Document Detail


Efficacy of conventional and implant-supported mandibular resection prostheses: study overview and treatment outcomes.
MedLine Citation:
PMID:  16872926     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
STATEMENT OF PROBLEM: While surgical restoration of mandibular resections has advanced dramatically with free-flap techniques, oral function and patient perceptions of function, as well as treatment outcomes, often indicate significant impairment. PURPOSE: This longitudinal prospective study was designed to determine whether conventional prostheses (CP) or implant-supported prostheses (IP) and current surgical reconstructive procedures restore patients' oral functions and quality of life to their status prior to segmental mandibulectomy with immediate fibula free-flap reconstruction. Study design and implementation, characteristics of the study sample, treatment completion rates, and selected presurgical and postsurgical functional and perceptual outcomes are presented. MATERIAL AND METHODS: Forty-six subjects were enrolled. Longitudinal evaluations of medical and dental histories, oromaxillofacial examinations, questionnaires, and sensory and functional tests were planned before and after surgery and after CP and IP treatment. Sample characteristics are described with descriptive statistics and comparisons of subject responses to questionnaire items at entry and postsurgical intervals were made with Fisher exact tests (alpha=.05). RESULTS: Conventional prostheses were completed in 33 of 46 subjects, and 16 of 33 CP subjects were treated with IP. Reasons for noncompletion of IP were recurrent/metastatic disease (16), refusal of implant therapy (7), lost to follow-up (4), treatment with a reconstruction plate (1), excessive radiation at implant sites (1), and death (1). All 16 recurrences/metastases occurred within 13 months of surgery. Only 3 of the 58 implants placed in 17 participants were considered failures. One failed due to lack of integration 31 weeks following placement, and 2 were buried due to unacceptable positioning for prosthetic restoration during denture fabrication. The remaining 55 implants were successful at final evaluation, ranging from 58 to 123 weeks following implant placement (mean duration=78.9 +/- 16.0 weeks). CONCLUSIONS: While 72% (33/46) of the subjects enrolled were able and willing to complete treatment with CP, only 35% (16/46) completed IP treatment. Careful consideration must be given to selection of the type of prosthetic rehabilitation and the timing of implant placement if an IP is planned.
Authors:
Neal Garrett; Eleni D Roumanas; Keith E Blackwell; Earl Freymiller; Elliot Abemayor; Weng Kee Wong; Bruce Gerratt; Gerald Berke; John Beumer; Krishan K Kapur
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Publication Detail:
Type:  Controlled Clinical Trial; Journal Article; Research Support, N.I.H., Extramural; Research Support, Non-U.S. Gov't; Research Support, U.S. Gov't, Non-P.H.S.    
Journal Detail:
Title:  The Journal of prosthetic dentistry     Volume:  96     ISSN:  0022-3913     ISO Abbreviation:  J Prosthet Dent     Publication Date:  2006 Jul 
Date Detail:
Created Date:  2006-07-28     Completed Date:  2006-10-24     Revised Date:  2007-11-14    
Medline Journal Info:
Nlm Unique ID:  0376364     Medline TA:  J Prosthet Dent     Country:  United States    
Other Details:
Languages:  eng     Pagination:  13-24     Citation Subset:  D; IM    
Affiliation:
Division of Advanced Prosthodontics, Biomaterials and Hospital Dentistry, UCLA School of Dentistry, University of California-Los Angeles, 10833 Le Conte Avenue, Los Angeles, CA 90095, USA. ngarrett@ucla.edu
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MeSH Terms
Descriptor/Qualifier:
Adult
Aged
Aged, 80 and over
Dental Implantation, Endosseous
Dental Prosthesis, Implant-Supported*
Dental Restoration Failure
Denture, Complete, Lower*
Denture, Partial, Removable*
Humans
Mandible / surgery*
Mastication
Middle Aged
Mouth Neoplasms / radiotherapy,  rehabilitation*,  surgery
Oral Surgical Procedures*
Prospective Studies
Quality of Life
Questionnaires
Reconstructive Surgical Procedures
Surgical Flaps
Treatment Outcome
Grant Support
ID/Acronym/Agency:
1R01 DE 11255/DE/NIDCR NIH HHS; C06 RR 14529-01/RR/NCRR NIH HHS

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