Immediately Loaded Zygomatic Implant Retained Maxillary Obturator used in the Management of a Patient following Total Maxillectomy

Abstract

Aim:This study aimed to report on the use of specialized zygomatic oncology osseointegrated implants to assist in the management of a patient struggling to cope with a large maxillary obturator prosthesis following a low-level total maxillectomy. Background: Maxillary obturator prostheses are commonly used in the rehabilitation of patients following maxillary resection. Whilst these prostheses can be retained adequately with remaining maxillary teeth and/or implants, as the horizontal component of the resection increases, the retention, and support of the obturator are increasingly difficult to manage. Case description:A 72-year-old female patient was referred with problems tolerating a large removable maxillary obturator prosthesis, following total maxillectomy three years previously. Despite successful disease control without the need for adjuvant therapy, the patient functioned poorly with the obturator prosthesis which was poorly retained and supported by the large defect. In addition, the movement of the obturator resulted in soreness and ulceration, and she relied on the heavy use of denture fixative to assist in the wearing of the obturator prosthesis. Following a radiographic investigation, four zygomatic oncology osseointegrated implants were placed into the residual zygomatic bodies and within a week were used to provide much-improved support and retention for the large obturator prosthesis, resulting in successful amelioration of the patient's pre-existing difficulties. Conclusion:The use of specialized remotely-anchored osseointegrated zygomatic implants can provide a means of effective support and retention for large prosthetic obturators even where the horizontal component of the maxillary resection is large. The density of the zygomatic bone provides excellent initial stability for these implants which can be used immediately to support Clinical significance: The use of zygomatic oncology implants provides an improved means of retaining and supporting maxillary obturator prostheses where these are required following partial or total maxillary resection.

A Case Report Depicting an Implant-Supported Prosthetic Rehabilitation of an immunocompromised Patient with a Bilateral Subtotal Maxillectomy Defect Secondary to Mucormycosis

“…(5) In edentulous maxillectomy patients,where the horizontal component of resection increases the residual alveolar ridge provides very little retention for the prosthesis, and the defect has to be engaged with the bung of the prosthesis to gain retention. Many patients find this uncomfortable, and as a result, the amount of undercut engaged is often limited, and this reduces the overall retention and tolerance of the prostheses (6) The loss of soft and hard tissue often makes an implant-supported prosthesis necessary to support the oral musculature and restore function. (7) Though conventional dental implants represent a valuable option for retention of a prosthesis only when the basal alveolar bone crest is still present, their use is impossible in the case of subtotal bilateral maxillectomy due to the absence of both bone and oral mucosa.…”

Mastication in maxillectomy patients: A comparison between reconstructed maxillae and implant supported obturators: A cross‐sectional study

“…Researchers have presented valid arguments in choosing the best reconstruction and rehabilitation method for maxillectomy patients, based on parameters such as quality of life (QoL) and functional outcomes 4‐7 . Implant‐supported obturation represents an alternative for surgical reconstruction of defects where the orbital floor is intact and no substantial loss of soft tissues exists 3,8,9 . The advantages of implant‐supported obturation include a shorter treatment period, no need for extensive reconstructive surgery with donor and recipient site morbidity, reduced post‐treatment morbidity, and lower costs 8 .…”

The impact of the masticatory system on functional rehabilitation and quality of life in patients with head and neck cancer

“…In patients with remaining natural teeth, removal of teeth with limited prognosis identified as potential cause of oral cavity infection before head and neck RT is associated with a lower risk of developing ORN than tooth extractions after or during RT [55]. In the Netherlands, oral health recommendations prior to RT are based on a 1992 protocol, which was revised in 2018 [42,43,56].…”

“…The obturator also continues to play a useful role for patients who cannot undergo complex autogenous reconstruction or in whom access to the surgical site is considered important for monitoring [35,[49][50][51]. However, inadequate retention makes this prosthetic rehabilitation of the maxilla challenging [50] where, as in the mandible, implant retention, especially in edentulous patients, has also proven useful [39,[52][53][54][55][56].…”