OHIP domainMinimumMaximumMeanSDFunctional limitation072.341.70Physical pain071.161.51Psychological discomfort081.642.27Physical disability080.751.77Psychological disability081.182.11Social disability080.611.40Handicap080.701.71Total0648.49.7Table 5 Summary of OHIP-14 (N = 44 and response range 0–8)
Outcome variablesCorrelationsSpearman’s rhoP valueOHRQoLOral health compared0.596
QuestionResponseFrequencyOral healthVery good/good81.8%Quality of LifeVery good/good90.9%General healthVery good/good81.8%Pain after hip operationExcessive35.0%Satisfaction hip operationVery85.7%Post op infection in hip siteNo95.3%Visible scar on hipYes48.8%Acceptable scarYes20 of 21aReduced sensibility on hip siteNo86.0%Problem walkingNo92.9%Augmented bone block still presentNo6.8%New augmentatio...
VariableFrequencyN or Mean ± SD%Patients Female2454.5 Male2045.5Age (years)61.16 ± 13.10 Age at operation53.73 ± 13.07 Time from augmentation to completing questionnaire (months)93.55 ± 31.75 Civil status Married3068.2 Single1125.0 Widow(er)36.8Housing Alone1227.3 With another person2352.3 > two persons920.5Education Up to primary711.3 Up to secondary23...
CategoryResponseQuestion (1) Perceived health-status General health“Very good” to “bad” Oral health“Very good” to “bad” Overall quality of life“Excellent” to “bad” (2) Lifestyle-related Smoking“Yes,” “no,” or “sometimes” Appetite“Good” to “bad” (3) Donor site-related Pain“Yes” and “no” Infection“Yes” a...
Gjerde, C.G., Shanbhag, S., Neppelberg, E. et al. Patient experience following iliac crest-derived alveolar bone grafting and implant placement. Int J Implant Dent 6, 4 (2020). https://doi.org/10.1186/s40729-019-0200-8
Download citation
Received: 10 October 2019
Accepted: 11 December 2019
Published: 05 February 2020
DOI: https://doi.org/10.1186/s40729-019-0200-8
Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were m...
A self-administered questionnaire.
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
The Ethics Committee was contacted in 2015, and no ethical approval was needed since this was then considered a quality control study. Written consent was obtained from all participants.
Not applicable.
Cecilie G Gjerde, Siddharth Shanbhag, Evelyn Neppelberg, Kamal Mustafa, and Harald Gjengedal declare that they have no competing interests.
Correspondence to Cecilie G. Gjerde.
Department of Oral and Maxillofacial Surgery, Institute of Clinical Dentistry, University of Bergen, Årstadveien 19, 5009, Bergen, Norway
Cecilie G. Gjerde & Evelyn Neppelberg
Centre for Clinical Dental Research, Institute of Clinical Dentistry, University of Bergen, Bergen, Norway
Cecilie G. Gjerde, Siddharth Shanbhag & Kamal Mustafa
Department of Oral and Maxillofacial Surgery, Head an...
This work was partially funded by the Research Council of Norway through the BEHANDLING project (grant no. 273551) and TROND MOHN Foundation, Norway (BFS2018TMT10).
The staff and surgeons at the Department of Oral and Maxillofacial Surgery, Head and Neck Clinic, Haukeland University Hospital, Bergen. Randi Aursland, master student, who helped collecting data. The patients included in this study.
Landes CA, Bundgen L, Laudemann K, Ghanaati S, Sader R. Patient satisfaction after prosthetic rehabilitation of bone-grafted alveolar clefts with nonsubmerged ITI Straumann dental implants loaded at three months. Cleft Palate Craniofac J. 2012;49(5):601–8.
Reisine S, Freilich M, Ortiz D, Pendrys D, Shafer D, Taxel P. Quality of life improves among post-menopausal women who received bone augment...
Locker D, Allen F. What do measures of ‘oral health-related quality of life’ measure? Community Dent Oral Epidemiol. 2007;35(6):401–11.
Sischo L, Broder HL. Oral health-related quality of life: what, why, how, and future implications. J Dent Res. 2011;90(11):1264–70.
Slade GD. Assessing change in quality of life using the Oral Health Impact Profile. Community Dent Oral Epidemiol. 1998;26...
Hill NM, Horne JG, Devane PA. Donor site morbidity in the iliac crest bone graft. Aust N Z J Surg. 1999;69(10):726–8.
Finkemeier CG. Bone-grafting and bone-graft substitutes. J Bone Joint Surg Am. 2002;84-A(3):454–64.
Hernigou P, Desroches A, Queinnec S, Flouzat Lachaniette CH, Poignard A, Allain J, et al. Morbidity of graft harvesting versus bone marrow aspiration in cell regenerative thera...
Schaaf H, Lendeckel S, Howaldt HP, Streckbein P. Donor site morbidity after bone harvesting from the anterior iliac crest. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2010;109(1):52–8.
Sakkas A, Wilde F, Heufelder M, Winter K, Schramm A. Autogenous bone grafts in oral implantology-is it still a “gold standard”? A consecutive review of 279 patients with 456 clinical procedures. Int J I...
Health-related quality of life
Oral Health Impact Profile-14
Oral health-related quality of life
Patient-reported outcome measures
Quality of life
The datasets used and/or analyzed during the current study are available from the corresponding author on reasonable request.
Favorable OHRQoL and satisfaction were reported after advanced reconstruction with iliac crest-derived grafts and implant treatment in orally compromised patients. However, this treatment requires substantial resources including hospitalization and sick leave.
Patients in our study reported satisfaction with the augmentation and implant installation, and as these patients were orally compromised before the operation, their satisfaction with getting fixed teeth most likely improved their perceived oral health condition. This might also, in part, explain why they reported good OHRQoL. Thus, our findings indicate that a majority of patients tolerate the au...
An important finding in this study is that a majority of patients were very satisfied after iliac crest-derived alveolar bone grafting and implant therapy. Although 90% of the patients in our study had successful bone grafting, only 70.1% reported implant survival together with prosthetic rehabilitation after 1 year. These figures are lower than those reported in previous studies [2, 3, 9]. A rev...
The correlation analyses performed did not show a significant correlation between the complications at the donor site and implant loss (Table 4).
The mean OHIP-14 score (Table 5) was 8.4 ± 9.7 (range 0–56) in 44 patients of whom 35 patients scored 14 or less. Nine patients scored a total sum of 1 [1], i.e. “hardly ever” impact on any single item and “at no time” on the remaining ...
The final sample consisted of 44 patients that responded and completed the questionnaire, giving a response rate of 74.6%: 24 women and 20 men, mean age of 61.2 years ± 13.1 (range 27–82 years). The mean time from augmentation surgery until completing the questionnaire was 7.8 years ± 2.65 (range 1.9–12 years).
Summary of demographic and lifestyle-related data is presented (Tabl...
Implants were placed 4–6 months after the grafting procedure. The implant installations were performed by different oral surgeons (not in the hospital) and different implant systems were used. The implants installed into the augmented bone were allowed to heal for an additional 4–6 months before loading.
The records of the original 69 patients were examined with regard to (1) grafting sit...
This cross-sectional retrospective cohort study was based on records from all patients (n = 69) who underwent advanced alveolar augmentation with autologous iliac bone grafts at the Department of Oral and Maxillofacial Surgery, Haukeland University Hospital, Bergen, Norway, over 10 years (2002–2012). These patients were orally compromised with severe chewing problems as well as speech diff...
Health-related QoL (HRQoL) is a dynamic concept referring to an individual’s subjective assessment and perspective of current general health condition as well as functional, social, and emotional well-being [23, 24]. Most people regard oral health as important for QoL, and this is mediated through the concept of oral health-related QoL (OHRQoL) [25]. In this regard, OHRQoL is an important PROM i...
Insufficient alveolar bone volume, as a result of periodontal disease, trauma, congenital anomalies and/or resorption atrophy, often presents a clinical challenge for optimal placement of dental implants for prosthetic rehabilitation. In such cases, augmentation of alveolar bone, with either autologous bone, allogeneic, xenogeneic, or alloplastic biomaterials, is a prerequisite for placing implant...
The objective of this study was to assess patient-reported outcomes such as satisfaction and quality of life after advanced alveolar bone augmentation with anterior iliac crest grafting and implant treatment in orally compromised patients.
This cross-sectional retrospective cohort study included 59 patients (29 women and 30 men) with major functional problems, who underwent advanced alveolar augm...
OHIP domainMinimumMaximumMeanSDFunctional limitation072.341.70Physical pain071.161.51Psychological discomfort081.642.27Physical disability080.751.77Psychological disability081.182.11Social disability080.611.40Handicap080.701.71Total0648.49.7Table 5 Summary of OHIP-14 (N = 44 and response range 0–8)
Outcome variablesCorrelationsSpearman’s rhoP valueOHRQoLOral health compared0.596
QuestionResponseFrequencyOral healthVery good/good81.8%Quality of LifeVery good/good90.9%General healthVery good/good81.8%Pain after hip operationExcessive35.0%Satisfaction hip operationVery85.7%Post op infection in hip siteNo95.3%Visible scar on hipYes48.8%Acceptable scarYes20 of 21aReduced sensibility on hip siteNo86.0%Problem walkingNo92.9%Augmented bone block still presentNo6.8%New augmentatio...
VariableFrequencyN or Mean ± SD%Patients Female2454.5 Male2045.5Age (years)61.16 ± 13.10 Age at operation53.73 ± 13.07 Time from augmentation to completing questionnaire (months)93.55 ± 31.75 Civil status Married3068.2 Single1125.0 Widow(er)36.8Housing Alone1227.3 With another person2352.3 > two persons920.5Education Up to primary711.3 Up to secondary23...
CategoryResponseQuestion (1) Perceived health-status General health“Very good” to “bad” Oral health“Very good” to “bad” Overall quality of life“Excellent” to “bad” (2) Lifestyle-related Smoking“Yes,” “no,” or “sometimes” Appetite“Good” to “bad” (3) Donor site-related Pain“Yes” and “no” Infection“Yes” a...
Gjerde, C.G., Shanbhag, S., Neppelberg, E. et al. Patient experience following iliac crest-derived alveolar bone grafting and implant placement.
Int J Implant Dent 6, 4 (2020). https://doi.org/10.1186/s40729-019-0200-8
Download citation
Received: 10 October 2019
Accepted: 11 December 2019
Published: 05 February 2020
DOI: https://doi.org/10.1186/s40729-019-0200-8
Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were ...
A self-administered questionnaire.
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
The Ethics Committee was contacted in 2015, and no ethical approval was needed since this was then considered a quality control study. Written consent was obtained from all participants.
Not applicable.
Cecilie G Gjerde, Siddharth Shanbhag, Evelyn Neppelberg, Kamal Mustafa, and Harald Gjengedal declare that they have no competing interests.
Correspondence to
Cecilie G. Gjerde.
Department of Oral and Maxillofacial Surgery, Institute of Clinical Dentistry, University of Bergen, Årstadveien 19, 5009, Bergen, Norway
Cecilie G. Gjerde & Evelyn Neppelberg
Centre for Clinical Dental Research, Institute of Clinical Dentistry, University of Bergen, Bergen, Norway
Cecilie G. Gjerde, Siddharth Shanbhag & Kamal Mustafa
Department of Oral and Maxillofacial Surgery, Head an...
This work was partially funded by the Research Council of Norway through the BEHANDLING project (grant no. 273551) and TROND MOHN Foundation, Norway (BFS2018TMT10).
The staff and surgeons at the Department of Oral and Maxillofacial Surgery, Head and Neck Clinic, Haukeland University Hospital, Bergen. Randi Aursland, master student, who helped collecting data. The patients included in this study.
Landes CA, Bundgen L, Laudemann K, Ghanaati S, Sader R. Patient satisfaction after prosthetic rehabilitation of bone-grafted alveolar clefts with nonsubmerged ITI Straumann dental implants loaded at three months. Cleft Palate Craniofac J. 2012;49(5):601–8.
Reisine S, Freilich M, Ortiz D, Pendrys D, Shafer D, Taxel P. Quality of life improves among post-menopausal women who received bone augment...
Locker D, Allen F. What do measures of ‘oral health-related quality of life’ measure? Community Dent Oral Epidemiol. 2007;35(6):401–11.
Sischo L, Broder HL. Oral health-related quality of life: what, why, how, and future implications. J Dent Res. 2011;90(11):1264–70.
Slade GD. Assessing change in quality of life using the Oral Health Impact Profile. Community Dent Oral Epidemiol. 1998;26...
Hill NM, Horne JG, Devane PA. Donor site morbidity in the iliac crest bone graft. Aust N Z J Surg. 1999;69(10):726–8.
Finkemeier CG. Bone-grafting and bone-graft substitutes. J Bone Joint Surg Am. 2002;84-A(3):454–64.
Hernigou P, Desroches A, Queinnec S, Flouzat Lachaniette CH, Poignard A, Allain J, et al. Morbidity of graft harvesting versus bone marrow aspiration in cell regenerative thera...
Schaaf H, Lendeckel S, Howaldt HP, Streckbein P. Donor site morbidity after bone harvesting from the anterior iliac crest. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2010;109(1):52–8.
Sakkas A, Wilde F, Heufelder M, Winter K, Schramm A. Autogenous bone grafts in oral implantology-is it still a “gold standard”? A consecutive review of 279 patients with 456 clinical procedures. Int J I...
Health-related quality of life
Oral Health Impact Profile-14
Oral health-related quality of life
Patient-reported outcome measures
Quality of life
The datasets used and/or analyzed during the current study are available from the corresponding author on reasonable request.
Favorable OHRQoL and satisfaction were reported after advanced reconstruction with iliac crest-derived grafts and implant treatment in orally compromised patients. However, this treatment requires substantial resources including hospitalization and sick leave.
Patients in our study reported satisfaction with the augmentation and implant installation, and as these patients were orally compromised before the operation, their satisfaction with getting fixed teeth most likely improved their perceived oral health condition. This might also, in part, explain why they reported good OHRQoL. Thus, our findings indicate that a majority of patients tolerate the au...
An important finding in this study is that a majority of patients were very satisfied after iliac crest-derived alveolar bone grafting and implant therapy. Although 90% of the patients in our study had successful bone grafting, only 70.1% reported implant survival together with prosthetic rehabilitation after 1 year. These figures are lower than those reported in previous studies [2, 3, 9]. A rev...
The correlation analyses performed did not show a significant correlation between the complications at the donor site and implant loss (Table 4).
The mean OHIP-14 score (Table 5) was 8.4 ± 9.7 (range 0–56) in 44 patients of whom 35 patients scored 14 or less. Nine patients scored a total sum of 1 [1], i.e. “hardly ever” impact on any single item and “at no time” on the remaining ...
The final sample consisted of 44 patients that responded and completed the questionnaire, giving a response rate of 74.6%: 24 women and 20 men, mean age of 61.2 years ± 13.1 (range 27–82 years). The mean time from augmentation surgery until completing the questionnaire was 7.8 years ± 2.65 (range 1.9–12 years).
Summary of demographic and lifestyle-related data is presented (Tabl...
Implants were placed 4–6 months after the grafting procedure. The implant installations were performed by different oral surgeons (not in the hospital) and different implant systems were used. The implants installed into the augmented bone were allowed to heal for an additional 4–6 months before loading.
The records of the original 69 patients were examined with regard to (1) grafting sit...
This cross-sectional retrospective cohort study was based on records from all patients (n = 69) who underwent advanced alveolar augmentation with autologous iliac bone grafts at the Department of Oral and Maxillofacial Surgery, Haukeland University Hospital, Bergen, Norway, over 10 years (2002–2012). These patients were orally compromised with severe chewing problems as well as speech diff...
Health-related QoL (HRQoL) is a dynamic concept referring to an individual’s subjective assessment and perspective of current general health condition as well as functional, social, and emotional well-being [23, 24]. Most people regard oral health as important for QoL, and this is mediated through the concept of oral health-related QoL (OHRQoL) [25]. In this regard, OHRQoL is an important PROM i...
Insufficient alveolar bone volume, as a result of periodontal disease, trauma, congenital anomalies and/or resorption atrophy, often presents a clinical challenge for optimal placement of dental implants for prosthetic rehabilitation. In such cases, augmentation of alveolar bone, with either autologous bone, allogeneic, xenogeneic, or alloplastic biomaterials, is a prerequisite for placing implant...
The objective of this study was to assess patient-reported outcomes such as satisfaction and quality of life after advanced alveolar bone augmentation with anterior iliac crest grafting and implant treatment in orally compromised patients.
This cross-sectional retrospective cohort study included 59 patients (29 women and 30 men) with major functional problems, who underwent advanced alveolar augm...
Fig. 17. The appearance of the case shown in Fig. 16 with the polythene “washer” removed at 2 weeks post-surgery, providing access to the zygomatic oncology implants
Fig. 17. The appearance of the case shown in Fig. 16 with the polythene “washer” removed at 2 weeks post-surgery, providing access to the zygomatic oncology implants
Fig. 16. Another ZIP flap case demonstrating the use of a perforated polythene “washer” to keep the flap from overgrowing the implant abutments during the healing phase
Fig. 16. Another ZIP flap case demonstrating the use of a perforated polythene “washer” to keep the flap from overgrowing the implant abutments during the healing phase
Fig. 15. Facial appearance 18 months following treatment
Fig. 15. Facial appearance 18 months following treatment
Fig. 14. Intra-oral view of perforated flap 3 weeks following radiotherapy
Fig. 14. Intra-oral view of perforated flap 3 weeks following radiotherapy
Fig. 13. Panoramic dental radiograph showing the position of the zygomatic implants and the seating of the initial fixed prosthesis
Fig. 13. Panoramic dental radiograph showing the position of the zygomatic implants and the seating of the initial fixed prosthesis
Fig. 12. Provisional acrylic fixed dental prosthesis fitted at 4 weeks post-surgery
Fig. 12. Provisional acrylic fixed dental prosthesis fitted at 4 weeks post-surgery
Fig. 11. Intra-oral view of the soft tissue flap at 3 weeks post-operatively with overgrowth of flap over the zygomatic oncology implants
Fig. 11. Intra-oral view of the soft tissue flap at 3 weeks post-operatively with overgrowth of flap over the zygomatic oncology implants
Fig. 10. Radial forearm flap inset and sutured into the maxillary defect and perforated by the zygomatic oncology implant abutments
Fig. 10. Radial forearm flap inset and sutured into the maxillary defect and perforated by the zygomatic oncology implant abutments
Fig. 9. Inter-occlusal registration using the pre-fabricated maxillary denture prosthesis relined with silicone putty over the implant abutment protection caps
Fig. 9. Inter-occlusal registration using the pre-fabricated maxillary denture prosthesis relined with silicone putty over the implant abutment protection caps
Fig. 8. Abutment level impression utilising light-cured acrylic tray material
Fig. 8. Abutment level impression utilising light-cured acrylic tray material
Fig. 7. Conventional zygomatic implant insertion on the non-defect side of the maxilla following extraction of the remaining teeth and an alveoloplasty
Fig. 7. Conventional zygomatic implant insertion on the non-defect side of the maxilla following extraction of the remaining teeth and an alveoloplasty
Fig. 6. Zygomatic oncology implants sited in the residual zygomatic bone on the defect side of the maxilla
Fig. 6. Zygomatic oncology implants sited in the residual zygomatic bone on the defect side of the maxilla
Fig. 5. Left-sided maxillary resection (Brown class 2b)
Fig. 5. Left-sided maxillary resection (Brown class 2b)
Fig. 4. Panoramic dental radiograph showing dental status at presentation
Fig. 4. Panoramic dental radiograph showing dental status at presentation
Fig. 3. Staging CT scan confirming maxillary destruction but preservation of the orbital floor
Fig. 3. Staging CT scan confirming maxillary destruction but preservation of the orbital floor
Fig. 2. Staging MRI scan showing destructive lesion left maxilla
Fig. 2. Staging MRI scan showing destructive lesion left maxilla
Fig. 1. Clinical view of left-sided maxillary tumour at presentation
Fig. 1. Clinical view of left-sided maxillary tumour at presentation
Domain
Score
Activity
100 (“I am as active as I have ever been”)
Anxiety
100 (“...
Butterworth, C.J., Rogers, S.N. The zygomatic implant perforated (ZIP) flap: a new technique for combined surgical reconstruction and rapid fixed dental rehabilitation following low-level maxillectomy.
Int J Implant Dent 3, 37 (2017). https://doi.org/10.1186/s40729-017-0100-8
Download citation
Received: 14 May 2017
Accepted: 23 July 2017
Published: 29 July 2017
DOI: https...
Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were...
Consent has been obtained from the patient for the use and publication of all images.
Chris Butterworth and Simon Rogers declare that they have no competing interests.
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Department of Oral & Maxillofacial Surgery, University Hospital Aintree, Lower Lane, Liverpool, L9 7AL, UK
C. J. Butterworth & S. N. Rogers
You can also search for this author in
PubMed Google Scholar
You can also search for this author in
PubMed Google Scholar
CB devised the treatment concept and undertook all implant surgeries and prostho...
Okay DJ, Genden E, Buchbinder D, Urken M. Prosthodontic guidelines for surgical reconstruction of the maxilla: a classification system of defects. J Prosthet Dent. 2001;86(4):352–63.
Rohner D, Bucher P, Hammer B. Prefabricated fibular flaps for reconstruction of defects of the maxillofacial skeleton: planning, technique, and long-term experience. Int J Oral Maxillofac Implants. 2013;28(5):e221...
The ZIP flap technique represents an innovative approach to the management of patients presenting with low-level malignant maxillary tumours. It provides effective closure of the resulting maxillary defect restoring speech and swallowing functions and also establishing a high-quality fixed dental rehabilitation in a rapid timescale, thus facilitating a more timely return to function and restored f...
Whilst technically, it would be possible to construct and fit the prosthesis on the same day or even a week later, the need for microvascular flap monitoring in the immediate post-operative period, together with the significant recovery period required by the patient following surgery has lead the authors to delay the fitting of the prosthesis at the 4 to 6-week period post-operatively. In terms o...
In contrast, the use of a soft tissue flap such as the RFFF or antero-lateral thigh flap can often be safely employed in elderly patients with peripheral vascular disease without unduly lengthening the operation too significantly with two-team operating. In addition, the predictability of these flaps with their excellent pedicle lengths is ideal for closure of the resulting oro-nasal surgical defe...
In low-level maxillectomy (Brown class II), the need for bony reconstruction is questionable depending on the horizontal component. With the preservation of the orbital floor, zygomatic prominence and some bony support for the nose, facial appearance, in the experience of the authors and, as demonstrated by this case, is not significantly worsened despite low-level removal of the maxilla. The key ...
In order to address some of the issues highlighted in this early case, the technique was modified slightly to try and prevent flap overgrowth and prosthesis fracture in the early stages. In order to prevent flap overgrowth over the zygomatic oncology implant abutments, the use of a polythene washer was instituted on subsequent cases treated in the unit. Once the flap was perforated, a 2-mm thick p...
The implant positions were then accurately registered by utilising light-cured resin tray material (Individo® Lux, Voco Gmbh, Germany) and abutment level impression copings. The resin material was applied in sections around the impression copings and cured incrementally to ensure a rigid splinting of the impression copings (Fig. 8). Abutment protection caps were then placed over all four abutment...
A 66-year-old male patient presented with an enlarging mass in the left maxilla (Fig. 1). The mass had been present for a few weeks. An incisional biopsy revealed squamous cell carcinoma. Staging scans were undertaken (Fig. 2) which demonstrated a T4N0M0 maxillary alveolus tumour in close proximity to the left orbital floor with obliteration of the maxillary antrum and destruction of the lateral m...
The surgical management and prosthodontic rehabilitation of the maxillectomy patient is complex with a variety of options available to the head and neck cancer team ranging from simple prosthodontic obturation [1] to reconstruction using pre-fabricated or digitally planned composite flaps [2] with or without the placement of osseointegrated implants [3]. The primary aims of treatment include effec...
This aim of this report is to describe the development and evolution of a new surgical technique for the immediate surgical reconstruction and rapid post-operative prosthodontic rehabilitation with a fixed dental prosthesis following low-level maxillectomy for malignant disease.
The technique involves the use of a zygomatic oncology implant perforated micro-vascular soft tissue flap (ZIP flap) fo...
Figure 17. The appearance of the case shown in Fig. 16 with the polythene “washer” removed at 2 weeks post-surgery, providing access to the zygomatic oncology implants
Figure 15. Facial appearance 18 months following treatment
Figure 15. Facial appearance 18 months following treatment
Figure 14. Intra-oral view of perforated flap 3 weeks following radiotherapy
Figure 13. Panoramic dental radiograph showing the position of the zygomatic implants and the seating of the initial fixed prosthesis
Figure 12. Provisional acrylic fixed dental prosthesis fitted at 4 weeks post-surgery
Figure 11. Intra-oral view of the soft tissue flap at 3 weeks post-operatively with overgrowth of flap over the zygomatic oncology implants
Figure 10. Radial forearm flap inset and sutured into the maxillary defect and perforated by the zygomatic oncology implant abutments
Figure 10. Radial forearm flap inset and sutured into the maxillary defect and perforated by the zygomatic oncology implant abutments
Figure 9. Inter-occlusal registration using the pre-fabricated maxillary denture prosthesis relined with silicone putty over the implant abutment protection caps
Figure 8. Abutment level impression utilising light-cured acrylic tray material
Figure 7. Conventional zygomatic implant insertion on the non-defect side of the maxilla following extraction of the remaining teeth and an alveoloplasty
Figure 6. Zygomatic oncology implants sited in the residual zygomatic bone on the defect side of the maxilla
Figure 5. Left-sided maxillary resection (Brown class 2b)
Figure 4. Panoramic dental radiograph showing dental status at presentation
Figure 3. Staging CT scan confirming maxillary destruction but preservation of the orbital floor
Figure 2. Staging MRI scan showing destructive lesion left maxilla
Figure 1. Clinical view of left-sided maxillary tumour at presentation
Table 1 Patient-reported quality of life outcomes following ZIP flap procedure
From: The zygomatic implant perforated (ZIP) flap: a new technique for combined surgical reconstruction and rapid fixed dental rehabilitation following low-level maxillectomy
Domain
Score
Activity
100 (“I am as active as I have ever been”)
Anxiety
100 (“I am not anxious about ...
References
Okay DJ, Genden E, Buchbinder D, Urken M. Prosthodontic guidelines for surgical reconstruction of the maxilla: a classification system of defects. J Prosthet Dent. 2001;86(4):352–63.
Rohner D, Bucher P, Hammer B. Prefabricated fibular flaps for reconstruction of defects of the maxillofacial skeleton: planning, technique, and long-term experience. Int J Oral Maxillofac Impl...
Conclusions
The ZIP flap technique represents an innovative approach to the management of patients presenting with low-level malignant maxillary tumours. It provides effective closure of the resulting maxillary defect restoring speech and swallowing functions and also establishing a high-quality fixed dental rehabilitation in a rapid timescale, thus facilitating a more timely return to function...
Immediate/early loading of zygomatic [8] and dental implants [9] have been well demonstrated already within the literature with very high implant survival rates. In the oncology setting, Boyes-Varley et al. [4] lost no zygomatic/oncology implants in their series of 20 patients restored with implant-retained obturators, 6 of whom received radiotherapy post-operatively. The case reported...
The use of soft tissue flaps to close a typical hemi-maxillectomy defect is an effective way of dealing with the oro-nasal communication, but in isolation, this technique works against dental rehabilitation as the bulk of the flap provides a very poor moveable foundation for a subsequent removable prosthesis. The move towards the use of composite reconstruction (especially the fibula flap) h...
Discussion
In order to reduce intra-operative time, the soft tissue free flap is harvested at the same time as the implant placement and prosthodontic procedures. On raising a skin island, it is appropriate to make it a little over-sized for the required defect to ensure that tension and possible dehiscence at the surgical margins during healing is reduced.
In low-level maxillectomy (Brown...
Procedural modifications to the ZIP flap technique
In order to address some of the issues highlighted in this early case, the technique was modified slightly to try and prevent flap overgrowth and prosthesis fracture in the early stages. In order to prevent flap overgrowth over the zygomatic oncology implant abutments, the use of a polythene washer was instituted on subsequent cases treated in th...
The radial forearm free flap (RFFF) was then disconnected from the arm and inset into the maxillary defect after creating a tunnel down into the left neck for the pedicle. The flap was carefully perforated over the zygomatic implant abutment protection caps using a short incision just through the skin layer followed by blunt dissection to allow the abutment and cap to perforate the flap ensuring a...
The ZIP flap technique
The patient underwent tracheostomy, a limited left-sided selective neck dissection for node sampling and vessels preparation. The maxillary tumour was excised in a standard manner via an intra-oral approach with preservation of the left orbital floor (Fig. 5). The resection extended to the maxillary alveolar midline in the incisor region with extension posteriorly just into...
Case presentation
A 66-year-old male patient presented with an enlarging mass in the left maxilla (Fig. 1). The mass had been present for a few weeks. An incisional biopsy revealed squamous cell carcinoma. Staging scans were undertaken (Fig. 2) which demonstrated a T4N0M0 maxillary alveolus tumour in close proximity to the left orbital floor with obliteration of the maxillary antrum and destruc...
Background
The surgical management and prosthodontic rehabilitation of the maxillectomy patient is complex with a variety of options available to the head and neck cancer team ranging from simple prosthodontic obturation [1] to reconstruction using pre-fabricated or digitally planned composite flaps [2] with or without the placement of osseointegrated implants [3]. The primary aims of treatment...
The zygomatic implant perforated (ZIP) flap: a new technique for combined surgical reconstruction and rapid fixed dental rehabilitation following low-level maxillectomy
Abstract
This aim of this report is to describe the development and evolution of a new surgical technique for the immediate surgical reconstruction and rapid post-operative prosthodontic rehabilitation with a fixed dental prost...