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implants - international magazine of oral implantology

I case report Fig. 1_Preoperative condition: circular hybrid bridge in regio 16–26 with abutment teeth 12–23 and implants in regio 16, 14, 13, 24, 25, 26 and an edentulous mandible. Introduction The restoration of the masticatory function af- ter therapy of malign tumours of the head and neck is of great importance for the social reinte- grationofoncologicalpatients.Especiallytheirlo- calisation in the head-and-neck area poses high psychological and psychosocial demands on the patient.Thefollowingarticlegivesinsightintolat- est therapeutic successes as well as a patient case from the author’s practice. Practicing dentists play an important role the prevention and early detection of carcinoma of the oral cavity, but they are equally central in mastica- tory functional rehabilitation post radiationem.1 In themajority,thesearesquamouscellcarcinomasof varyinglocalisation.Maligntumoursofthesalivary glands are less frequent (adenoid-cystic carcino- mas,mucoepidermoid,adenoandsalivaryductcar- cinomas), lymphoepitheliomas and sarkomas.2 Ad- verse therapy effects often result from combined radio(chemo)therapeuticalandsurgicaltreatment, often affecting the physiological anatomy and function. However, both radiation and chemother- apy are integral aspects of the treatment, in addi- tion to the tumour surgery itself. Head-and-neck radiation is performed in squamous cell carcinoma oftheoralcavityandtheoropharynxaswellasma- lign tumours of the salivary glands and malign lymph nodes.1 Therapeutic effects Early,mostlyreversibletherapyeffects(mucosi- tis) are differentiated from late, mostly permanent therapy effects (radioxerostomy, radiation caries, radiationfibrosis,riskofinfectedosteoradionecro- sis (IORN)).2-5 Infected osteoradionecrosis (IORN) is the most severe local complication. Progressive osteolysis oftencanonlybetreatedbypartialresectionsofthe jawandtheyusuallydemandsubsequentelaborate surgical rehabilitation.2 IORN is often triggered by operations of the jaw or prosthesis pressure marks. In more than 60 % of IORN cases, infection stems from the dental area, which is increased by the fac- tor three in cases of lacking periradiotherapeutic care.6 Theextentoftheextractionhasbeendiscussed controversially,butaselectivediagnosisisrecom- Implant-supported rehabilitation after radiation therapy Authors_Dr Umut Baysal, Dr Arzu Tuna & Dr Rainer Valentin, Germany 32 I implants2_2013 Fig. 1