Extraoral implants in the rehabilitation of craniofacial defects: implant and prosthesis survival rates and peri-implant soft tissue evaluation.
OBJECTIVE
Few reports have evaluated cumulative survival rates of extraoral rehabilitation and peri-implant soft tissue reaction at long-term follow-up. The objective of this study was to evaluate implant and prosthesis survival rates and the soft tissue reactions around the extraoral implants used to support craniofacial prostheses.


METHODS
A retrospective study was performed of patients who received implants for craniofacial rehabilitation from 2003 to 2010. Two outcome variables were considered: implant and prosthetic success. The following predictor variables were recorded: gender, age, implant placement location, number and size of implants, irradiation status in the treated field, date of prosthesis delivery, soft tissue response, and date of last follow-up. A statistical model was used to estimate survival rates and associated confidence intervals. We randomly selected 1 implant per patient for analysis. Data were analyzed using the Kaplan-Meier method and log-rank test to compare survival curves.


RESULTS
A total of 150 titanium implants were placed in 56 patients. The 2-year overall implant survival rates were 94.1% for auricular implants, 90.9% for nasal implants, 100% for orbital implants, and 100% for complex midfacial implants (P = .585). The implant survival rates were 100% for implants placed in irradiated patients and 94.4% for those placed in nonirradiated patients (P = .324). The 2-year overall prosthesis survival rates were 100% for auricular implants, 90.0% for nasal implants, 92.3% for orbital implants, and 100% for complex midfacial implants (P = .363). The evaluation of the peri-implant soft tissue response showed that 15 patients (26.7%) had a grade 0 soft tissue reaction, 30 (53.5%) had grade 1, 6 (10.7%) had grade 2, and 5 (8.9%) had grade 3.


CONCLUSIONS
From this study, it was concluded that craniofacial rehabilitation with extraoral implants is a safe, reliable, and predictable method to restore the patient's normal appearance.
Chairman of Department of Stomatology, Hospital Santa Catarina, São Paulo, Brazil. mmcuri@terra.com.br
Marcos Martins
MM
Curi
Marcelo Ferraz
MF
Oliveira
Giuliano
G
Molina
Camila Lopes
CL
Cardoso
Loretta De Groot
Lde G
Oliveira
Per-Ingvar
PI
Branemark
Karina de Cássia Braga
Kde C
Ribeiro
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002648:Child; D016371:Cranial Irradiation; D004431:Ear, External; D005147:Facial Bones / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008416:Mastoid / Q000601:surgery; D008875:Middle Aged; D009296:Nasal Cavity / Q000601:surgery; D009666:Nose; D020273:Orbital Implants; D010027:Osteotomy / Q000379:methods; D019736:Prostheses and Implants; D011474:Prosthesis Design; D019919:Prosthesis Implantation / Q000379:methods; D060489:Prosthesis Retention; D012189:Retrospective Studies; D012867:Skin / Q000473:pathology; D012886:Skull / Q000601:surgery*; D016019:Survival Analysis; D013701:Temporal Bone / Q000601:surgery; D016896:Treatment Outcome; D055815:Young Adult