Osteoradionecrosis of a Mandible: A Case Report of Implant-Supported Rehabilitation

Abstract

The head and neck are the sixth most common sites of cancer in the world; the survival rate at 5 years from diagnosis is 60%. Surviving patients, after the critical phase of the disease, require proper rehabilitation. The treatment of oral neoplasia, such as surgery and radiotherapy, may often determine significant disability, such as impaired speech, swallowing, mastication and facial deformity, with severe consequences on the quality of life of these patients. Dental implant-based prosthodontic rehabilitation is a consolidated technique for improving the quality of life in patients who have overcome oral cancer. Implants provide stability and support for removable prostheses in oral cavities seriously deformed by surgical treatment. Moreover, mobile prostheses have the advantage of being removable, to check the health of oral tissues and intercept possible relapses of the neoplasia. On the other hand, a lack of residual bone following resection makes it difficult to place implants in an ideal position, and patients who have been submitted to radiotherapy of the head and neck are reported to have a reduced success rate. This paper presents the case of a 67-year-old woman rehabilitated with dental implant-based prosthesis after a hemimandibulectomy due to osteoradionecrosis, without bone reconstruction.

A New Medical Record Proposal to the Prognostic Risk Assessment for MRONJ in Oncologic Patients: “Sapienza Head and Neck Unit” Proposal

“…Patients should be kept under close observation, so during the dental examination it is extremely important to motivate the patient regarding dental care; the importance of fluoride applications and rinses with chlorhexidine (0.12% daily) must be clearly specified [ 34 ]. If despite all the attention, a surgical intervention becomes necessary (for example, a tooth extraction), the goal is to be the most conservative possible so as to minimize the trauma [ 32 , 33 , 34 , 35 ]. Bone manipulating should be minimal, burs should be avoided, as well as anesthetics with vasoconstrictors (which would decrease the blood supply), the local hemostasis must be accurate, the antibiotic coverage must be carried out with broad-spectrum antibiotics to be administered before and after surgical treatment for at least fifteen days.…”

A Retrospective Analysis of Treatment Outcomes Following Guided Bone Regeneration at Sites Exhibiting Severe Alveolar Ridge Atrophy

“…Several causes lead patients to have bone loss, such as the progressive bone resorption that occurs after tooth loss, periodontal diseases, oncological or traumatic problems, and surgical resections. 22,23 The purpose of this study was to clinically and histologically evaluate horizontal and vertical bone gain, as well as implant survival/success rate after the reconstruction of alveolar bone defects with the GBR technique. All patients were partial edentulous in one or two jaws with severe (bone height 6 mm) monolateral or bilateral atrophy.…”

“…The implant-prosthetic rehabilitation of patients with severe bone atrophy has become a common practice nowadays. Several causes lead patients to have bone loss, such as the progressive bone resorption that occurs after tooth loss, periodontal diseases, oncological or traumatic problems, and surgical resections 22,23 …”

Clinical evaluation with 18 months follow-up of new PTTM enhanced dental implants in maxillo-facial post-oncological patients

“…Ablative surgery is followed by a reconstructive phase after which the patient may need to undergo radiotherapy, a condition that may compromise the success of oral rehabilitation (1)(2)(3). Radiotherapy side effects may include mucositis, xerostomia, damage of the salivary glands and osteoradionecrosis, which could lead the surgeons to proceed to a partial jaw resection (4)(5)(6). Chemotherapy side effects are similar to those of radiotherapy and, usually, is possible to perform dental surgery safely before and after chemotherapy if the patient is not further compromised by also undergoing bisphosphonate drug therapy (7,8).…”

“…Chemotherapy side effects are similar to those of radiotherapy and, usually, is possible to perform dental surgery safely before and after chemotherapy if the patient is not further compromised by also undergoing bisphosphonate drug therapy (7,8). The options for a prosthetic rehabilitation are either the tooth-supported prosthesis or implant-supported overdenture (4,5). However, deformation to the oral structures, by surgical treatments, may prevent a proper osseointegration and result in failure and also conventional tissue-supported restorations may lead to soft tissue management problems (6,(9)(10)(11)(12)(13).…”