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Rates and Determinants of Prosthodontic Rehabilitation After Segmental Jaw Surgery
Amal Idrissi Janati1, Ameena Nizar Beema2, Jordan Gigliotti3
1Assistant Professor, Faculty of Dental Medicine and Oral Health Sciences, McGill University, Montreal, Quebec, Canada; Research Director, Department of Dentistry and Oral and Maxillofacial Surgery, Montreal General Hospital, Montreal, Quebec, Canada.
Prosthodontic rehabilitation (PR) is often not achieved after jaw surgery, particularly for cancer patients receiving radiotherapy. Radiotherapy significantly predicts failure to receive PR, especially implant-supported prostheses, indicating a need for pre-treatment solutions.
Area of Science:
- Oral and Maxillofacial Surgery
- Reconstructive Surgery
- Prosthodontics
Background:
- Maxillofacial pathologies often necessitate jaw resections, leading to functional deficits.
- Vascularized free flaps (VFFs) and dental implants have improved reconstructive options.
- The impact of these advancements on prosthodontic rehabilitation (PR) rates and barriers is not well understood.
Purpose of the Study:
- To determine the rate of PR following jaw segmental resection and VFF reconstruction.
- To identify risk factors associated with the failure to achieve PR.
Main Methods:
- Retrospective cohort study of 184 patients aged ≥15 years undergoing jaw segmental resection and VFF reconstruction (2015-2021).
- Predictor variables included age, sex, smoking, diagnosis, radiotherapy, flap type, and anterior tooth loss.
- Kaplan-Meier analysis and Cox/logistic regression were used to analyze time to PR and PR status.
Main Results:
- Overall PR rate was 41%, with 19.5% receiving implant-supported prostheses.
- Median time to PR was 44 months, delayed in men, smokers, cancer patients, and those receiving radiotherapy.
- Multivariate analysis identified radiotherapy as the primary predictor of failure for both overall PR and implant-supported PR.
Conclusions:
- A significant proportion of patients do not achieve PR after jaw surgery, particularly cancer patients treated with radiotherapy.
- Implant-supported prostheses are even less common in this patient group.
- There is a critical need for strategies to facilitate PR before radiotherapy in patients undergoing jaw resection.
