Restoring dentition, restoring confidence
Featured Products Promotional FeaturesPosted by: Dental Design 16th January 2023
It goes without saying that dentistry is a heroic profession, as clinicians are often the first to notice early symptoms of diseases, conditions or illnesses that may not have been detected otherwise. Mouth cancer is one such disease that has serious ramifications for the individual if it is not caught early, and clinicians are in a prime position to spot these early warning signs.
This disease is life-altering, affecting innumerable aspects of one’s life, including their dentition and oral health. The dental team play an invaluable role in a patient’s rehabilitation journey, with the care they deliver continually improving due to advancements made to various treatment modalities.
Mouth cancer and oral health
It is reported that new cases of mouth cancer in the UK have increased by 58% in the last decade.[i] Squamous cell carcinoma is considered the most common kind of mouth cancer, but other types include: adenocarcinoma (develops in salivary glands), sarcoma (grows from abnormalities in the oral tissues), oral malignant melanoma (starts in cells that produce skin pigment) and lymphoma (grows from cells in lymph glands/mouth).[ii]
Oral cancer can manifest differently depending on its type. The main treatment pathways include chemotherapy, radiotherapy and/or surgery. The oral cavity undergoes intense changes during and after these different procedures, which can have a huge effect on the patient’s oral health and quality of life (QOL). Researchers have noted several complications following radiotherapy, such as radiotherapy-induced xerostomia and hyposalivation,[iii] two issues that can vastly impact a person’s health and confidence.[iv] Mucositis is another common side effect of mouth cancer treatment that can negatively affect oral function and a patient’s QOL.[v]
Surgical intervention can lead to facial deformities, loss of oral tissues and problems with mastication, swallowing and speech.[vi] This can affect the patient’s social life and mental condition, too. To correct these issues and restore a patient’s dental function and confidence, a dental prosthesis can be used for full dental rehabilitation.
Improved treatment options
Studies have determined that, in some cases, the use of a removable prosthesis would be challenging due to alterations of the patient’s oral anatomy, as a result of treatment.vi The benefits afforded by dental implants in these cases are recognised, whether in the form of fixed implant supported prostheses or a dental implant supported overdenture.vi The efficacy of zygomatic implants has been proven in various studies, with their ability to provide adequate remote anchorage for a range of oral prostheses.[vii]
A study set out to examine how the method of oral maxilla rehabilitation has shifted between 1994 and 2020 at the Liverpool University Foundation NHS Trust.[viii] Focusing on patients with cancer (the majority being squamous cell carcinoma), researchers noted that, over time, there had been a distinguished change in preferred methods of reconstruction. Namely, that there had been a reduced reliance on composite flaps for defect restoration, with roughly half of patients in the last five years having a radial free flap. The increased use of remotely anchored zygomatic implants for prosthesis support is cited as the driver for this change. The researchers concluded that the majority of patients now have free tissue reconstructions, with a strong emphasis on the inclusion of primary zygomatic implants through loaded implant-supported fixed bridge reconstruction. Despite being limited to one institution, this study does demonstrate the evolution of reconstructive methodologies, highlighting zygomatic implants in particular.
First and foremost, restoring comfort, aesthetics and function to the patient is of the utmost importance, and the development of improved procedural modalities have allowed clinicians to deliver life-changing treatment. The zygomatic implant perforated (ZIP) flap technique was developed by Prof Butterworth and his colleagues for the rehabilitation of oncology patients who have had ablative surgery. While heavily technique and skill sensitive, the Zip flap technique can provide full dental rehabilitation within days of surgery, and before radiotherapy (if required), with positive patient outcomes reported.[ix]
Give more to your patients
Dedication is required to take on zygomatic implant training, but the rewards are countless. Not only can clinicians treat patients who have undergone treatment for cancer, but also for maxillary atrophy, failed conventional dental implant placement, failed sinus augmentation and grafting procedures.
For many clinicians, training in this field may not be currently financially viable, or they may lack the time for sufficient commitment. In this instance, clinicians can refer challenging cases to the Centre for Oral-Maxillofacial and Dental Implant Reconstruction. The team at this international ZAGA centre, based in Manchester and led by Specialist Oral Surgeon Professor Cemal Ucer, are experts in delivering zygomatic implant treatment. They implement the ZAGA (Zygoma Anatomy-Guided Approach) concept to reduce complications and deliver outstanding outcomes for every case. If interested in learning more about zygomatic implants, clinicians can visit on the day of the surgery and observe first-hand. The clinic utilises state-of-the-art equipment and technologies to maintain the highest standards of quality, for clinicians’ and their patients’ peace of mind.
When severe atrophy of the jaw develops whether as a result of disuse or ablative surgery, the role of the dental team cannot be understated in the patient’s rehabilitation. Choosing the correct pathway for optimum treatment outcomes will help to restore oral function and comfort, providing patients with what they need to start living their life comfortably and confidently once again.
Please contact Professor Ucer at ucer@icedental.institute or Mel Hay at mel@mdic.co
01612 371842
www.ucer-clinic.dental
Professor Cemal Ucer (BDS, MSc, PhD, Oral Surgeon, ITI Fellow)
[i] Oral Health Foundation. (2019). The State of Mouth Cancer UK Report 2019/2020. [online] Available at: https://www.dentalhealth.org/thestateofmouthcancer [Accessed 15 Sep. 2022].
[ii] NHS Choices (2019b). Overview – Mouth cancer. [online] NHS. Available at: https://www.nhs.uk/conditions/mouth-cancer/ [Accessed 15 Sep. 2022].
[iii] Mercadante, V., Al Hamad, A., Lodi, G., Porter, S. and Fedele, S. (2017). Interventions for the management of radiotherapy-induced xerostomia and hyposalivation: A systematic review and meta-analysis. Oral Oncology, [online] 66, pp.64–74. Available at: https://www.sciencedirect.com/science/article/abs/pii/S1368837516302780 [Accessed 15 Sep. 2022].
[iv] Practitioners, T.R.A.C. of general (n.d.). Dry mouth: Xerostomia and salivary gland hypofunction. [online] Australian Family Physician. Available at: https://www.racgp.org.au/afp/2016/july/dry-mouth-xerostomia-and-salivary-gland-hypofuncti#:~:text=Mouth%20dryness%20may%20present%20as [Accessed 15 Sep. 2022].
[v] Jehn, P., Stier, R., Tavassol, F., Dittmann, J., Zimmerer, R., Gellrich, N.-C., Krüskemper, G. and Spalthoff, S. (2019). Physical and Psychological Impairments Associated with Mucositis after Oral Cancer Treatment and Their Impact on Quality of Life. Oncology Research and Treatment, [online] 42(6), pp.342–349. Available at: https://www.karger.com/Article/Abstract/499720 [Accessed 15 Sep. 2022].
[vi] Takaoka, K., Segawa, E., Yamamura, M., Zushi, Y., Urade, M. and Kishimoto, H. (2015). Dental implant treatment in a young woman after marginal mandibulectomy for treatment of mandibular gingival carcinoma: a case report. International Journal of Implant Dentistry, [online] 1(1). Available at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5005787/ [Accessed 15 Sep. 2022].
[vii] Hackett, S., El‐Wazani, B. and Butterworth, C. (2020). Zygomatic implant‐based rehabilitation for patients with maxillary and mid‐facial oncology defects: A review. Oral Diseases. [online] Available at: https://onlinelibrary.wiley.com/doi/full/10.1111/odi.13305 [Accessed 15 Sep. 2022].
[viii] Rogers, S.N., Adatia, A., Hackett, S., Boscarino, A., Patel, A., Lowe, D. and Butterworth, C.J. (2022). Changing trends in the microvascular reconstruction and oral rehabilitation following maxillary cancer. European Archives of Oto-Rhino-Laryngology, [online] 279(8), pp.4113–4126. Available at: https://link.springer.com/article/10.1007/s00405-022-07277-y [Accessed 16 Sep. 2022].
[ix] Butterworth, C.J., Lowe, D. and Rogers, S.N. (2021). The Zygomatic Implant Perforated (ZIP) flap reconstructive technique for the management of low‐level maxillary malignancy – clinical & patient related outcomes on 35 consecutively treated patients. Head & Neck, [online] 44(2), pp.345–358. Available at: https://onlinelibrary.wiley.com/doi/10.1002/hed.26933 [Accessed 16 Sep. 2022].
