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Introduction
Professor Butterworth is a Consultant Maxillofacial Prosthodontist,
Regional Head & Neck Cancer Centre,
University Hospital Aintree, Merseyside, United Kingdom.
Honorary Professor in Maxillofacial Prosthodontics
Dept Molecular and Clinical Cancer Medicine
University of Liverpool.
Areas of interest;
Zygomatic implants in oral and facial rehabilitation.
Peri implant soft tissue modification following free flap reconstruction.
Quality of life of oral cancer patients
Computerised surgical planning
Current institution
Additional affiliations
April 1998 - November 2003
April 2011 - April 2012
November 2003 - present
Publications
Publications (71)
This aim of this report is to describe the development and evolution of a new surgical
technique for the immediate surgical reconstruction and rapid post-operative prosthodontic
rehabilitation with a fixed dental prosthesis following low – level maxillectomy for malignant
disease.
The technique involves the use of a zygomatic oncology implant p...
Objectives:
This literature review reports the current evidence for the use of zygomatic implants in head and neck oncology patients for the prosthetic rehabilitation of defects of the mid-face and maxilla.
Methods:
MEDLINE, Embase and Cochrane databases were searched using strict search terms. Two independent reviewers reviewed the articles and...
This unpublished data examines over 10 years of experience using zygomatic implants in head and neck oncology patients both at the time of primary oncological resective surgery and at secondary timepoints.
Background
The zygomatic implant perforated (ZIP) flap technique provides immediate reconstruction and rapid dental rehabilitation for low-level malignant tumors.
Methods
Patients who underwent ZIP flap reconstruction between December 2015 and February 2021 were followed prospectively.
Results
Thirty-five consecutively treated patients were studi...
Introduction Head and neck cancer (HANC) significantly impacts the oral cavity and dental health issues may complicate cancer treatment and post-treatment quality of life. Pre-treatment dental evaluation is critical for identifying and managing existing oral health problems. However, limited literature exists on the dental health status of patients...
Ablative defects of the maxilla caused by malignant tumours create a multitude of difficulties for patients and the clinical teams looking after them. Tumours of the maxilla, while relatively uncommon, require significant multi-disciplinary involvement due to their effects on the aesthetic, functional and psychological aspects of the patients invol...
Background
Zygomatic implant (ZI) surgery and restoration is a complex procedure, requiring experienced clinicians to execute with success. This study assessed the opinion and clinical experiences of a cohort of practitioners involved in provision of zygomatic implant treatment on aspects of the surgical and prosthodontic procedures.MethodA survey...
Purpose
The maxillectomy defect is complex and the best means to achieve optimal reconstruction, and dental rehabilitation is a source of debate. The refinements in zygomatic implant techniques have altered the means and speed by which rehabilitation can be achieved and has also influenced the choice regarding ideal flap reconstruction. The aim of...
Purpose
Osteoradionecrosis (ORN) of the mandible is a serious complication of head and neck radiotherapy. This study aims to investigate the effect of hyperbaric oxygen (HBO) treatment on ORN in two randomized, controlled multicentre trials.
Methods and materials
Patients with ORN with indication for surgical treatment were randomised to either gr...
Cleft Lip and/or Palate (CLP) is the most common cranio-facial abnormality thought to be caused by a combination of genetic and environmental factors causing challenges with feeding, dental development and speech. Cleft affected individuals often present a unique set of challenges with regards to their oro-facial and dental development and require...
Zygomatic implants are an established treatment option in the management of the atrophic maxilla and in oncology rehabilitation, but evidence for their use in patients with a history of cleft palate is sparse. Zygomatic implants were used to retain a maxillary prosthesis in 7 edentulous patients with an unrepaired or repaired cleft lip and palate....
Zygomatic and modified zygomatic implants emerge as a key adjunct in the management of patients presenting with maxillary and mid-facial benign and malignant diseases requiring radical resection to effect cure. Their popularity has gained momentum, especially over the past 10 years and the evidence for their successful use continues to evolve and b...
Purpose
Hyperbaric oxygen (HBO) has been advocated in the prevention and treatment of osteoradionecrosis (ORN) of the jaw after head and neck radiation therapy, but supporting evidence is weak. The aim of this randomized trial was to establish the benefit of HBO in the prevention of ORN after high-risk surgical procedures to the irradiated mandible...
Background
Zygomatic implants can provide excellent remote anchorage to support the prosthetic rehabilitation of patients treated for maxillary and midfacial tumors.
Methods
Patients who underwent zygomatic implant placement by the author between 2006 and 2016 as part of their oncology treatment were followed prospectively.
Results
Forty‐nine con...
This case report describes the multidisciplinary clinical management of a male patient, diagnosed at the age of 7, with Regional Odontodysplasia of the right maxilla. Following fixed orthodontic treatment to align his teeth, extraction of malformed teeth and subsequent bone grafting, the patient was successfully rehabilitated with implant-supported...
Head and neck oncology patients are high risk for ingestion or aspiration of dental instruments during treatment, due to altered anatomy and sensation. This article describes a case report of accidental ingestion of an implant screwdriver during the prosthetic phase of oral rehabilitation of a 79 year old oncology patient. The management protocol i...
Background:
Osteoradionecrosis of the mandible is the most common serious complication of radiotherapy for head and neck malignancy. For decades, hyperbaric oxygen has been employed in efforts to prevent those cases of osteoradionecrosis that are precipitated by dental extractions or implant placement. The evidence for using hyperbaric oxygen rema...
This report details the use of zygomatic oncology osseointegrated implants to support and retain a maxillary obturator in a 13-year-old male patient who underwent a right-sided hemi-maxillectomy (Brown Class 2b) (Brown and Shaw, Lancet Oncol 11:1001–8, 2010) for a myxoid spindle cell carcinoma. At the time of maxillary resection, two zygomatic onco...
Introduction
Mandibular osteoradionecrosis (ORN) is a common and serious complication of head and neck radiotherapy for which there is little reliable evidence for prevention or treatment. The diagnosis and classification of ORN have been inconsistently and imprecisely defined, even in clinical trials.
Methods
A systematic review of diagnosis and...
This article annotates a philosophy toward achieving best results for the patient with head and neck cancer, in particular relating to oral, mandibular, and maxillary resection. At the same time are highlighted the pitfalls that, if not avoided, are likely to result in a poor outcome even with a successful flap transfer. There is a paucity of evide...
This is the official guideline endorsed by the specialty associations involved in the care of head and neck cancer patients in the UK and provides recommendations on the pre-treatment oral and dental assessment, during and after treatment and oral rehabilitation. Restorative dentists are core members of the multidisciplinary team treating head and...
This is the official guideline endorsed by the specialty associations involved in the care of head and neck cancer patients in the UK and provides recommendations on the pre-treatment oral and dental assessment, during and after treatment and oral rehabilitation. Restorative dentists are core members of the multidisciplinary team treating head and...
This poster presents a new technique in the management of head and neck cancer patients requiring maxillectomy. This new technique involves the use of zygomatic oncology implants together with a soft tissue (radial forearm) free flap reconstruction with early prosthodontic loading at approximately 4 weeks pot surgery.
This poster presents a consequetive series of patients treated for mid-facial malignant disease with rhinectomy/mid-facial resection together with the placement of primary and secondary zygomatic implants to aid with the retention of a facial prosthesis. High levels of implant survival and a tendancy towards early loading with bar/magnet prostheses...
Background:
Transoral endoscopic ENT surgical procedures are a mainstay of treatment for a variety of conditions and are often preferable to open surgery where possible. Cases of micrognathia, prominent incisor teeth or trismus may create difficulties in gaining sufficient access to undertake such procedures. Extraction of the anterior maxillary t...
Head and neck cancer (HNC) patients face complex oral health issues following treatment. The aims of this study were to determine the proportion of HNC patients attending their dentist regularly and investigate clinicodemographic characteristics associated with attendance. Two surveys asked about patient attendance patterns and dentition. Pre-treat...
Background:
Patients experience considerable dental-related difficulties following head and neck cancer (HNC) treatment including problems with chewing, dry mouth, oral hygiene, appearance and self-esteem. These can go unrecognised in busy follow-up clinics. The Patient Concerns Inventory (PCI) is specifically for HNC patients, enabling them to se...
Unlabelled:
Oral cancer patients undergo life-altering curative treatment that consists of surgery or a combination of surgery and radiotherapy. This can severely alter the functional anatomy of the oral cavity and create a challenging environment for successful oral rehabilitation. A multidisciplinary team approach is required to rehabilitate the...
Unlabelled:
Osteonecrosis of the jaw--bisphosphonate-related (ONJ-BR) is an established clinical entity associated with both oral and intravenous (IV) bisphosphonate therapy. An update for the general practitioner on the indications for bisphosphonate therapy and both risk assessment and prevalence of ONJ-BR is provided. Management philosophy with...
The aim of this survey was to investigate the views of general dental practitioners (GDPs) on their perceived roles and the barriers regarding dental care of patients following head and neck radio-therapy.
From a total of 1163 GDPs on the Mersey Postgraduate Dental Deanery mailing list, 369 were selected at random. Questionnaires were sent out in F...
The aim of this paper is to provide a systematic review of articles concerning primary osseointegrated dental implants in the head and neck oncology setting. We searched MEDLINE (1950 to March 2009) and Embase (1980 to March 2009) using the terms head and neck, oral, maxillofacial, craniofacial, jaws, mandible, maxilla, zygoma, dental implants, oss...
Since the introduction of the Points Based Immigration System to the UK the opportunities for overseas trained dentists to train in the UK have been limited. This paper describes a new opportunity which has resulted from the Tier 5 Medical Training Initiative.
Osteoradionecrosis (ORN) of the jaws is a feared complication of treatment for head and neck cancer, and understandably much attention has been given to its prevention; good oral hygiene, careful preventative dental care, and extractions done before radiotherapy have been highlighted by many authors. Such necessary dental extractions when the heali...
The annual Conference of the BSSPD (British Society for the Study of Prosthetic Dentistry) was held in York on April 6th and 7th 2009. At the symposium on Mandibular Overdentures, presenters offered a synopsis of the research available on the efficacy of implant-supported mandibular overdentures in the edentulous mandible. Emphasis was given to bot...
The Annual Conference of the BSSPD (British Society for the Study of Prosthetic Dentistry) was held in York on 6 and 7 April 2009. At the symposium on mandibular overdentures, presenters offered a synopsis of the research available on the efficacy of implant-supported mandibular overdentures in the edentulous mandible. Emphasis was given to both qu...
This study aimed to evaluate the responsiveness of denture patients to the Liverpool Oral Rehabilitation Questionnaire (LORQ). Changes in scores for 20 core items completed from 2000 to 2005 by 16 patients both before and after oral rehabilitation were assessed. The median age of respondents was 68 years and the median time between questionnaires w...
This paper discusses the merits of Computer Tomography (CT) based dental implant planning in the rehabilitation of patients following oral cancer This case report describes the process of prosthetic work-up, computerised implant planning, surgical treatment and successful prosthetic oral rehabilitation of a patient following segmental mandibulectom...
Surgical procedures to improve the quality of peri-implant soft tissue are a routine part of dental implant practice, especially in the edentulous patient with a significant lack of attached keratinised tissue. The use of a dressing plate at the recipient site can be beneficial in supporting free, keratinised, soft-tissue grafts during the early he...
Trismus can be a problematic consequence of treatment for oral and oropharyngeal cancer. The aim of this study was to investigate the relationship between trismus, subjective function and health-related quality of life, in order to postulate a clinically relevant cut-off that might be useful as an indicator of patients who might benefit from interv...
The Liverpool Oral Rehabilitation Questionnaire (LORQ) is a health-related quality of life instrument assessing the impact of oral rehabilitation on patients' health-related quality of life (HRQOL) following treatment for oral cancer. The small number of patients wearing prostheses in previous studies limited the validation of the denture/denture s...
A national survey of 178 consultants and specialists in restorative dentistry was undertaken to assess their use of health-related quality of life questionnaires in patients having oral rehabilitation following treatment for oral cancer. The response rate was 74% (132). 42% treated patients following oral cancer, 25% forming part of the head and ne...
A case is presented in which diffuse lymphangiomatosis resulted in the complete loss of the maxillary dentoalveolar complex and underlying basal bone. The complex investigation and treatment of this patient over a 10-year period is presented, and the importance of a multidisciplinary team approach in providing a functional and esthetic rehabilitati...
Since the first version of the Liverpool Oral Rehabilitation Questionnaire (LORQ) was first published in 2004, the questionnaire has been modified to include more detail on chewing and appearance, and also details of denture, dental and implant status.
The aim of this study is to report the ongoing development and validation of the LORQ version3.
A...
This clinical report presents a patient who developed peri-implant bone loss around 2 maxillary endosseous root-form implants after restoration with cement-retained single crowns. Significant localized bone loss occurred around 1 of the implants due to retained excess cement. Reparative treatment consisted of a guided bone regeneration technique. F...
The involvement of reactive oxygen species (ROS) in periodontal pathology is unclear but will be modulated by in vivo antioxidant defence systems. The aim of this cross-sectional study was to determine both local (saliva and gingival crevicular fluid (GCF) and peripheral (plasma and serum) antioxidant capacity in periodontal health and disease.
Twe...
This clinical report presents a patient who developed peri-implant bone loss around 2 maxillary endosseous root-form implants after restoration with cement-retained single crowns. Significant localized bone loss occurred around 1 of the implants due to retained excess cement. Reparative treatment consisted of a guided bone regeneration technique. F...
This study aimed to evaluate the responsiveness of denture patients to the Liverpool Oral Rehabilitation Questionnaire (LORQ). Changes in scores for 20 core items completed from 2000 to 2005 by 16 patients both before and after oral rehabilitation were assessed. The median age of respondents was 68 years and the median time between questionnaires w...
Restorative dentistry is constantly evolving as a result of innovative treatment solutions based on new materials, treatment techniques and technologies, with composite materials being a prime example. The advent of fibre reinforcement has further increased the potential uses of composites within restorative dentistry. This paper discusses fibre ty...
Aim: To audit the use of oral midazolam and metoclopramide as a premedicant prior to the induction of general anaesthesia for uncooperative adult patients with special needs. Objectives: To demonstrate that such a premedicant regimen is effective, safe and carries no significant post-operative effects. Design: A hospital based clinical audit. Subje...
Drug-induced gingival overgrowth is an iatrogenic clinical condition, which affects a proportion of patients medicated for conditions such as hypertension, epilepsy and the prevention of organ transplant rejection. Clinical manifestation can vary in severity from minor problems to complete coverage of the standing teeth. Drifting of teeth can also...
To assess the activity of consultants in restorative dentistry in the United Kingdom in the provision of osseointegrated dental implants within the National Health Service Hospital service and to evaluate their attitudes concerning the relevant medical and oral factors considered in patient selection for implant treatment.
Anonymous postal question...
A case is presented of a young boy with cleidocranial dysplasia, whose multiple supernumerary teeth prevented the eruption of most of his permanent teeth. His maxillary incisor teeth failed to erupt following removal of anterior supernumerary elements and orthodontic traction. Lack of abutment teeth and a difficult maxillary base made prosthetic tr...
