Page 131 - Craniomaxillofacial Implant Surgery - Jeroen P.J. Dings

General discussion and future perspectives
As no physical examination was executed, the hygiene regimen, the possible need for aftercare or classification of peri-implant skin reactions were based on subjective assessment by the patients themselves. Therefore, no distinction could be made in the 46.1% of respondents with minor soft tissue complications according to the classification of Holgers with regard to peri-implant skin reactions46. Auricular prostheses were reported to be cleaned less frequently (p=0.01), although no significant difference was found in minor soft tissue complications between different anatomic locations and the various retentive systems. Comparison with literature is difficult, as most studies lack information on the presence of skin complications, and do not make use of the aforementioned strict diagnostic criteria identified by Holgers et al, or hygiene maintenance.
In general, cleaning under bars is shown to be more difficult in comparison with magnets. However, to our knowledge, no relation is found in literature with regard to impact of hygiene on implant success32,33,36.
The choice for a retentive mechanism in these areas is principally governed by the
location of the defect, design of the prosthesis indication and the practitioner’s ability47.
In our study, magnetic retention systems were predominantly used for orbital epitheses
due to eased insertion of the prostheses, compensation of non-parallelism of the
installed implants and low moment forces on the supporting abutments and implants.
The same retention methods for orbital prostheses are predominantly described in literature37,47. Bar-clip retention is mostly used for retention of auricular prostheses47.
For the nasal region, bar-clip, as well as magnet retention are reported. In general, 7 bar-clips require more space within the future prosthesis, which is often lacking in the
orbital- and nasal regions. Results from our study concerning psychological- and social aspects revealed no statistically significant differences for type of attachment.
Patients’ experiences with implant-retained prosthesis and their previous adhesive- retained prosthesis were also determined in this study. All patients who had experience with adhesive-retained prostheses preferred bone anchorage with regard to enhanced and reliable retention, as also ease of handling (p=0.04). An implant-retained prosthesis often is not experienced as an extraneous object due to its enhanced support and stability16,45,48,49. Furthermore, prosthetic durability is prolonged with regard to less discoloration and degradation of prostheses because no adhesives and solvents are used50.
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