ABSTRACT: The aim of this study is to analyze implant survival in patients who received radiotherapy treatment for oral malignancies and in patients who had suffered mandibular osteoradionecrosis.
We reviewed retrospectively 225 implants placed in 30 patients who had received radiotherapy as part of the oncologic treatment. Radiation doses ranged between 50 and 70 Gy. 39 implants were placed after a combined treatment of radiotherapy and chemotherapy. Data referred to tumour type and reconstruction, presence of osteoradionecrosis, region of implant installation and type of prostheses were recorded. Survival rates were calculated with cumulative Kaplan-Meier survival curves and compared between different groups with a log-rank test.
152 osseointegrated implants were placed in patients who presented previous reconstruction procedure. Five patients developed osteorradionecrosis as a complication of the radiotherapy treatment. Once osteoradionecrosis had healed in these patients, 41 implants were installed. The overall 5 year survival rate in irradiated patients was 92.6%. Irradiated patients had a marginally significantly higher implant loss than non-irradiated patients. (p = 0.063). The 5 year survival rate in the osteoradionecrosis group was of 48.3% and in the non-osteoradionecrosis group 92.3%, with a statistically significant difference between both groups. (p = 0.002).
Osseointegrated implants enhance oral rehabilitation in most irradiated patients, even being an acceptable option for patients who had suffered osteoradionecrosis. Totally implant supported prostheses are recommended after irradiation providing functional, stable and aesthetically satisfactory rehabilitation.
Journal of oral and maxillofacial surgery: official journal of the American Association of Oral and Maxillofacial Surgeons 07/2011; 70(5):1052-63. · 1.58 Impact Factor
Journal of oral and maxillofacial surgery: official journal of the American Association of Oral and Maxillofacial Surgeons 07/2011; 69(11):e482-7. · 1.58 Impact Factor
ABSTRACT: The aim of the present study was to assess the duration of each treatment phase that a patient with dentofacial disorders and eligible for orthodontic surgery undergoes and to identify those factors that determine the time. We have also included a description of the demographic and skeletal characteristics of the patients treated at our center, the surgery type, and movements performed.
A sample of 148 patients undergoing orthognathic surgery from 2004 to 2007 at Princesa University Hospital, Madrid, was studied. The demographic data of each patient, their facial pattern, skeletal disorders, and surgical movements performed were recorded, as was the duration of orthodontic treatment, both pre- and postoperatively, length of surgery, and length of hospital stay.
The length of preoperative orthodontic treatment was 24 months and that of postoperative treatment was 12 months. The average operative time was 4 hours for those interventions in which both dental arches were involved, and the average length of hospital stay was 3 days. No relevant differences were found for the length of orthodontic treatment according to gender, age, or type of skeletal disorder. Differences were observed in the length of hospital stay between those patients who underwent segmentation of the maxilla and those who did not.
The length of the different phases into which an orthodontic surgical treatment is divided can differ within some given limits. However, it does not depend on either the patients' demographic skeletal characteristics or the surgical movements performed.
Journal of oral and maxillofacial surgery: official journal of the American Association of Oral and Maxillofacial Surgeons 01/2010; 68(1):88-92. · 1.58 Impact Factor
ABSTRACT: Arthroscopic surgery has been shown to be an effective treatment for patients with temporomandibular disorders, relieving patients' symptoms and restoring adequate mandibular function. For those patients with poor arthroscopic outcomes, various treatment modalities are possible, such as nonsurgical therapy, open surgery, or repeat arthroscopic surgery. The purpose of this study was to evaluate our results with rearthroscopy in patients with temporomandibular joint dysfunction.
The clinical data and operative reports for 50 patients who underwent a second arthroscopic procedure from 1994 to 2004 were reviewed retrospectively. Outcome assessments were based on reductions in pain, measured using a visual analog scale, and improvements in maximal interincisal opening. The minimum follow-up period was 2 years.
Significant differences were evident between presurgical and postsurgical pain at months 1, 6, 12, and 24. The mean score of preoperative pain on the visual analogue scale was 61.65 mm, which was reduced to 36.28 mm at 2-year follow-up. With regard to mandibular function, all patients presented with restricted mouth opening, with a mean preoperative maximal interincisal opening of 26.73 mm. Postoperatively, the maximal interincisal opening showed a statistically significant improvement (P < .05), and at 2-year follow-up, we obtained a total improvement of 7 mm. Only 8 patients (16%), who had an unsuccessful result after a second arthroscopy, underwent further surgical intervention (open surgery).
Arthroscopic surgery is a reliable and effective procedure for temporomandibular joint dysfunction that improves pain and mouth opening, with the advantages of being minimally invasive and repeatable. Repeat arthroscopic surgery, with a proven history of fewer complications, can be attempted before open arthrotomy.
Journal of oral and maxillofacial surgery: official journal of the American Association of Oral and Maxillofacial Surgeons 10/2008; 66(10):2086-92. · 1.58 Impact Factor