• 11/26/2007
  • web-based article
  • K Nelson, S Heberer, and C Glatzer
  • J Prosthet Dent, November 1, 2007; 98(5): 405-10

Statement of Problem:
Dental implants have been increasingly used for prosthodontic rehabilitation of patients following oral tumor resection and postsurgical radiotherapy. However, only a few long-term studies have examined the implant survival rate and other factors related to prosthodontic treatment in oral tumor resection patients.

The purpose of this study was to evaluate the long-term survival of dental implants and implant-retained prostheses in oral cancer resection patients.

Material and Methods:
Ninety-three patients (63 men, 30 women) with a mean age of 59 years (range of 26-89 years) received 435 implants after the resection of a head and neck tumor. Twenty-nine patients received postsurgical radiotherapy prior to implant placement. The factors related to implant survival or failure were monitored over a mean observation period of 10.3 years (range of 5 to 161 months). Prosthodontic rehabilitation was evaluated with respect to the rates of technical failures and complications. Data were analyzed using a Kaplan-Meier curve and comparisons were made with the log-rank test or the Wilcoxon test (a=.05).

Of the 435 implants, 43 implants were lost; the cumulative survival rate was 92%, 84%, and 69% after 3.5, 8.5, and 13 years, respectively. Twenty-eight implants in 6 patients were counted as lost since the patients had died. Twenty-nine irradiated patients received 124 implants, of which 6 implants were lost prior to prosthodontic rehabilitation. In 68 patients with 78 rigid bar-retained dentures, only minor technical complications were identified. However, all 25 fixed implant-supported restorations had no technical component failures and did not require technical maintenance.

This study demonstrates that implant-retained and -supported prostheses in oral cancer resection patients, irrespective of the cancer treatment procedure, show lower long-term survival rates than those in patients without prior cancer surgery. Rigid fixation of the implant-supported prosthesis appears to minimize the complication rates. The poor implant survival rate was due to the higher mortality rate among these patients, and not to a lack of osseointegration.

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