Efficacy of conventional and implant-supported mandibular resection prostheses: study overview and treatment outcomes.
BACKGROUND
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.


OBJECTIVE
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.


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.
Garrett
Neal
N
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
Roumanas
Eleni D
ED
Blackwell
Keith E
KE
Freymiller
Earl
E
Abemayor
Elliot
E
Wong
Weng Kee
WK
Gerratt
Bruce
B
Berke
Gerald
G
Beumer
John
J
Kapur
Krishan K
KK
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003758:Dental Implantation, Endosseous; D019094:Dental Prosthesis, Implant-Supported; D019232:Dental Restoration Failure; D003826:Denture, Complete, Lower; D003832:Denture, Partial, Removable; D006801:Humans; D008334:Mandible / Q000601:surgery*; D008409:Mastication; D008875:Middle Aged; D009062:Mouth Neoplasms / Q000532:radiotherapy / Q000534:rehabilitation* / Q000601:surgery; D019647:Oral Surgical Procedures; D011446:Prospective Studies; D011788:Quality of Life; D019651:Plastic Surgery Procedures; D013524:Surgical Flaps; D011795:Surveys and Questionnaires; D016896:Treatment Outcome