Journal of Oral Implantology Dental implants in oral rehabilitation of a maxillary cancer reconstruction: A case report --Manuscript Draft-Manuscript Number:
AAID-JOI-D-13-00136R1
Full Title:
Dental implants in oral rehabilitation of a maxillary cancer reconstruction: A case report
Short Title:
Implant restoration in a cancer patient
Article Type:
Clinical Case Letter
Keywords:
Implant-supported prosthesis, maximum bite force, masticatory performance, Maxillectomy, quality of life.
Corresponding Author:
Tomoki Sumida, D.D.S., Ph. D. Kyushu University Fukuoka, Fukuoka JAPAN
Corresponding Author Secondary Information: Corresponding Author's Institution:
Kyushu University
Corresponding Author's Secondary Institution: First Author:
Tomoki Sumida, D.D.S., Ph. D.
First Author Secondary Information: Order of Authors:
Tomoki Sumida, D.D.S., Ph. D. Hiroyuki Nakano, D.D.S., Ph. D. Hiroyuki Hamakawa, D.D.S., Ph. D. Yoshihide Mori, D.D.S., Ph. D.
Order of Authors Secondary Information: Abstract:
A 67-year-old man presented reporting difficulty eating, and intraoral investigation revealed that he had undergone a hemimaxillectomy at another hospital 2 years previously. The resected area was covered with a thick abdominal myocutaneous flap (AMF). Dental implants were placed in the residual left alveolar ridge. After treatment, masticatory performance and maximum bite force both improved dramatically, from a score of 2 to 9, and from 0.03 kN to 1.58 kN, respectively. Dental implants can significantly improve the biting force and masticatory performance in oral cancer patients with jawbone resection, even in cases where half of the alveolar ridge has been resected.
Response to Reviewers:
November 5th 2013 James L. Rutkowski, Editor-in-Chief Journal of Oral Implantology Dear Prof. Rutkowski, We have revised our manuscript in accordance with all of the reviewers’ suggestions, and the major revisions are indicated below. (These line numbers correspond to the text in the reviewed PDF.) Reply to Reviewer #1 Preoperative OPG is now included as Figure 1c, and sinus floor elevation and the prosthetic procedure is now described in the Case Report section in detail. In this case, we performed the sinus lift using chin bone. Reply to Reviewer #2 We have substantially revised the manuscript, and have itemized these revisions
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below (including line numbers where appropriate), for your consideration. 1.We agree that the title was too long, and have revised it as per your suggestion. 2.We agree that “hemimaxillectomy” is a more scientific term, and accordingly we have inserted it consistently in the manuscript. 3.We have revised the sentences in the manuscript from active to passive voice, as per your comment. 4.Lines 8 to 10 have been reworded in accordance with the reviewer’s suggestion. 5.The last sentence has been deleted in accordance with the reviewer’s suggestion. 6.In the Introduction, “perforation” has been changed to “oro-antral communication” in line 23. 7.In line 23, the main issue with oro-antral communication has now changed, and two references have been added. 8.In line 25, the expression was now been changed. 9.In lines 28–30, and 34–36, the text has been corrected in accordance with the reviewer’s advice. 10.In lines 39–43, some text has been changed in accordance with the reviewer’s comments. 11.In line 46, the repetitive sentence has been deleted. 12.Some of the words in lines 46 and 47 have been moved to line 43. 13.In lines 47–57, the surgical and prosthetic procedures are now described, and an additional figure has been added to the manuscript. We think that this will appeal to JOI readers. 14.In lines 60–62, some words have been changed now in the Discussion section. 15.This statement has now been deleted. 16.In lines 64–67, the sentences have been revised. 17.In line 74, the word “our” has been changed to “this”. 18.From lines 75–78, the wording has been changed in accordance with the reviewer’s suggestions. 19.In line 79, the wording has been changed in accordance with the reviewer’s suggestions. 20.In lines 81–84, the wording has been changed in accordance with the reviewer’s suggestions. 21.We completely agree with the reviewer’s comments relating to lines 85–88, and they have been changed accordingly. 22.In line 90, the wording has been changed. 23.In line 91, the last sentence has been deleted.
In terms of figures, a color intra-oral picture has now been provided, and one new figure has been added. Therefore, they have been renumbered. And now figure legends have been included in the manuscript.
I look forward to hearing from you at your earliest convenience. Sincerely, [omitted for blinding purposes]
Powered by Editorial Manager® and ProduXion Manager® from Aries Systems Corporation
Article File
Dental implants in oral rehabilitation of a maxillary cancer reconstruction: A case report
Tomoki Sumida, DDS, PhD1,2*, Hiroyuki Nakano, DDS, PhD1, Hiroyuki Hamakawa, DDS, PhD2, Yoshihide Mori, DDS, PhD1
1
Division of Oral and Maxillofacial Surgery, Department of Maxillofacial Diagnostic and
Surgical Sciences, Kyushu University School of Dentistry, Fukuoka, Japan 2
Department of Oral and Maxillofacial Surgery, Ehime University Graduate School of
Medicine, Ehime, Japan
*Corresponding author, email: [email protected]
ABSTRACT A 67-year-old man presented reporting difficulty eating, and intraoral investigation revealed that he had undergone a hemimaxillectomy at another hospital 2 years previously. The resected area was covered with a thick abdominal myocutaneous flap (AMF). Dental implants were placed in the residual left alveolar ridge. After treatment, masticatory performance and maximum bite force both improved dramatically, from a score of 2 to 9, and from 0.03 kN to 1.58 kN, respectively. Dental implants can significantly improve the biting force and masticatory performance in oral cancer patients with jawbone resection, even in cases where half of the alveolar ridge has been resected.
Keywords: Implant-supported prosthesis, maximum bite force, masticatory performance, Maxillectomy, quality of life. Short title: Implant restoration in a cancer patient
INTRODUCTION The treatment of patients with oral cancer usually involves surgery, radiotherapy, and/or chemotherapy.1 Various complications can develop after oral cancer resection, particularly if a major maxillectomy was performed. Maxillary resection sometimes results in oro-antral communication, which leads to difficulties in speech and swallowing. Pterygoid and zygomatic implants were reported to be useful in these cases.2,3 Dentures can be constructed in edentulous cases involving reconstruction of large defects using thick flaps, however, this is not always effective. Thus, resection of the maxilla often leads to damage that affects not only mastication, but also speech and swallowing; as a result, the patient’s quality of life (QOL) invariably declines.4 This report discusses the application of implant dentistry for the oral rehabilitation of an oral cancer patient who underwent a hemimaxillary resection, reconstruction with a microvascular free abdominal flap (FAF), and radiotherapy. Maxillary reconstruction with a thick FAF is a method used to close the space between the oral cavity and the maxillary sinus.5 However, thick flaps disrupt oral functions, particularly occlusion. If there is enough remaining alveolar bone for implant insertion, implant-retaining treatment may be able to restore occlusion. This case report describes a successful oral reconstruction via the implementation of an implant-supported prosthesis for a large maxillary defect after reconstruction with a FAF.
CASE REPORT A 67-year-old male patient presented at our hospital with the chief complaint of dysfunctional occlusion. He had cancer of the right maxilla and underwent preoperative radiotherapy
and
chemotherapy in
another
hospital.
After
the
radiotherapy,
a
hemimaxillectomy and a FAF graft were performed. There were no serious complications following the surgery. However, treatment with a denture was impossible due to the thick flap and lack of residual teeth, and the patient was thus only able to eat soft foods. The condition of the patient at the first visit, 2 years after surgery, is shown in Figures 1 and 2. The panoramic radiograph before implantation revealed that the sinus floor was low on the left side, corresponding to the upper molar region (Figure 3). The bone height from sinus floor to alveolar ridge was less than 5 mm. Therefore, sinus floor elevation was performed via the lateral window technique, using autologous bone from the mental region. After 6 months, 12–14 mm of bone height was confirmed by panoramic radiograph. A total of 5 MkIII implants (Brånemark System®) were inserted into the left maxilla, each with a diameter of 4.0 mm, and with lengths of 12 mm (1 implant), and 10 mm (4 implants) (Figures 4 and 5). Six months the insertion of the implants a second operation was performed, and good osseointegration of the implants was achieved. The prosthetic procedure was then performed. Due to the angle of the insertion of the implants, a multi-unit system (Brånemark System®) was utilized. After the multi-unit abutments were set, the temporary prostheses
were adjusted to the patient’s satisfaction with regard to occlusion, and the shape of the prostheses. After adjustment of the temporary prostheses, the final hybrid prostheses lined with metal were set with retaining screws. Using standard procedures, the final prosthesis was set in the oral cavity. The final prosthesis was elongated to the canine on the right side, for esthetic reasons (Figure 6). Masticatory function improved after implant treatment, and the patient was able to eat a normal diet and chew on the left side. However, the right anterior teeth were not in contact with the lower teeth (Figure 7). Maximum bite force improved dramatically after the implantation increased to within the normal range, as did masticatory function as measured by xylitol gum (Figures 8 and 9). The patient was able to eat a normal diet, and he was satisfied with the outcome. There were no serious problems for over 5 years. It was, however, very difficult for the patient to clean the area around the abutment; therefore, follow-up was required every 3 months for cleaning. DISCUSSION After a minor maxillectomy, the defect is usually covered by an obturator prosthesis. In such cases, this type of prosthesis is usually sufficient for helping the patient with activities such as eating and speaking, even if the defect resulted in oro-antral communication. If the defect cannot be obturated using a conventional obturator prosthesis, the use of an implant support obturator prosthesis is a very useful treatment approach. Thus, a large
proportion of patients with maxillary cancer use an obturator prosthesis supported by implants. Moreover, obturator prostheses are easy to maintain and are associated with a favorable prognosis with regard to the implants.6 Obturation, local or locoregional flaps, and soft tissue free flaps are good options for maxillary reconstruction; however, the lack of bone reconstruction often leads to difficulties in occlusal reconstruction, because osseous implants cannot be used for dental rehabilitation.7 Implant therapy using reconstructed bone with skin flaps greatly increases patient QOL.8 However, the problem of reversal of the implant:crown ratio due to the thickness of the soft tissue and the thinness of the bone remains, 9 and this problem was observed in the case reported herein. Another maxillary cancer patient underwent total maxillectomy and reconstruction using the fibula and flaps. In such cases, an implant-supported obturator prosthesis is difficult to stabilize due to the soft thick flaps. Therefore, the placement of implants into the residual zygomatic bone is sometimes chosen and used to set the screw-retained obturator prosthesis. Based on such experiences, a decision was taken to treat the patient in the present case by inserting five implants, all on the left side. Fortunately, esthetic considerations were not of great importance to this patient, and he was satisfied with the occlusal reconstruction of the dentulous remains. After placement of the dental implant, this patient was very satisfied because he had regained the ability to masticate. However, some problems remained; for example, it was difficult for
the patient to perform self-maintenance of the implant because it is a long-span, one-piece bridge. However, daily self-cleaning is necessary. Therefore, the upper structure of the prosthesis must be changed to a more hygienic one before bone loss occurs. Compared to our routine work, it was extremely rewarding to help this patient return to a normal life. Even in a patient who had undergone a hemimaxillectomy, the restoration of function using dental implants was quite useful.
ACKNOWLEDGEMENT This work was supported by a Grant for Scientific Research from the Amada Foundation, awarded to T. Sumida. Conflict of Interest The authors declare that they have no conflict of interest.
REFERENCES 1. Deng H, Sambrook PJ, Logan RM. The treatment of oral cancer: an overview for dental professionals. Aust Dent J. 2011;56:244–252. 2. Bidra AS, May GW, Tharp GE, Chambers MS. Pterygoid implants for maxillofacial rehabilitation
of
a
patient
with
a
bilateral
maxillectomy
defect.
J
Oral
Implantol. 2013;39:91–97. 3. D'Agostino A, Procacci P, Ferrari F, Trevisiol L, Nocini PF. Zygoma implant-supported prosthetic rehabilitation of a patient after subtotal bilateral maxillectomy. J Craniofac Surg. 2013;24:e159–162. 4. Lin PY, Lin KC, Jeng SF. Oromandibular reconstruction: the history, operative options and strategies, and our experience. ISRN Surg. 2011;2011:824251. 5. Baker SR. Closure of large orbital-maxillary defects with free latissimus dorsi myocutaneous flaps. Head Neck Surg. 1984;6:828–835. 6. Korfage A, Schoen PJ, Raghoebar GM, Bouma J, Burlage FR, Roodenburg JL, Vissink A, Reintsema H. Five-year follow-up of oral functioning and quality of life in patients with oral cancer with implant-retained mandibular overdentures. Head Neck. 2011;33:831–839. 7. Bianchi B, Ferri A, Ferrari S, Copelli C, Boni P, Sesenna E. Iliac crest free flap for maxillary reconstruction. J Oral Maxillofac Surg. 2010;68:2706–2713. 8. Bodard AG, Bémer J, Gourmet R, Lucas R, Coroller J, Salino S, Breton P. Dental implants
and free fibula flap: 23 patients. Rev Stomatol Chir Maxillofac. 2011;112:e1–4. 9. Anne-Gaëlle B, Samuel S, Julie B, Renaud L, Pierre B. Dental implant placement after mandibular reconstruction by microvascular free fibula flap: current knowledge and remaining questions. Oral Oncol. 2011;47:1099–1104.
Figure legends Figure 1: A 67-year-old male patient with carcinoma of the maxilla underwent preoperative radiotherapy and chemotherapy. Intraoral findings at the first visit. Figure 2: A right partial maxillectomy and rectus abdominis myocutaneous flap graft were performed. Figure 3: The panoramic view before implantation. Figure 4: Two years after surgery, five implants were inserted into the remnant maxilla with sinus floor elevation. Figures 5: After the tumor surgery, placement of a denture was not possible. The patient deemed the final prosthesis satisfactory. This figure shows the upper prostheses. Figure 6: Masticatory function improved after implant treatment, and the patient was able to eat a normal diet and chew on the left side. Figures 7: After implant treatment, masticatory performance and maximum bite force both improved drastically. Figure 8: The bite force increased to within the normal range. Figure 9: Masticatory performance as measured by xylitol gum indicated that the patient’s bite force was restored to a satisfactory level after implant treatment.
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*Copyright Form Click here to download Copyright Form: Copyright Transfer.jpg
Rebuttal Letter (for revisions) Click here to download Rebuttal Letter (for revisions): Rebuttal letter .doc
AAID-JOI-D-13-00136R1
Full Title:
Dental implants in oral rehabilitation of a maxillary cancer reconstruction: A case report
Short Title:
Implant restoration in a cancer patient
Article Type:
Clinical Case Letter
Keywords:
Implant-supported prosthesis, maximum bite force, masticatory performance, Maxillectomy, quality of life.
Corresponding Author:
Tomoki Sumida, D.D.S., Ph. D. Kyushu University Fukuoka, Fukuoka JAPAN
Corresponding Author Secondary Information: Corresponding Author's Institution:
Kyushu University
Corresponding Author's Secondary Institution: First Author:
Tomoki Sumida, D.D.S., Ph. D.
First Author Secondary Information: Order of Authors:
Tomoki Sumida, D.D.S., Ph. D. Hiroyuki Nakano, D.D.S., Ph. D. Hiroyuki Hamakawa, D.D.S., Ph. D. Yoshihide Mori, D.D.S., Ph. D.
Order of Authors Secondary Information: Abstract:
A 67-year-old man presented reporting difficulty eating, and intraoral investigation revealed that he had undergone a hemimaxillectomy at another hospital 2 years previously. The resected area was covered with a thick abdominal myocutaneous flap (AMF). Dental implants were placed in the residual left alveolar ridge. After treatment, masticatory performance and maximum bite force both improved dramatically, from a score of 2 to 9, and from 0.03 kN to 1.58 kN, respectively. Dental implants can significantly improve the biting force and masticatory performance in oral cancer patients with jawbone resection, even in cases where half of the alveolar ridge has been resected.
Response to Reviewers:
November 5th 2013 James L. Rutkowski, Editor-in-Chief Journal of Oral Implantology Dear Prof. Rutkowski, We have revised our manuscript in accordance with all of the reviewers’ suggestions, and the major revisions are indicated below. (These line numbers correspond to the text in the reviewed PDF.) Reply to Reviewer #1 Preoperative OPG is now included as Figure 1c, and sinus floor elevation and the prosthetic procedure is now described in the Case Report section in detail. In this case, we performed the sinus lift using chin bone. Reply to Reviewer #2 We have substantially revised the manuscript, and have itemized these revisions
Powered by Editorial Manager® and ProduXion Manager® from Aries Systems Corporation
below (including line numbers where appropriate), for your consideration. 1.We agree that the title was too long, and have revised it as per your suggestion. 2.We agree that “hemimaxillectomy” is a more scientific term, and accordingly we have inserted it consistently in the manuscript. 3.We have revised the sentences in the manuscript from active to passive voice, as per your comment. 4.Lines 8 to 10 have been reworded in accordance with the reviewer’s suggestion. 5.The last sentence has been deleted in accordance with the reviewer’s suggestion. 6.In the Introduction, “perforation” has been changed to “oro-antral communication” in line 23. 7.In line 23, the main issue with oro-antral communication has now changed, and two references have been added. 8.In line 25, the expression was now been changed. 9.In lines 28–30, and 34–36, the text has been corrected in accordance with the reviewer’s advice. 10.In lines 39–43, some text has been changed in accordance with the reviewer’s comments. 11.In line 46, the repetitive sentence has been deleted. 12.Some of the words in lines 46 and 47 have been moved to line 43. 13.In lines 47–57, the surgical and prosthetic procedures are now described, and an additional figure has been added to the manuscript. We think that this will appeal to JOI readers. 14.In lines 60–62, some words have been changed now in the Discussion section. 15.This statement has now been deleted. 16.In lines 64–67, the sentences have been revised. 17.In line 74, the word “our” has been changed to “this”. 18.From lines 75–78, the wording has been changed in accordance with the reviewer’s suggestions. 19.In line 79, the wording has been changed in accordance with the reviewer’s suggestions. 20.In lines 81–84, the wording has been changed in accordance with the reviewer’s suggestions. 21.We completely agree with the reviewer’s comments relating to lines 85–88, and they have been changed accordingly. 22.In line 90, the wording has been changed. 23.In line 91, the last sentence has been deleted.
In terms of figures, a color intra-oral picture has now been provided, and one new figure has been added. Therefore, they have been renumbered. And now figure legends have been included in the manuscript.
I look forward to hearing from you at your earliest convenience. Sincerely, [omitted for blinding purposes]
Powered by Editorial Manager® and ProduXion Manager® from Aries Systems Corporation
Article File
Dental implants in oral rehabilitation of a maxillary cancer reconstruction: A case report
Tomoki Sumida, DDS, PhD1,2*, Hiroyuki Nakano, DDS, PhD1, Hiroyuki Hamakawa, DDS, PhD2, Yoshihide Mori, DDS, PhD1
1
Division of Oral and Maxillofacial Surgery, Department of Maxillofacial Diagnostic and
Surgical Sciences, Kyushu University School of Dentistry, Fukuoka, Japan 2
Department of Oral and Maxillofacial Surgery, Ehime University Graduate School of
Medicine, Ehime, Japan
*Corresponding author, email: [email protected]
ABSTRACT A 67-year-old man presented reporting difficulty eating, and intraoral investigation revealed that he had undergone a hemimaxillectomy at another hospital 2 years previously. The resected area was covered with a thick abdominal myocutaneous flap (AMF). Dental implants were placed in the residual left alveolar ridge. After treatment, masticatory performance and maximum bite force both improved dramatically, from a score of 2 to 9, and from 0.03 kN to 1.58 kN, respectively. Dental implants can significantly improve the biting force and masticatory performance in oral cancer patients with jawbone resection, even in cases where half of the alveolar ridge has been resected.
Keywords: Implant-supported prosthesis, maximum bite force, masticatory performance, Maxillectomy, quality of life. Short title: Implant restoration in a cancer patient
INTRODUCTION The treatment of patients with oral cancer usually involves surgery, radiotherapy, and/or chemotherapy.1 Various complications can develop after oral cancer resection, particularly if a major maxillectomy was performed. Maxillary resection sometimes results in oro-antral communication, which leads to difficulties in speech and swallowing. Pterygoid and zygomatic implants were reported to be useful in these cases.2,3 Dentures can be constructed in edentulous cases involving reconstruction of large defects using thick flaps, however, this is not always effective. Thus, resection of the maxilla often leads to damage that affects not only mastication, but also speech and swallowing; as a result, the patient’s quality of life (QOL) invariably declines.4 This report discusses the application of implant dentistry for the oral rehabilitation of an oral cancer patient who underwent a hemimaxillary resection, reconstruction with a microvascular free abdominal flap (FAF), and radiotherapy. Maxillary reconstruction with a thick FAF is a method used to close the space between the oral cavity and the maxillary sinus.5 However, thick flaps disrupt oral functions, particularly occlusion. If there is enough remaining alveolar bone for implant insertion, implant-retaining treatment may be able to restore occlusion. This case report describes a successful oral reconstruction via the implementation of an implant-supported prosthesis for a large maxillary defect after reconstruction with a FAF.
CASE REPORT A 67-year-old male patient presented at our hospital with the chief complaint of dysfunctional occlusion. He had cancer of the right maxilla and underwent preoperative radiotherapy
and
chemotherapy in
another
hospital.
After
the
radiotherapy,
a
hemimaxillectomy and a FAF graft were performed. There were no serious complications following the surgery. However, treatment with a denture was impossible due to the thick flap and lack of residual teeth, and the patient was thus only able to eat soft foods. The condition of the patient at the first visit, 2 years after surgery, is shown in Figures 1 and 2. The panoramic radiograph before implantation revealed that the sinus floor was low on the left side, corresponding to the upper molar region (Figure 3). The bone height from sinus floor to alveolar ridge was less than 5 mm. Therefore, sinus floor elevation was performed via the lateral window technique, using autologous bone from the mental region. After 6 months, 12–14 mm of bone height was confirmed by panoramic radiograph. A total of 5 MkIII implants (Brånemark System®) were inserted into the left maxilla, each with a diameter of 4.0 mm, and with lengths of 12 mm (1 implant), and 10 mm (4 implants) (Figures 4 and 5). Six months the insertion of the implants a second operation was performed, and good osseointegration of the implants was achieved. The prosthetic procedure was then performed. Due to the angle of the insertion of the implants, a multi-unit system (Brånemark System®) was utilized. After the multi-unit abutments were set, the temporary prostheses
were adjusted to the patient’s satisfaction with regard to occlusion, and the shape of the prostheses. After adjustment of the temporary prostheses, the final hybrid prostheses lined with metal were set with retaining screws. Using standard procedures, the final prosthesis was set in the oral cavity. The final prosthesis was elongated to the canine on the right side, for esthetic reasons (Figure 6). Masticatory function improved after implant treatment, and the patient was able to eat a normal diet and chew on the left side. However, the right anterior teeth were not in contact with the lower teeth (Figure 7). Maximum bite force improved dramatically after the implantation increased to within the normal range, as did masticatory function as measured by xylitol gum (Figures 8 and 9). The patient was able to eat a normal diet, and he was satisfied with the outcome. There were no serious problems for over 5 years. It was, however, very difficult for the patient to clean the area around the abutment; therefore, follow-up was required every 3 months for cleaning. DISCUSSION After a minor maxillectomy, the defect is usually covered by an obturator prosthesis. In such cases, this type of prosthesis is usually sufficient for helping the patient with activities such as eating and speaking, even if the defect resulted in oro-antral communication. If the defect cannot be obturated using a conventional obturator prosthesis, the use of an implant support obturator prosthesis is a very useful treatment approach. Thus, a large
proportion of patients with maxillary cancer use an obturator prosthesis supported by implants. Moreover, obturator prostheses are easy to maintain and are associated with a favorable prognosis with regard to the implants.6 Obturation, local or locoregional flaps, and soft tissue free flaps are good options for maxillary reconstruction; however, the lack of bone reconstruction often leads to difficulties in occlusal reconstruction, because osseous implants cannot be used for dental rehabilitation.7 Implant therapy using reconstructed bone with skin flaps greatly increases patient QOL.8 However, the problem of reversal of the implant:crown ratio due to the thickness of the soft tissue and the thinness of the bone remains, 9 and this problem was observed in the case reported herein. Another maxillary cancer patient underwent total maxillectomy and reconstruction using the fibula and flaps. In such cases, an implant-supported obturator prosthesis is difficult to stabilize due to the soft thick flaps. Therefore, the placement of implants into the residual zygomatic bone is sometimes chosen and used to set the screw-retained obturator prosthesis. Based on such experiences, a decision was taken to treat the patient in the present case by inserting five implants, all on the left side. Fortunately, esthetic considerations were not of great importance to this patient, and he was satisfied with the occlusal reconstruction of the dentulous remains. After placement of the dental implant, this patient was very satisfied because he had regained the ability to masticate. However, some problems remained; for example, it was difficult for
the patient to perform self-maintenance of the implant because it is a long-span, one-piece bridge. However, daily self-cleaning is necessary. Therefore, the upper structure of the prosthesis must be changed to a more hygienic one before bone loss occurs. Compared to our routine work, it was extremely rewarding to help this patient return to a normal life. Even in a patient who had undergone a hemimaxillectomy, the restoration of function using dental implants was quite useful.
ACKNOWLEDGEMENT This work was supported by a Grant for Scientific Research from the Amada Foundation, awarded to T. Sumida. Conflict of Interest The authors declare that they have no conflict of interest.
REFERENCES 1. Deng H, Sambrook PJ, Logan RM. The treatment of oral cancer: an overview for dental professionals. Aust Dent J. 2011;56:244–252. 2. Bidra AS, May GW, Tharp GE, Chambers MS. Pterygoid implants for maxillofacial rehabilitation
of
a
patient
with
a
bilateral
maxillectomy
defect.
J
Oral
Implantol. 2013;39:91–97. 3. D'Agostino A, Procacci P, Ferrari F, Trevisiol L, Nocini PF. Zygoma implant-supported prosthetic rehabilitation of a patient after subtotal bilateral maxillectomy. J Craniofac Surg. 2013;24:e159–162. 4. Lin PY, Lin KC, Jeng SF. Oromandibular reconstruction: the history, operative options and strategies, and our experience. ISRN Surg. 2011;2011:824251. 5. Baker SR. Closure of large orbital-maxillary defects with free latissimus dorsi myocutaneous flaps. Head Neck Surg. 1984;6:828–835. 6. Korfage A, Schoen PJ, Raghoebar GM, Bouma J, Burlage FR, Roodenburg JL, Vissink A, Reintsema H. Five-year follow-up of oral functioning and quality of life in patients with oral cancer with implant-retained mandibular overdentures. Head Neck. 2011;33:831–839. 7. Bianchi B, Ferri A, Ferrari S, Copelli C, Boni P, Sesenna E. Iliac crest free flap for maxillary reconstruction. J Oral Maxillofac Surg. 2010;68:2706–2713. 8. Bodard AG, Bémer J, Gourmet R, Lucas R, Coroller J, Salino S, Breton P. Dental implants
and free fibula flap: 23 patients. Rev Stomatol Chir Maxillofac. 2011;112:e1–4. 9. Anne-Gaëlle B, Samuel S, Julie B, Renaud L, Pierre B. Dental implant placement after mandibular reconstruction by microvascular free fibula flap: current knowledge and remaining questions. Oral Oncol. 2011;47:1099–1104.
Figure legends Figure 1: A 67-year-old male patient with carcinoma of the maxilla underwent preoperative radiotherapy and chemotherapy. Intraoral findings at the first visit. Figure 2: A right partial maxillectomy and rectus abdominis myocutaneous flap graft were performed. Figure 3: The panoramic view before implantation. Figure 4: Two years after surgery, five implants were inserted into the remnant maxilla with sinus floor elevation. Figures 5: After the tumor surgery, placement of a denture was not possible. The patient deemed the final prosthesis satisfactory. This figure shows the upper prostheses. Figure 6: Masticatory function improved after implant treatment, and the patient was able to eat a normal diet and chew on the left side. Figures 7: After implant treatment, masticatory performance and maximum bite force both improved drastically. Figure 8: The bite force increased to within the normal range. Figure 9: Masticatory performance as measured by xylitol gum indicated that the patient’s bite force was restored to a satisfactory level after implant treatment.
Figure Click here to download high resolution image
Figure Click here to download high resolution image
Figure Click here to download high resolution image
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*Copyright Form Click here to download Copyright Form: Copyright Transfer.jpg
Rebuttal Letter (for revisions) Click here to download Rebuttal Letter (for revisions): Rebuttal letter .doc
