The use of dental implants, cast bars and sleeve overdentures in oral cancer patients

Key Points

  • Discusses how difficult it can be to rehabilitate oral cancer patients.

  • Shows that most oral cancer patients may need referral to specialist rehabilitation.

  • Presents a novel way of rehabilitating oral cancer patients with a prosthesis which has the benefits of both a fixed and removable prosthesis.

  • Describes the complication rate associated with this prosthesis.

Abstract

Surgical resection of an oral tumour (and the associated free flap reconstruction) can significantly alter the oral anatomy. The lack of sulcus depth, alveolar ridge, presence of a mobile flap and limited tongue movement can make it impossible for patients to control a removable prosthesis. To help this cohort of patients, dental implants can be invaluable. The Oral Rehabilitation Team at Central Manchester University Dental Hospital have used dental implants to rehabilitate oral cancer patients for over thirty years. After their resective surgery, a number of patients were dentally rehabilitated with a laboratory-made, precious metal-alloy bar supported by at least four dental implants. A metal-alloy under-sleeve retained overdenture was then provided to fit over the milled bar. The majority of the 50 patients in this case series had tumours in the anterior floor of the mouth. It was noted that 76% of the patients received a rim resection and were reconstructed with a fasciocutaneous, soft tissue free flap. Six percent of patients received a segmental resection and were reconstructed with either a fibular or deep circumflex iliac artery free flap. The dental implants and sleeve overdentures had a survival rate of 100%. None of the dentures lost retention, implying that the frictional grip between the overcasting and the milled bar was sufficient to appease the retention demands of this cohort. However, 10% of patients encountered complications. This would suggest a success (or complication free) rate of 90% for this cohort of 50 oncology patients. This would still imply that milled bars/sleeve overdentures carry a relatively low maintenance burden and may be a useful treatment option for oral cancer patients.

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Figure 1
Figure 2: (a) An edentulous oral cancer patient who received a mandibular rim resection and reconstruction with a radial forearm free flap.
Figure 3: (a) An oral cancer patient previously rehabilitated with a milled bar and sleeve overdenture in the mandible.
Figure 4: (a) An oral cancer patient rehabilitated with implants supporting a CAD designed, non-precious metal, milled bar.
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Ali, R., Al-Khayatt, A. & Barclay, C. The use of dental implants, cast bars and sleeve overdentures in oral cancer patients. Br Dent J 224, 605–613 (2018). https://doi.org/10.1038/sj.bdj.2018.309

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