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BDS4 Head and Neck Cancer symposium > Oral Rehabilitation > Flashcards

Oral Rehabilitation Flashcards

1
Q

What are some of the challenges of oral rehabilitation in head and neck cancer patients?

A
  • Psychological issues- anxiety and depression
  • Disfiguration
  • Issues eating
  • Issues speaking
  • 50% don’t return to work
  • Expensive to treat
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2
Q

What may be done in the dental assessment phase prior to starting cancer treatment?

A
  • Plan extraction of teeth (strategic- keep key teeth)
  • Reduce tori
  • Instigate prevention- 5000ppmF toothpaste, diet modification, jaw exercises, perio therapy
  • Impressions/scans
  • Photographs
  • Planning software- implants
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3
Q

What are the side effects of radiotherapy and surgery?

A
  • Taste changes
  • Xerostomia- caries
  • Structural changes in teeth- changes in pulp space, difficulty with RCT
  • Mucositis
  • ORN
  • Trismus
  • Soft tissue changes
  • PDL changes
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4
Q

What are the epidemiological features of ORN?

A
  • Seen in patients as low as 30gy
  • Incidence 5%
  • Seen in tonsillar and retromolar region in patients with OPC
  • Mandible is most affected- often precipitated by extraction
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5
Q

What can be done to provide patient with aesthetic and functional outcome without extraction?

A

Decorate tooth- add precision attachment
-> Denture fits well

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6
Q

What may implants be placed into?

A

remaining bone

vascularised bone grafts

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7
Q

What is the issue with soft tissue post resection?

A
  • Free flaps are from areas outwith mouth (mobile, NK)
  • Can lead to florid tissues
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8
Q

What are the different ways overdentures can be retained on implants?

A

Ball abutments

Bars

magnets

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9
Q

What are the ADV/DIS of implant retained overdentures?

A

ADV- Restore multiple teeth, easy to clean, easy to take in and out, improves retention

DIS- not splinted, removable

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10
Q

What are we looking for when doing maintenance appointment for people receiving cancer treated?

A
  • Look for BOP
  • Discomfort
  • Bone levels- clinically, radiographically, on loading
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11
Q

What are co-axis implant bodies and their function?

A

Threaded implant that can have different fixture angulation (12, 24, 36)
- Utilise existing bone to maintain restorative platform at angle ensuring optimal aesthetic outcome
- Good for preventing trismus

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12
Q

What are the considerations when determining how to rehabilitate a maxillary defect?

A
  • Dentate?
  • Large or small
  • Split thickness grafts
  • Load bearing tissues
  • Denture wearing
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13
Q

What are the functions of obturators?

A
  • Separate mouth from nose
  • Improve speech and eating
  • Restore palatal contour
  • Replace dentition
  • Provide retention, stability and support for complete denture
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14
Q

What surgical enhancements can be done as part of Oral rehabilitation?

A
  • Skin graft- keratinised tissue
  • Access to defect- removal of turbinates
  • Salvaging premaxillary segment
  • Soft palate resection and velopharyngeal function
  • Retention of key teeth
  • Use of palatal mucosa
  • Implant placement
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15
Q

What are the different obturators used in head and neck cancer patient;s journey?

A

Surgical obturator- fitted at time of surgery (screwed in)
-> Close wound and help patient leave hospital
-> Cover plate

Interim- has teeth, helps eat and speak in post operative and healing periods

Definitive obturator- precision retained denture
-> Aim to achieve peripheral seal

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16
Q

What is a glossectomy?

A

Tongue resection

17
Q

What can be done in dentures when there is an issue with swallowing due to glossectomy?

A

Augment palatal aspect
- Acrylic on polished surface so that tongue can contact denture and help initiate first phase of swallow

18
Q

What are the advantages of primary dental implants?

A

Quicker restoration

Good evidence for nasal/orbital protheses

Psychological help

Good if obturator likely to be compromised

Get out of hospital quicker- return to normal life

19
Q

What are the disadvantage of primary dental implants?

A

May place in poor location due to scarring and healing

May have to wait for healing to get more bone volume

Implant survival and usefulness is improved by delayed placement in resected mandibles

Need patient to be present in surgery to make stents

20
Q

What flap is used for zygomatic implant?

A

Zip

21
Q

What should be assessed when planning for implants when carrying out oral rehabilitation?

A
  • Assess motivation
  • Assess how viable rehab will be without implants (consider use of 3D planning and surgical guide production)
  • Compliance with attendance and co-morbidities
  • Make suggestions of treatment
22
Q

What can be done to help with the provisional when significant resection is required?

A

Use software to mirror defect side with non-defect side
-> 3D print a guide

23
Q

What are the stages of ‘Jaw in a Day’

A
  • Plan case
  • Implants are placed into fibula
  • This is attached
  • Put provisional abutments on
  • Patient wakes up rehabbed
  • Converted into definitive prothesis
24
Q

What are the different methods in digital driven jaw reconstruction?

A
  1. Navigation and robotics
  2. Planned functional reconstruction- fully guided and occlusion based
  3. Guided anatomical reconstruction
  4. Planned anatomical reconstruction- digitally planned but unguided
  5. Anatomical reconstruction- intra-operative intuitive surgery

 Shape of bone should be based on where tooth should be rather than symmetry for jaw reconstruction from aesthetic profile point of view
 Recommend surgical guides similar to fibula

25
Q

What are the challenges with microvascular construction?

A
  • Time
  • Difficult surgical design
  • Anatomical issues- tumour itself
  • Implant positions
  • Soft tissue
26
Q

What would be the best practice in placing implants for oral rehab in cancer patients? (opposite of most current practice)

A
  • Plan implant position
  • Plan implants
  • Put microvascular reconstruction in that position

 Previously took 6 years to rehab now 2 years
 Cheaper and quicker for patients

27
Q

What may oral rehab for patients in future look like?

A
  • Same day rehab without compromise of quality of success
  • Secondary- navigated surgery with innovative implant placement to reduce surgical morbidity

** Issues with keratinised tissue grafts, time, hygiene costs

BDS4 Head and Neck Cancer symposium (5 decks)

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