Denver Cosmetic Dentist | Dental Arts of Cherry Hills

ORAL CANCER REHABILITATION TREATMENT

Oral Cancer Rehabilitation Treatment

*Quoted from the Oral Cancer Foundation

State of the Science

The strategy and techniques of rehabilitation of a head and neck cancer patient are directly related to the location of the cancer and to the extent and type of surgical intervention and radiation modalities used. Oral carcinomas not detected and evaluated in their early clinical stages usually invade contiguous structures, thereby setting the stage for extensive surgical procedures that are generally followed by radiation therapy.

Removal of extensive segments of the tongue, floor of mouth, mandible, and hard and soft palate as well as the regional lymphatics usually mandates extensive rehabilitative management. Generally, maxillofacial prosthodontists restore maxillary resections with obturator prostheses. However, in many instances a soft palate speech bulb-obturator retained in the maxillae (for restoration of velopharyngeal function) or a palatal augmentation prosthesis (if tongue function is lost) is required for optimal rehabilitation. Currently, rehabilitation of a maxillectomy and/or soft palate defect via an obturator prosthesis is most effective in restoring function. Recent advances in microsvascular free flap tissue transfers have been used successfully to reconstruct composite defects of the mandible, buccal mucosa, and tongue.

Current rehabilitative practice is centered in five principles:

1. The process of rehabilitation begins at time of initial diagnosis and interdisciplinary treatment planning with the oncologists and head and neck surgeons.

2. The dentition should be preserved if possible.

3. Rehabilitative treatment plans are be based on fundamental principles of prosthodontics, including a philosophy of preventive dentistry and conservative restorative dentistry.

4. Surgery before prosthetic rehabilitation may be indicated to improve the existing anatomic configuration after ablative cancer surgery, reconstructive surgery, and/or radiation therapy.

5. Multidisciplinary cancer care is required to achieve the best functional, physical, and psychologic outcomes.

The need to treat tumors expediently often delays planning for rehabilitation. However, without a highly interactive and dynamic dialogue among health care providers during the initial treatment planning process, efforts to provide optimal rehabilitative care are impaired. Other health professionals-including social workers, vocational rehabilitation counselors, nurses, nutritionists, occupational therapists, physical therapists, speech pathologists, and dental hygienists-are also vital members of the team. Because a team of this breadth is not typically encountered in the community setting, comprehensive rehabilitation is best managed in a medical center venue.

Factors affecting the cancer surgical treatment plan for oral cancer patients include the following:

• Prognosis and systemic status of patient

• Potential size and site of defect

• Potential nature of functional and/or cosmetic defect

• Adjunctive therapy (e.g., chemotherapy or radiation) that may compromise the surgical result

• Anticipated changes to function and cosmesis, based on the cancer surgery and the availability, accessibility, and cost of rehabilitative procedures

Planning

Planning for patients who need rehabilitation of the maxillofacial complex includes consideration of surgical defects associated with the maxilla, mandible, tongue, soft palate, and facial region, including the patient with a combined orofacial abnormality. The role and impact of radiation and chemotherapy also need consideration.

Specific abnormalities result directly from the extent and nature of cancer treatment as well as the patient’s functional and psychological ability to respond to changes induced by therapy. Thus, rehabilitation may be directed to hypernasality, mastication and deglutition dysfunction, control of oral secretions, compromised interarch relations, speech deficits (tongue disarticulation), salivary gland dysfunction, and/or cosmetics.

In recent years there have been significant advances in some of the strategies for rehabilitating the oral cancer patient. These include fundamental qualitative improvements in biomaterials (including osseointegrated implants), microvascular free flap tissue transfers, and hyperbaric oxygen technology (by which gas highly concentrated in oxygen is delivered under increased pressure to patients).

Still, long-term success depends in large measure on effective follow-up protocols. The traditional idea that a patient’s original maxillofacial prosthesis will adequately support his or her lifelong needs is no longer valid. The prosthesis needs ongoing evaluation, adjustment, and usually replacement over time. Most removable extraoral prostheses need to be remade every 2 to 3 years; removable intraoral maxillofacial prostheses require regular maintenance and generally need replacement every 5 to 7 years. In addition, the ongoing long-term sequelae of radiation therapy for head and neck cancer require the dentist to keep the periodontium in optimal condition. Furthermore, restorations of abutment teeth used to retain an intraoral maxillofacial prosthesis must be sound and noncarious, and implant prostheses in this population require extensive maintenance for optimal functional results.

The standard of care for patients receiving a palatal resection (maxillectomy, palatectomy and/or soft palate resection) includes three stages of maxillofacial prosthetic intervention:

1. Immediate placement of a surgical obturator prosthesis (inserted in the operating room, usually by the maxillofacial prosthodontist, at completion of surgery to separate the oral cavity from nasal cavities created by cancer surgery).

2. Placement of a provisional or interim postsurgical obturator prosthesis (inserted after the surgical obturator and packing is removed 7 days postoperatively, worn in the postoperative healing period).

3. Placement of a definitive postsurgical obturator prosthesis.

Major technologic advances have occurred in recent years in osseointegration (the process by which natural bone attaches to the metal or ceramic component of an implant), thereby facilitating the use of dental implants. Brånemark et al. have pioneered the modern-day use of this technology, in which implant materials capable of bearing forces produced during normal function interface both structurally and functionally with bone. Dental implants are now being used in both oral and extraoral settings and have significantly improved the restoration of both form and function to the oral and craniofacial region. Potentially, implant-borne prostheses can be used in the majority of intraoral and extraoral defects. However, in patients with intraoral defects, the most useful implant sites usually are not within the radiation treatment volume. An emerging exception appears to be the case of fibula free flaps, where implants are used to restore segmentally resected mandibles prior to post-surgical radiation. For extraoral prostheses, bioadhesives have traditionally been used to enhance retention, but they have considerable limitations. Indeed, patients and clinicians often become frustrated by the difficulty of achieving optimal effects with adhesives. Both experience and specialized education can improve the clinician’s ability to provide these components of extraoral and intraoral rehabilitative care.

The characteristics of successful osseointegration include: 1. biocompatible implant materials 2. non-traumatic, aseptic surgical procedures 3. an initial healing period in which functional loading of forces is deferred and 4. stress-reducing prosthodontic procedures. Patients should be selected with great care, and proper maintenance

and follow-up are imperative. Successful osseointegration can permit the restoration of masticatory function following mandibular fibula free flap microvascular transfers. Osseointegration in the maxillary-resected patient and implant-retained facial prostheses have become acceptable in major cancer centers worldwide.

RELATED SERVICES

PREVENTION AND PRESERVATION

BEFORE & AFTER

Slide title

Write your caption here

Button
Slide title

Write your caption here

Button
Slide title

Write your caption here

Button
Slide title

Write your caption here

Button

TESTIMONIALS

I highly recommend Dr. Konstantinos Harogiannis for all dental applications. He is an extremely competent and caring doctor performing prosthodontic, implant, cosmetic and reconstructive work. After surgery, he provided me with a well fitting temporary partial with 4 manufactured teeth, prior to a permanent partial. Kudos to Dr. Harogiannis, and many thanks.

-Mary Anne Chalaby

Thank you for all of your hard work restoring my teeth. You are a bright, talented and compassionate individual. Being surrounded by a friendly and competent office staff, is an added bonus.

-Carol

Dr. Kostas and the staff at Dental Arts of Cherry Hills are by far the most professional and caring group of prosthodontist ‘s around. I spent over 2 years researching the best place to replace a couple of missing and broken teeth. I ended up doing a complete set of new teeth with a combination of veneers and implants. Dr. Kostas made my smile look like a million bucks. Dental Arts of Cherry Hills was an exceptional value and they used the highest quality veneers and implants. I am extremely happy with the way my teeth look now. I get complemented often how beautiful my teeth look. Nobody knows they are cosmetically done unless I tell them. If your considering an implant or veneers you will be in good hands with Dr. Kostas and his staff. Just a side note Dr. Kostas and Gina ( his most awesome assistant ) came in on their off day to finish my teeth. They go out of their way to accommodate everyone. 5 stars is not enough to describe this Dr. I promise you will be happy by choosing Dr. Kostas. Don’t hesitate any longer… A great smile will do wonders for your self image…. I love my new teeth and have not stopped smiling since.

-Corey Engelen E.

CONTACT US

Dental Arts offers you the full range of professional support from prevention to diagnosis and treatment. Our team of experts and specialists will assist and guide you through your treatment options.

Amalgam Replacement

A replacement of amalgam with bionert tooth-coloured ceramic restorations stabilises the tooth permanently and creates a more attractive appearance.

Erosion damages

In response to a meal the body produces acids which make the teeth vulnerable. Saliva has the ability to neutralise these acids and remineralize the enamel within hours.

The effectiveness of this repair mechanism can be highly disturbed by our nutrition choices. Especially consistent consumption of acidic drinks or food increases the risk of enamel damage significantly. Also eating disorders or other reasons to expose the teeth to stomach acid can have a dramatic impact on enamel and dentin.

Frequent consultation with a dental hygienist. and if indicated a nutritionist. will help to build a foundation for your dental health. If it is required to rebuild teeth concerning shape, colour and function, minimally invasive dentistry plays a major role.

If a bulimia is diagnosed the health insurance often bears the incurred costs. Unfortunately, people suffering bulimia are often ashamed to talk about their problems. The sooner the problem is identified, the better measures can be applied to save your teeth.

Caries (tooth decay)

Healthy teeth are important for a high quality of life. Caries is the most common dental disease in the world and it is mainly a consequence of wrong eating habits. At greatest risk are fissures (grooves in the grinding surface of the molars) and parts of the dentition that are hard to reach with a toothbrush.

During the treatment of tooth damage caused by dental decay, the affected part is removed by drilling and the cavity is medically sealed. To prevent your teeth from dental decay it is recommended to attend dental hygiene treatments regularly.

Frenectomy (removal of a frenulum)

A frenectomy is the removal of a frenulum. a small fold of tissue inside the lip in the middle of the upper and lower jaw. inserting into the jawbone. In some cases the frenulum can be too short and limit the mobility of the upper or lower lip. In other cases it can have a negative effect on the development of the tooth position. leading to misalignment and esthetic compromises. Prominent is for instance a big gap between the two upper central incisors (diastema). It is also often described as the main reason of gum loss and root exposure of teeth close to the frenulum. If these negative effects are observed an early surgical treatment to remove the frenulum is indicated. In many times the removal is already performed in childhood. Minimal invasive surgical methods are applied.

Call Us