Almost half of the cancer cases were diagnosed in advanced stage (stages III and IV).     

A convenient method for guarding against localized mucositis during radiation therapy

Metal restorations, such as full gold crowns and dental implants, can cause forward and back scatter radiation during radiation therapy with a dose enhancement to adjacent tissues. Mucositis, one of the most common complications of the radiation treatment of oral, as well as other head and neck malignancies can result. A method for constructing a buccolingual guard in the clinical setting using hydroplastic material is described. The guard can be easily oriented and adapted to an existing radiation stent, adding positional stability and patient comfort. When adequate thickness of material is used, the guard can attenuate forward and back scatter radiation, separate the adjacent tissues from metal restorations, and protect the oral mucosa from localized incidents of mucositis.     

Low prevalence of human papillomavirus in a geographic region with a high incidence of head and neck cancer

BACKGROUND: The main purpose of this study was to determine the prevalence of human papillomavirus (HPV) infection in patients with head and neck carcinomas from Brazil. MATERIALS AND METHODS: Forty-five patients with head and neck squamous cell carcinoma were included in the study, from 1995 to 1996. Forty-two were male and 3 female, with age ranging from 32 to 82 years (median 61). Five patients (11%) did not have previous history of use of tobacco and 38 (90.5%) were heavy smokers. Tumor sites were pyriform sinus, 10; tongue, 11 (oral, 6; base, 5); larynx, 7; floor of mouth, 3; tonsil, 6; retromolar area, 3; inferior gingiva 2; buccal mucosa, 2; and maxillary sinus in 1 patient. Twenty-five were stage IV, 17 stage III, and 3 stage II. RESULTS: The presence of HPV DNA was detected in 5 of 45 patients (11%), all of them with HPV 16. Two patients had HPV DNA in normal mucosa and tumor tissue, 1 patient had HPV DNA only in the normal mucosa and tumor tissue, 1 patient had HPV DNA only in the normal mucosa, and 2 patients were positive for HPV DNA in tumor tissue. Four patients were male and 1 was female; 2 patients were nonsmokers. Three patients had tonsil carcinoma, 1 patient had a tongue carcinoma, and 1 patient had a pyriform sinus cancer. CONCLUSIONS: The role of chemical carcinogens seems to be more important in the genesis of head and neck cancer than is HPV infection. The presence of HPV DNA in 5 of 45 patients stimulates further investigation to determine the role of HPV as a risk factor for head and neck carcinoma.     

Plasma levels of interferon gamma and interleukin 10 in patients with lymphonodular toxoplasmosis

Endosteal implants fail for a variety of reasons. These include failure to osseointegrate, long-term loss of osseointegration, and invasion of a vital structure or anatomic placement that prohibits its use. This case report describes the removal of an implant because of patient discomfort secondary to invasion of the mandibular canal. These histologic findings offered a unique opportunity to examine an osseointegrated human dental implant section.     

Proteoglycan expression by human trabecular meshworks

The aim of the present study was to clinically assess the peri-implant and periodontal conditions 1 year after placement of oral implants (ITI Dental Implant System) in partially edentulous patients. In all, 127 patients (median age 50 years, range 17 to 79) were examined. They were all treated according to a concept of comprehensive dental care and had received fixed partial dentures (FPD). Significant differences were observed between implants and contralateral control teeth with respect to mean pocket probing depth (PPD) (2.55 mm at implants/2.02 mm at teeth), mean probing attachment level (PAL) (2.97 mm/2.53 mm) and bleeding on probing (BOP) (24%/12%) (Wilcoxon matched pairs sign rank test, P < or = 0.01), whereas mean modified plaque index (0.22/0.30), mean modified bleeding index (0.35/0.44) and mean recession (-0.42 mm/-0.51 mm) did not significantly differ between implants and teeth. Compared to control teeth, the width of keratinized mucosa at implants was significantly smaller at lingual, but not at buccal aspects. Regression analyses showed no significant association between the amount of keratinized mucosa and degree of inflammation. Recession, PPD and PAL were slightly influenced by the amount of keratinized mucosa indicating greater resistance to probing. Grouping the implants according to various lengths, type of fixation of the FPD or combination with natural teeth did not result in statistically significant different clinical parameters, whereas grouping according to different localization within the oral cavity did. For example, the mean PAL in 83 anterior implants was 2.52 mm, whereas 175 posterior implants had a mean PAL of 3.18 mm (Mann-Whitney U-test, P < or = 0.01). Regression analyses between the mean PAL for all implants in each patient and the mean PAL of the corresponding dentition revealed an r2 of 0.23 (P < or = 0.01). Using multiple regression analysis, the mean PAL of the implants showed to be significantly influenced by the combined factors "fullmouth" PII, "fullmouth" BOP and mean PAL of all teeth. The results of this study suggest that in partially edentulous patients the overall periodontal condition may influence the clinical condition around implants and thus reinforces the importance of periodontal treatment prior to and supportive periodontal therapy after the incorporation of osseointegrated oral implants.     

Mechanism of lymph node metastases: current concepts

Advances in head and neck surgical techniques with aggressive adjuvant treatment have reduced the incidence of locoregional failure in many types of head and neck cancer. Failure to control distant disease, however, remains of the most frustrating aspects in the care of these patients. A strong foundation in the biology of invasion and metastasis is necessary to understand more clearly the reasons for the development of distant and locally recurrent disease. This article focuses on basic mechanisms of invasion and metastasis in head and neck squamous cell carcinoma.     

Rehabilitation outcomes of long-term survivors treated for head and neck cancer

BACKGROUND: Little is known about the rehabilitation outcomes of long-term survivors following treatment for head and neck cancer. There are, for example, no studies on physical and psychosocial rehabilitation outcomes of T1 glottic larynx carcinoma, despite the fact that these form the majority of head and neck cancer sites. Thus, this investigation afforded a unique opportunity for examining similarities and differences among T1 glottic larynx patients, laryngectomy patients, and those who had surgery for cancer of the oral cavity and/or oropharynx along a variety of physical and psychosocial dimensions. METHODS: To describe the impact of these three types of head and neck cancer and their treatment on the physical and psychosocial functioning of long-term survivors, a self-report questionnaire was completed by 110 patients treated between 2 and 6 years previously in a major cancer center. RESULTS: Data indicate that a higher percentage of patients treated with laryngectomy or commando procedures still experience severe psychosocial distress between 2 and 6 years after their last treatment than do patients treated with radiotherapy for a T1 carcinoma of the glottic larynx. Psychosocial and physical complaints are still reported by many laryngectomy patients, apparently the result of problems in effective communication with others. Many commando procedure patients experience problems with respect to food intake, and with disfigurement and its consequences. T1 larynx patients mainly experience a considerable number of physical complaints. The greater the time that had elapsed since treatment, the fewer the psychosocial problems associated with head and neck tumors. Open discussion of the illness in the family, social support, and perceptions of adequate information from the specialist are the most important predictors of positive rehabilitation outcomes. CONCLUSIONS: This study indicates that T1 larynx patients report many physical complaints even though several years had elapsed since treatment. Also, laryngectomy patients may need psychosocial guidance for a longer posttreatment period and that health care personnel must involve the partner as much as possible in all communications. Commando procedure patients in particular feel hindered by their disfigurement and its consequences. Future research with respect to validation of the specific head and neck modules is needed.     

The expression of regenerative growth factors in chronic liver injury and repair

The outcomes of surgical reconstruction for patients who have undergone extensive tumor resection of the mandible and associated soft tissue have been less than desirable for many reasons: lack of cancer cure, radiation problems, as well as inadequate functional reconstructive results. These patients traditionally have undergone multiple surgical procedures for restoration of the surgical deformity. With the advent of new donor sites and successful transfer of microvascular hard and soft tissue, one can restore the largest defects created during cancer excision. Combining these techniques with biocompatible dental implants and reconstructive bone plates, technology has advanced to the point of predictable outcomes. The restoration of appearance, mandibular function, and mastication is mandated by patients. Dental implants are now placed in vascularized bone reconstruction of the mandible immediately at the time of ablative surgery. This obviates the need for additional surgical reconstructive procedures, adjunctive hyperbaric oxygen therapy, and problems associated with the placement of dental implants in irradiated tissue.     

The nonsubmerged osseointegrated dental implant

Implant patients are seeking means of restoring their health and appearance with minimal side effects. Dental implant surgery must react to these demands by continuing to develop minimally invasive implant surgery techniques, imaging that customizes surgical procedures, and materials and drugs that reduce surgical costs and complications, shorten recovery, and increase the longevity of components, enabling patients to live active lifestyles. Nonsubmerged osseointegrated implants fit nicely into the future of dental surgery.     

Growth and invasion of differentiated thyroid gland carcinoma: importance of signal transduction

To define the long-term dental sequelae of therapy for childhood rhabdomyosarcoma of the head and neck, and to identify factors in their development, we retrospectively reviewed the serial panoramic radiographs and clinical records of 22 survivors of head or neck rhabdomyosarcoma who had been followed for at least 5 years. Patients were divided into four groups based upon age at the time of therapy and three groups based upon radiation doses. All patients had received similar multiagent chemotherapy. Dental sequelae of oncotherapy occurred in over half of the long-term survivors of head and neck rhabdomyosarcoma. The abnormalities comprised root stunting in 54%, microdontia in 23%, and hypodontia in 50% of patients; 36% had multiple abnormalities. Microdontia and multiple abnormalities were more prevalent in patients treated at the earliest age, and abnormalities tended to be more prevalent with increasing doses of radiation. Five patients (23%) developed severe cosmetic and/or functional sequelae necessitating surgical and/or orthodontic intervention. The high frequency of dental sequelae we observed suggests that meticulous long-term dental and radiographic follow-up are needed. Early detection and treatment of the complications of therapy will expedite their correction and minimize morbidity.     

Radiotherapy of epipharyngeal carcinoma: successes and limits as examples of new treatment strategies

In treating cancer patients, disease free survival and survival have been improved during the last decade by technical progress and new systemic therapies. In radiation therapy as well as in any other cancer treatment potential long-term side effects and complications need special attention. The success of doubling tumour control by radiation therapy in patients with head and neck tumours illustrates the needs of long-term follow-ups. Cost-effectiveness has to be considered, when treatment results of RT equal surgical results, as it is often the case in head and neck tumours as well as in other malignant diseases.     

Implant retained overdentures in mandibular reconstruction: a case report

This case report describes the clinical and laboratory procedures used in the rehabilitation of a patient treated for oral cancer with surgery and radiation therapy. During surgery, a large portion of the mandible was removed and reconstructed with a bone graft. Following therapy, the patient was left with poor esthetics and difficulties with mastication and speech. The goal of prosthodontic treatment was to improve esthetics and restore function. This was successfully achieved through the placement of dental implants and the construction of an implant retained overdenture. A bar was employed to split the implants together and an O-ring system was chosen for retention. The decision to use this type of prosthesis and attachment selection was based on the patient's dental history, esthetic demands, and the need for stress distribution.     

Second primary cancers after cancers of the colon and rectum in New South Wales, Australia, 1972-1991

In this article, we present a survey on dental care and oral implantology in Beijing, China. The Chinese population comprises 1.2 billion or about 20% of the world's population. This survey shows: (i) there is a well-developed dental system in China, mostly operated by the Chinese government; (ii) in Beijing, there are 1328 dentists and oral surgeons and 515 special dental nurses working in dental departments of hospitals; (iii) about 2 million new patients visit the dentist every year; (iv) oral implantology is a new technology for the Chinese dentist and oral surgeon, as shown by the finding that in 1992, only 384 persons were treated with oral implants in a few hospitals in Beijing; however, most hospitals are interested in performing oral implantology in the near future; (v) imported implants are too expensive for Chinese patients, and therefore good qualified domestic implants and cheaper imported implants have a great market potential.     

Problems associated with the atrophic mandible

A range of treatment options has been presented regarding the use of dental implants to rehabilitate patients who otherwise have compromised function using conventional tissue-borne prostheses. This patient population offers significant challenges to both the surgeon and the prosthodontist. Generally speaking, IODs retained on two or more endosteal osseointegrated implants; transosteal, subperiosteal, ramus frame implant-supported and implant-retained prostheses, and a totally implant-supported design offer options to treat the severely atrophic mandible. When bone support or volume is so lacking that augmentation procedures are required, bone grafting can be considered as a treatment option. The state-of-the-art of implant treatment for the atrophic mandible offers to the dental professional and patient a variety of options. Thus far, it is too early to make specific recommendations as to which treatment offers the best option for each patient. It is fair to say that the ISP remains the gold standard against which other treatments can be compared.     

Endosseous implants for prosthetic rehabilitation in bone grafted alveolar clefts

The authors report their experience in the surgical and prosthetic rehabilitation of three patients affected by sequelae of cleft lip and palate, with residual alveolar cleft and absence of maxillary anterior teeth. The patients were treated by means of late secondary bone grafting of the alveolar cleft, followed by the insertion of endosseous titanium plasma-sprayed implants (IMZ). After a further healing period (6-12 months) fixed dental prostheses were constructed. Preliminary results from this series have shown how dental prostheses supported by endosseous implants in grafted alveolar clefts are a very reliable possibility in dental rehabilitation of this malformation.     

Aesthetic considerations for maxillary obturators retained by implants

Maxillary obturators are prostheses used to replace maxillary tissues, missing congenitally or removed by trauma or tumor ablative surgery. These prostheses are used to restore function (speech, swallowing, and mastication) and aesthetics. A considerable number of edentulous patients have difficulty in retaining this type of prosthesis. Utilization of osseointegrated dental implants is a significant adjunct in treating these cases, but it must be undertaken with careful planning to ensure predictable aesthetic results. The learning objective of this article is to discuss the technique of designing aesthetic maxillary prostheses supported by osseointegrated dental implants. The discussion includes indications and contraindications, and a postcarcinoma surgery case is used to illustrate the clinical procedure.     

Oral management of the cancer patient. Part II: chemotherapy

This second of a three-part series reviews chemotherapy treatment and the responsibilities dental care providers have for patients in all phases of this type of cancer treatment. The goals of dental care are to maintain the integrity of the oral mucosa, prevent secondary infection, provide relief, and assist in maintaining dietary intake. The dental hygienist plays a key role in the recognition, treatment or monitoring of dental conditions that could cause complications to the patient during and post chemotherapy, as well as in educating and motivating the patient in optimal oral self-care.