Immediate Dental Implantation in Oncologic Jaw Reconstruction: Workflow Optimization to Decrease Time to Full Dental Rehabilitation
Immediate Dental Implantation in Oncologic Jaw Reconstruction: Workflow Optimization to Decrease Time to Full Dental Rehabilitation
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DOI：
10.1097/gox.0000000000002100
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发表时间：
2019-01-01
影响因子：
1.5
通讯作者：
Matros, Evan
中科院分区：
文献类型：
--
作者：
Allen, Robert J., Jr.;Shenaq, Deana S.;Matros, Evan
所有患者的目标都应该是在下颌骨切除术或上颌切除术后进行完整的牙齿康复。但是，尽管技术和重建技术取得了进步，但许多患者未能及时或完全实现口腔康复。认识到这一缺陷，我们最近采用了一种创新的工作流程来增加接受牙齿修复的患者数量，而不考虑肿瘤病理或是否需要辅助放疗。术前，每个骨颌重建都经过虚拟手术计划，将骨内种植体植入腓骨骨皮自由皮瓣。植牙体在术中切除和重建肿瘤时放置。初次手术后4 - 6周，患者返回手术室进行前庭成形术和牙种植体暴露。在前庭成形术的3天内，在牙科诊所放置一个临时的牙科假体，如果需要，患者可以开始放射治疗。在辅助放射治疗后，临时假体可以替换为永久性假体。在我们的机构，这种创新的工作流程允许早期的下颌美学修复，并大大增加了能够实现口腔康复的患者数量。在这里，我们描述了这个创新的工作流程，并提供了成功执行的技术要点。
Full dental rehabilitation following segmental mandibulectomy or maxillectomy for oncologic tumor ablation should be the goal for every patient. But despite advances in technology and reconstructive techniques, many patients do not achieve timely or complete oral rehabilitation. Recognizing this fault, we recently adopted an innovative workflow to increase the number of patients undergoing dental restoration, irrespective of tumor pathology or need for adjuvant radiotherapy. Preoperatively, every osseous jaw reconstruction undergoes virtual surgical planning to incorporate the placement of endosseous implants into the fibula osteocutaneous free flap. The dental implants are then placed intraoperatively at the time of tumor ablation and reconstruction. Four-to-six weeks following the initial surgery, the patient returns to the operating room for vestibuloplasty and exposure of the dental implants. Within 3 days of the vestibuloplasty, a temporary dental prosthesis is placed in the dental clinic, and the patient can then begin radiation therapy if needed. Following adjuvant radiation therapy, the temporary prosthesis can be replaced with a permanent one. At our institution, this innovative workflow has allowed for earlier aesthetic restoration of the jaw and greatly expanded the number of patients able to achieve oral rehabilitation. Herein, we describe this innovative workflow and provide technical pearls for successful execution.