A Clinical Evaluation of Implant-Supported Maxillary Obturator Prostheses: An Original Study.

Introduction: Rehabilitation after the maxillectomy is challenging to the clinician and the patient. Since the invention of the implants, the rehabilitation has changed the treatment strategies. Hence in our study, we evaluated the maxillary obturator that is implant supported. Materials and
Methods: We piloted a retrospective analysis of the patients who received the maxillary obturator prosthesis with implant support from the department records from 2010 to 2020. We finalized 50 subjects who fit the criteria and evaluated clinically for various parameters. The comparison of these parameters was done using the Chi-square tests deliberating P < 0.05 as significant.
Results: We observed that the implant survival was 94%. There was significant variation for the implant bone height (P = 0.001) and the implant threads exposed (P = 0.044) for the posterior and the anterior regions.
Conclusion: The implant-supported maxillary obturator prosthesis has been shown to perform clinically satisfactorily. The success of the implant-supported maxillary obturator is dependent on the time of the placement, load applied, the radiation regime, and the patient follow-up. Copyright:

INTRODUCTION

Maxillectomy is a commonly resorted treatment for the treatment of large tumors and also the fracture sequelae in improper healing. The most common modality of the treatment in this scenario is the rehabilitation with an obturator.[123] The construction of the obturator can be planned ahead in the cases where the patient is partially edentulous and in cases where a minor defect has to be treated. However for the large defects, the construction of the obturator may be challenging. The retention of the maxillary obturator may be poor due to the absence of proper seal and other supporting tissues surrounding it. Seldom can it take the support of the remaining dentition for the retention and stability.[45] The advent of the dental implants has been a game changer in the prosthesis reconstruction. The maxillary obturator with the implant support has been recently gaining popularity in maxillectomy cases.[56] Hence in our study, we evaluated the maxillary obturator prosthesis that is implant supported.

MATERIALS AND METHODS

We piloted a retrospective clinical evaluation of the “implants supported maxillary obturator prostheses (IMOP)” from the institutional records. Ethical clearance and the patient consent were obtained for the study. The subjects were included from the last 10 years from 2010 to 2020 who underwent the maxillectomy and were given the IMOP. Only total maxillectomies that were done for various etiologies were considered for the study. The clinical parameters such as the survival of the prosthesis, failure, the bone support at the mesial and the distal surfaces of the anterior and posterior regions, the radiation regimes, and patient satisfaction were documented and compared for the significance using the Chi-square tests deliberating P < 0.05 as significant.

RESULTS

We observed that of the 50 subjects finalized, a total of 201 implants were placed. The mean age of the survival was 5.4 years. The success and failure were seen in 47 and 3 cases, respectively. The radiation was given for 37 subjects. There was a significant difference for the implant bone height (P = 0.001) and the implant threads exposed (P = 0.044) for the posterior and the anterior regions. Forty subjects considered in our study expressed satisfaction with the IMOP Table 1.

Table 1

Comparison of the various parameters related to the implant-supported maxillary obturator prostheses

Parameter	Observation		P
Total IMOPs	50
Survival, n (time period)	47 (5.4 years)
Failure rate	3
Radiation taken	37
No radiation	13
Parameter	Anterior	Posterior	P
Implant bone height
Mesial	0.82±0.97	0.30±0.47	0.001
Distal	0.58±0.56	0.20±0.85
Implant threads exposed after placement
Mesial	3.74±2.41	1.12±1.54	0.044
Distal	3.00±1.63	1.01±0.96
Patient satisfaction	40

IMOP: Implant-supported maxillary obturator prostheses

DISCUSSION

The defect left after the maxillectomy may be debilitating to the patient. The obturator that is stable will aid in the rehabilitation after these resective procedures.[567] Hence in our study, we evaluated the clinical parameters after the rehabilitation with IMOP. Good success rate of 94% was seen in our study. In our study, we observed that 80% of the subjects expressed satisfaction with the IMOP which is similar to the study of Huang et al.[7] There was a significant bone height difference observed for the anterior and the posterior regions that may have also led to the thread exposure of the implant. Our observation is in unison with the study of Roumanas et al.[5] The significant bone loss in the anterior region may be due to the altered load patterns to the axis of the implant.[2345] The support and the stability of the IMOP may be increased when it is closely adapted and maximally extended into the defect.[5]

The limitations of the study apart from the small sample size were that the type of the maxillectomy, the implants, and the defect size were not evaluated.

CONCLUSION

The implant-supported maxillary obturator prosthesis has been shown to perform clinically satisfactorily in our study. The condition of the patient and the defect has to be considered for the selection of the type of the implant. Further prospective studies are suggested.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.