Severely Scarred Oronasal Cleft Defects in Edentulous Adults: Initial Data on the Long-Term Outcome of Telescoped Obturator Prostheses Supported by Zygomatic Implants
Restricted accessOtherFirst published online July, 2013
Severely Scarred Oronasal Cleft Defects in Edentulous Adults: Initial Data on the Long-Term Outcome of Telescoped Obturator Prostheses Supported by Zygomatic Implants
Prosthetic rehabilitation of edentulous patients presenting with severely scarred oronasal cleft defects. To document the outcome of telescopic obturator prostheses attached to zygomatic implants in edentulous cleft lip and palate patients.
Patients and Methods
Four edentulous patients suffering from the consequences of cleft lip and palate were selected from a cohort of 52 patients who had received zygomatic implants between 1998 and 2010. Oronasal communication had persisted and severe scars and chronic infection were noted in the cleft region. Bone grafting procedures were contraindicated due to high risk for dehiscence. For the functional support of telescopic prostheses, nine zygomatic implants and two standard dental implants had been placed.
Results
The zygomatic implants and the telescopic prostheses survived an average of 62 months (37 to 99 months) and were successful. Patients' satisfaction and oral function improved (on visual analog scale and oral health impact profile).
Conclusions
Telescopic obturator dentures supported by zygomatic implants represent a feasible option for the prosthetic rehabilitation of cleft lip and palate patients with severe impairments of the edentulous ridges including atrophy, scar tissue, ridge defects, oronasal communication, and chronic infection in the cleft region.
BedrossianE.Rehabilitation of the edentulous maxilla with the zygoma concept: a 7-year prospective study. Int J Oral Maxillofac Implants.2010; 25: 1213–1221.
2.
BedrossianE.RangertB.StumpelL.IndresanoT.Immediate function with the zygomatic implant: a graftless solution for the patient with mild to advanced atrophy of the maxilla. Int J Oral Maxillofac Implants.2006; 21: 937–942.
3.
BrånemarkP.I.GröndahlK.OhrnellL.O.NilssonP.PetrusonB.SvenssonB.EngstrandP.NannmarkU.Zygoma fixture in the management of advanced atrophy of the maxilla: technique and long-term results. Scand J Plast Reconstr Surg Hand Surg.2004; 38: 70–85.
4.
BremerF.GradeS.KohorstP.StieschM.In vivo biofilm formation on different dental ceramics. Quintessence Int.2011; 42: 565–574.
5.
CarlsonR.V.BoydK.M.WebbD.J.The revision of the Declaration of Helsinki: past, present and future. Br J Clin Pharmacol.2004; 57: 695–713.
6.
CawoodJ.I.HowellR.A.A classification of the edentulous jaws. Int J Oral Maxillofac Surg.1988; 17: 232–236.
7.
CuneM.S.MeijerG.J.KooleR.Anterior tooth replacement with implants in grafted alveolar cleft sites: a case series. Clin Oral Implants Res.2004; 15: 616–624.
8.
DellonA.L.The moving two-point discrimination test: clinical evaluation of the quickly adapting fiber/receptor system. J Hand Surg.1978; 3: 474–481.
9.
DuskováM.Kot'ováM.UrbanF.SosnaB.JirkalováR.StrnadelT.KristenM.LeamerováE.GojisO.Reconstruction of maxilla alveolus for application of dental implant in patients with cleft defect. Acta Chir Plast.2004; 46: 115–121.
10.
EspositoM.WorthingtonH.V.ThomsenP.CoulthardP.Interventions for replacing missing teeth: dental implants in zygomatic bone for the rehabilitation of the severely deficient edentulous maxilla. Cochrane Database Syst Rev.2003: (3); CD004151.
11.
GagglA.J.BürgerH.K.VirnikS.A.SchachnerP.ChairiF.M.The microvascular corticocancellous femur flap for reconstruction of the anterior maxilla in adult cleft lip, palate and alveolus patients [published online ahead of print]. Cleft Palate Craniofac J.2011; 49: 305–313.
12.
GolatoM.C.dos SantosD.M.MorenoA.SantiagoJ.F.J.HahhadaM.PesqueiraA.A.MiyaharaG.I.Prosthetic treatments for patients with oronasal communication. J Craniofac Surg.2011; 22: 1445–1447.
13.
HarrisonJ.W.Dental implants to rehabilitate a patient with an unrepaired complete cleft of the hard and soft palate: a clinical report. Cleft Palate Craniofac J.1992; 29: 485–488.
14.
HartelJ.PoglC.HenkelK.O.GundlachK.K.Dental implants in alveolar cleft patients: a retrospective study. J Craniomaxillofac Surg.1999; 27: 354–357.
15.
HeckmannS.M.HeckmannJ.G.WeberH.P.Clinical outcomes of three Parkinson's disease patients treated with mandibular implant overdentures. Clin Oral Implants Res.2000; 11: 566–571.
16.
HirschJ.M.OhrnellL.O.HenryP.J.AndreassonL.BrånemarkP.I.ChiapascoM.GyntherG.FinneK.HiguchiK.W.IsakssonS.. A clinical evaluation of the Zygoma fixture: one year of follow-up at 16 clinics. J Oral Maxillofac Surg.2004; 62: 22–29.
17.
HjermstadM.J.FayersP.M.HaugenD.F.CaraceniA.HanksG.W.LogeJ.H.FainsingerR.AassN.KaasaS.European Palliative Care Research Collaborative (EPCRC). Studies comparing numerical rating scales, verbal rating scales, and visual analogue scales for assessment of pain intensity in adults: a systematic literature review. J Pain Symptom Manage.2011; 41: 1073–1093.
18.
HofmannE.BehrM.HandelG.Frequency and costs of technical failures of clasp- and double crown-retained removable partial dentures. Clin Oral Investig.2002; 6: 104–108.
19.
JansmaJ.RaghoebarG.M.BatenburgR.H.StellingsmaC.van OortR.P.Bone grafting of cleft lip and palate patients for placement of endosseous implants. Cleft Palate Craniofac J.1999; 36: 67–72.
20.
JaquiéryC.RohnerD.KunzC.BucherP.PetersF.SchenkR.K.HammerB.Reconstruction of maxillary and mandibular defects using prefabricated microvascular fibular grafts and osseointegrated dental implants—a prospective study. Clin Oral Implants Res.2004; 15: 598–606.
21.
JensenJ.Sindet-PedersenS.EnemarkH.Reconstruction of residual alveolar cleft defects with one-stage mandibular bone grafts and osseointegrated implants. J Oral Maxillofac Surg.1998; 56: 460–466.
22.
JohnM.T.KoepsellT.D.HujoelP.MigliorettiD.L.LeRescheL.MicheelisW.Demographic factors, denture status, and oral health-related quality of life. Commun Dent Oral Epidemiol.2004; 32: 125–132.
23.
KearnsG.PerrottD.H.SharmaA.KabanL.B.VargervikK.Placement of endosseous implants in grafted alveolar clefts. Cleft Palate Craniofac J.1997; 34: 520–525.
24.
KissB.BenedekB.SzijártóG.CsuklyG.SimonL.TakácsB.Virtual patient: a photo-real virtual human for VR-based therapy. Stud Health Technol Inform.2004; 98: 154–156.
25.
KramerF.J.BaethgeC.SwennenG.BremerB.Schwestka-PollyR.DempfR.Dental implants in patients with orofacial clefts: a long-term follow-up study. Int J Oral Maxillofac Surg.2005; 34: 715–721.
26.
KrennmairG.KrainhöfnerM.WaldenbergerO.PiehslingerE.Dental implants as strategic supplementary abutments for implant-tooth-supported telescopic crown-retained maxillary dentures: a retrospective follow-up study for up to 9 years. Int J Prosthod.2007; 20: 617–622.
27.
LandesC.A.Implant-borne prosthetic rehabilitation of bone-grafted cleft versus traumatic anterior maxillary defects. J Oral Maxillofac Surg.2006; 64: 297–307.
28.
LandesC.A.Zygoma implant-supported midfacial prosthetic rehabilitation: a 4-year follow-up study including assessment of quality of life. Clin Oral Implants Res.2005; 16: 313–325.
29.
LandesC.A.BündgenL.LaudemannK.GhanaatiS.SaderR.Patient satisfaction after prosthetic rehabilitation of bone grafted alveolar clefts with non-submerged ITI Straumann dental implants loaded at three months [published online ahead of print]. Cleft Palate Craniofac J.2011; 49: 601–608.
30.
LandesC.A.PaffrathC.KoehlerC.ThaiV.D.StübingerS.SaderR.LauerH.C.PiwowarczykA.Zygoma implants for midfacial prosthetic rehabilitation using telescopes: 9-year follow-up. Int J Prosthod.2009; 22: 20–32.
31.
LandesC.A.WeichertF.GeisP.HelgaF.WagnerM.Evaluation of two 3D virtual computer reconstructions for comparison of cleft lip and palate to normal fetal microanatomy. Anat Rec A Discov Mol Cell Evol Biol.2006; 288: 248–262.
32.
LangerY.LangerA.Tooth-supported telescopic prostheses in compromised dentitions: a clinical report. J Prosthet Dent.2000; 84: 129–132.
33.
LoeH.The Gingival Index, the Plaque Index, and the Retention Index Systems. J Periodontol.1967; 38(suppl): 610–616.
34.
LukasD.SchulteW.Periotest—a dynamic procedure for the diagnosis of the human periodontium. Clin Phys Physiol Meas.1990; 11: 65–75.
35.
LundT.W.WadeM.Use of osseointegrated implants to support a maxillary denture for a patient with repaired cleft lip and palate. Cleft Palate Craniofac J.1993; 30: 418–420.
36.
MatsuiY.OhnoK.NishimuraA.ShirotaT.KimS.MiyashitaH.Long-term study of dental implants placed into alveolar cleft sites. Cleft Palate Craniofac J.2007; 44: 444–447.
37.
MooreD.McCordJ.F.Prosthetic dentistry and the unilateral cleft lip and palate patient. The last 30 years. A review of the prosthodontic literature in respect of treatment options. Eur J Prosthodont Restor Dent2004; 12: 70–74.
38.
NaertI.AlsaadiG.van SteenbergheD.QuirynenM.A.10-year randomized clinical trial on the influence of splinted and unsplinted oral implants retaining mandibular overdentures: peri-implant outcome. Int J Oral Maxillofac Implants.2004; 19: 695–702.
39.
PhamA.V.AbarcaM.De MeyA.MalevezC.Rehabilitation of a patient with cleft lip and palate with an extremely edentulous atrophied posterior maxilla using zygomatic implants: case report. Cleft Palate Craniofac J.2004; 41: 571–574.
40.
RonchiP.ChiapascoM.FrattiniD.Endosseous implants for prosthetic rehabilitation in bone grafted alveolar clefts. J Craniomaxillofac Surg.1995; 23: 382–386.
SolerL.MarescauxJ.Patient-specific surgical simulation. World J Surg.2008; 32: 208–212.
43.
StiévenartM.MalevezC.Rehabilitation of totally atrophied maxilla by means of four zygomatic implants and fixed prosthesis: a 6-40 month follow-up. Int J Oral Maxillofac Surg.2010; 39: 358–363.
44.
TakahashiT.FukudaM.YamaguchiT.KochiS.Use of endosseous implants for dental reconstruction of patients with grafted alveolar clefts. J Oral Maxillofac Surg.1997; 55: 576–583.
45.
WeiglP.LauerH.C.Advanced biomaterials used for a new telescopic retainer for removable dentures. J Biomed Mater Res.2000; 53: 337–347.
46.
WöstmannB.BalkenholM.WeberA.FergerP.RehmannP.Long-term analysis of telescopic crown retained removable partial dentures: survival and need for maintenance. J Dent.2007; 35: 939–945.
47.
VerdiF.J.JrLanziG.L.CohenS.R.PowellR.Use of the Branemark implant in the cleft palate patient. Cleft Palate Craniofac J.1991; 28: 301–303.
48.
ZaherA.R.WeichertF.BramsiepeN.LandesC.A.AwadS.ShamaaA.WagnerM.Computation of a tetrahedral mesh for striated muscle deformation simulation. J Microsc.2010; 237: 168–177.
49.
ZwahlenR.A.GrätzK.W.OechslinC.K.StuderS.P.Survival rate of zygomatic implants in atrophic or partially resected maxillae prior to functional loading: a retrospective clinical report. Int J Oral Maxillofac Implants.2006; 21: 413–420.
