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Dentoalveolar outcomes in maxillary reconstruction: A retrospective review of 85 maxillectomy reconstructions
Author(s) -
Petrides George A.,
Hicks Gabrielle,
Dunn Masako,
Froggatt Catriona,
Wallace Christine,
Howes Dale,
Leinkram David,
Low TsuHui Hubert,
Ch'ng Sydney,
Wykes James,
Palme Carsten E.,
Clark Jonathan R.
Publication year - 2021
Publication title -
anz journal of surgery
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.426
H-Index - 70
eISSN - 1445-2197
pISSN - 1445-1433
DOI - 10.1111/ans.17001
Subject(s) - medicine , rehabilitation , dentistry , odds ratio , retrospective cohort study , referral , implant , soft tissue , dentures , confidence interval , orthodontics , surgery , physical therapy , family medicine , pathology
Background Although microvascular free flaps are often used to reconstruct maxillary defects, dentoalveolar rehabilitation is arguably less common despite its importance to midface function and aesthetics. The aim of this study is to review the contemporary management of maxillary defects in a single quaternary referral institution to identify factors that assist or impede dentoalveolar rehabilitation. Methods A retrospective review of maxillary reconstructions performed between February 2017 and December 2020 was performed. Patient characteristics, defect classification, operative techniques, complications and dentoalveolar outcomes were recorded. Results A total of 85 maxillary reconstructions were performed in 73 patients. Of the 64 patients where dental rehabilitation was required, 31 received a functional denture (48%) with 24 (38%) being implant‐retained. Significant predictors of successful rehabilitation included the use of virtual surgical planning (VSP; 86% vs. 25%, p < 0.001), preoperative prosthodontic assessment (82% vs. 21%, p < 0.001), prefabrication (100% vs. 40%, p = 0.002) and use of the zygomatic implant perforator flap technique (100% vs. 39%, p = 0.001). Preoperative prosthodontic consultation was associated with 21‐fold increase in the odds of rehabilitation (odds ratio 20.9, 95% confidence interval 6.54–66.66, p < 0.005). Conclusion Preoperative prosthodontic evaluation, VSP and reconstructive techniques developed to facilitate implant placement are associated with increased dental rehabilitation rates. Despite using an institutional algorithm, functional dentures are frequently prevented by factors including soft tissue constraints, disease recurrence and patient motivation.