Masticatory and swallowing threshold performances with conventional and implant-supported prostheses after mandibular fibula free-flap reconstruction.
BACKGROUND
Significant strides in microvascular surgical techniques allow predictable restoration of bony and soft tissue orofacial defects. In combination with prosthetic rehabilitation, varying degrees of improvement in esthetics, speech intelligibility, and swallowing have been noted; however, the relative impact of conventional and implant-supported prostheses on restoration of masticatory function are not known.


OBJECTIVE
The purpose of this study was to determine whether conventional or implant-supported dental prostheses and current surgical reconstructive procedures restore patients' masticatory function to presurgical levels.


METHODS
Of the 46 subjects enrolled in this study, 23 (7 edentulous and 16 partially dentate) completed conventional prosthesis (CP) treatment and masticatory evaluation, and of these, 15 (3 edentulous and 12 partially dentate) completed treatment and evaluation with an implant-supported prosthesis (IP). Standardized masticatory performance tests with peanuts and carrots as the test food were made on the defect and nondefect sides. Tests of swallowing threshold performance were made with carrots as the test food. Statistical analysis included repeated-measures analysis of variance (ANOVA) with post hoc Tukey HSD tests (alpha=.05).


RESULTS
Masticatory function at entry was markedly compromised. Further performance declines were noted following surgery (PS) on both the defect and nondefect sides. Restoration with CP and IP produced improvements (significant for defect side only, P<.05) in performance over the PS interval and were not significantly different from performances at entry prior to surgery. In addition, the performance on the defect side with the IP was significantly greater than the performance with the CP (P<.001).


CONCLUSIONS
Impairment in masticatory ability remains following free-flap reconstruction prior to prosthetic rehabilitation. Both CP and IP may provide improved masticatory ability, permitting patients to regain the functional level they possessed prior to surgical intervention. The IP may contribute to greater support and stability of the prosthesis, resulting in increased use for mastication and superior performance on the defect side compared to the CP.
Roumanas
Eleni D
ED
Division of Advanced Prosthodontics, Biomaterials and Hospital Dentistry, The Jane and Jerry Weintraub Center for Reconstructive Biotechnology, UCLA School of Dentistry, Los Angeles, CA, USA. eroumana@ucla.edu
Garrett
Neal
N
Blackwell
Keith E
KE
Freymiller
Earl
E
Abemayor
Elliot
E
Wong
Weng Kee
WK
Beumer
John
J
Fueki
Kenji
K
Fueki
Warawan
W
Kapur
Krishan K
KK
D016025:Bone Transplantation; D003679:Deglutition; D019094:Dental Prosthesis, Implant-Supported; D003817:Dentition; D003826:Denture, Complete, Lower; D003828:Denture, Overlay; D003832:Denture, Partial, Removable; D003778:Dentures; D005260:Female; D006801:Humans; D008297:Male; D008334:Mandible / Q000601:surgery*; D008409:Mastication; D009062:Mouth Neoplasms / Q000534:rehabilitation* / Q000601:surgery; D019647:Oral Surgical Procedures; D019651:Plastic Surgery Procedures; D012044:Regression Analysis; D013524:Surgical Flaps