46 The Open Pathology Journal, 2011, 5, 46-51 1874-3757/11 2011 Bentham Open Open Access The Impact of Dental Implants on Maxillofacial Patient’s Quality of Life Jorge Gonzalez * Center for Maxillofacial Prosthodontics, Baylor College of Dentistry, 3302 Gaston Ave, Dallas, TX 75246, USA Abstract: Avulsive injuries and ablative surgery for both aggressive benign and malignant disease, even when well- reconstructed, leave anatomy that provides no effective means of stabilizing prosthesis. For such patients, implant- stabilized or, preferably, implant-supported restorations have become the ultimate goal. Defects of the entire craniofacial complex, including esthetic and functional problems, can now be addressed much more predictable and completely than ever before. Keywords: Surgical reconstruction, prosthetic reconstruction, distorted anatomy, radiation therapy, implant anchorage, osteoblastic activity. INTRODUCTION “Avulsive injuries and ablative surgery for both aggressive benign and malignant disease, even when well- reconstructed, leave anatomy that provides no effective means of stabilizing a prosthesis” [1]. Surgical consequences are not negligible; depending on tumor location and size, significant substance loss can occur in the maxilla, in the mandible, or on the oral floor. Such defects interfere with major oral functions such as mastication, deglutition, and speech, and lead to facial deformities that can hinder the patient’s return to normal social life [2]. Currently for most cancers and other oral lesions, the common treatment is surgical excision and some radiotherapy [3] (Fig. 1). Therapeutic radiation causes a number of physiologic changes that may adversely affect prosthetic reconstruction. Xerostomia is one of the most common changes associated with therapeutic radiation. In xerostomic patients, the salivary film that is beneficial for denture comfort and adequate denture retention is eliminated or greatly reduced [4]. Decreased salivary flow may be associated with an increase in the rate of dental caries. Although caries in the xerostomic patient are not a direct result from radiation to the teeth, it appears to be a multi- factorial problem associated with loss of the buffering capacity and lubrication from the saliva, decreased oral hygiene because of tissue discomfort, and other less obvious factors [5]. A return to near normal caries rate is possible only with meticulous oral hygiene, routine use of topical fluoride, and replenishment of lost mineralized structure with re-mineralizing solutions [6] (Fig. 2). However, it must be emphasized that the demographic picture of the oral cancer patient does not provide optimism for this long-term, extremely diligent approach to oral hygiene. Too often, despite the efforts of the dental team, dental caries continues to be a significant risk to the patient’s dentition [5]. *Address correspondence to this author at the Center for Maxillofacial Prosthodontics, Baylor College of Dentistry, 3302 Gaston Ave, Dallas, TX 75246, USA; Tel: 214-828-8990; E-mail: jgonzalez@bcd.tamhsc.edu In recent years, maxillofacial reconstruction has evolved and improved considerably. Substantial loss in the mandible, with or without interruption of bone continuity, can be compensated by sophisticated techniques using pedicle or microanastomosed flaps (e.g., free micro-anastomosed fibula transfer) [7-9]. Symmetry of the lower facial area can usually be preserved, and functional problems can be minimized. Despite surgical reconstruction, some problems remain for dental prosthetic reconstruction, since the support area that stabilizes a conventional prosthesis is reduced [10-11]. In patients with associated maxillary defects, two types of prostheses should be considered: conventional removable and implant supported. REMOVABLE PROSTHESES The prognosis for removable prostheses depends on the quality and quantity of the remaining anatomical structures, the ability of these structures to tolerate increased physiologic demands from dental prostheses, and the capacity of the patient to accept the artificial prostheses [5]. Conventionally, clasps or attachments have been used to provide retention for dental prostheses, as well as engaging undercuts in the surrounding tissues and residual dentition to support extensive cantilevers. Such lever system eventually precede a cyclic redistribution of adverse load patterns and subsequent deterioration of the mechanical retentive system, creating a need for supplemental support [12]. In addition, it is difficult to maintain maxillary and mandibular prostheses in satisfactory condition over the long term because of a variety of factors, including recurrence or metastasis of the primary tumor, ulceration, or myelitis. Irradiated patients who wear a non-stable tissue-supported prostheses are at risk for mucosal ulceration, bone exposure, and, ultimately, osteoradionecrosis [1]. OBTURATOR PROSTHESES An obturator prosthesis is a removable intraoral device that is frequently used in cases of maxillary resection resulting in an oral, nasal, sinus cavity communication, decreased palatal support, and partial loss of the maxillary vestibule. Surgical compensation in such maxillary defects is