Amsterdam UMC and Academic Centre for Dentistry Amsterdam (ACTA), Vrije Universiteit Amsterdam, Department of Oral and Maxillofacial Surgery / Oral Pathology, Cancer Center Amsterdam, De Boelelaan 1117, 1081 HV Amsterdam, the Netherlands.
Amsterdam UMC and Academic Centre for Dentistry Amsterdam (ACTA), Vrije Universiteit Amsterdam, Department of Oral and Maxillofacial Surgery / Oral Pathology, Cancer Center Amsterdam, De Boelelaan 1117, 1081 HV Amsterdam, the Netherlands.
J Craniomaxillofac Surg. 2021 Sep;49(9):845-854. doi: 10.1016/j.jcms.2021.03.002. Epub 2021 Apr 30.
The study aimed at evaluating, comprehensively, implant-based dental rehabilitation in head and neck cancer patients after maxillofacial reconstruction with a vascularized free fibula flap (FFF). Data were obtained by retrospectively reviewing the medical records of patients treated in Amsterdam UMC-VU Medical Center. Dental implant survival and implant success according to the Albrektsson criteria were analyzed. Additionally, prosthetic-related outcomes were studied, with a focus on functional dental rehabilitation. In total, 161 implants were placed in FFFs, with a mean follow-up of 4.9 years (range 0.2-23.4). Implant survival was 55.3% in irradiated FFFs and 96% in non-irradiated FFFs. Significant predictors for implant failure were tobacco use and irradiation of the FFF. Implant success was 40.4% in irradiated FFFs and 61.4% in non-irradiated FFFs, mainly due to implant failure and non-functional implants. Implant-based dental rehabilitation was started 45 times in 42 patients, out of 161 FFF reconstructions (27.9%). Thirty-seven patients completed the dental rehabilitation, 29 of whom achieved functional rehabilitation. Irradiation of the FFF negatively influenced attainment of functional rehabilitation. For patients with functional rehabilitation, the body mass index varied at different timepoints: FFF reconstruction, 24.6; dental implantation 23.5; and after placing dental prosthesis, 23.9. Functional implant-based dental rehabilitation, if started, can be achieved in the majority of head and neck cancer patients after FFF reconstruction. Actively smoking patients with an irradiated FFF should be clearly informed about the increased risk for implant and prosthetic treatment failure.
本研究旨在全面评估头颈部癌症患者接受游离腓骨血管化重建术后，基于种植体的口腔修复效果。研究数据来源于阿姆斯特丹 UMC-VU 医学中心患者的病历回顾。采用 Albrektsson 标准分析了种植体的存活率和成功率。此外，研究还关注了与修复体相关的结果，重点是功能性口腔修复。研究共在游离腓骨血管化重建术后的患者中植入了 161 枚种植体，平均随访时间为 4.9 年（0.2-23.4 年）。在接受放疗的游离腓骨血管化重建术后患者中，种植体的存活率为 55.3%，在未接受放疗的患者中为 96%。吸烟和游离腓骨血管化重建术后放疗是种植体失败的显著预测因素。在接受放疗的游离腓骨血管化重建术后患者中，种植体成功率为 40.4%，在未接受放疗的患者中为 61.4%，主要是由于种植体失败和非功能性种植体。在 161 例游离腓骨血管化重建术后患者中，有 42 例患者共 45 次开始了基于种植体的口腔修复。37 例患者完成了口腔修复，其中 29 例实现了功能性修复。游离腓骨血管化重建术后放疗对实现功能性修复有负面影响。对于实现了功能性修复的患者，体重指数在不同时间点有所不同：游离腓骨血管化重建术时为 24.6；植入种植体时为 23.5；放置牙修复体后为 23.9。如果开始进行功能性基于种植体的口腔修复，大多数头颈部癌症患者在游离腓骨血管化重建术后都可以实现。应明确告知接受放疗的游离腓骨血管化重建术后患者，吸烟会增加种植体和修复体治疗失败的风险。
