Page 145 - Craniomaxillofacial Implant Surgery - Jeroen P.J. Dings

The linear- and angular deviations found in this study, when comparing actual CMF implant positions versus the preoperatively planned implant positions, indicate that the inaccuracies introduced by digitally designed skin-supported surgical templates are clinically unacceptable and further clinical research and technical improvement is warranted.
The second part of this thesis aimed to assess the survival rate of CMF implants. In Chapter 4, implant survival was related to ‘timing of implant placement in relation to ablative surgery’, ‘radiation therapy’ and ‘adjunctive HBO treatment’. In this retrospective cohort study of 35 consecutive patients with a total of 44 nasal implants (17 patients) and 59 orbital implants (18 patients), the mean duration of follow-up was 35 months (8-156 months). It was concluded that orbital and nasal implants inserted during ablative surgery showed a significant higher survival rate (p=0.044) than implants installed after ablative surgery. No significant difference in survival of implants placed in irradiated versus non-irradiated bone, possible benefit of preventive HBO therapy or relation with CMF location was found.
The third part of the thesis focused on the subjective assessment of patients
and other observer groups with regard to the clinical outcome of prosthetic and
autologous reconstruction of CMF defects. In Chapter 5, a retrospective clinical study
is described, in which treatment outcome and quality of life was determined by using questionnaires regarding different aspects of CMF prostheses (durability, comfort, type
of retentive system, prosthesis hygiene), overall satisfaction, self-image and impact
on socialization. High Cronbach’s alpha values (0.82) showed an adequate internal
consistency. A total of 52 patients, comprising 12 orbital, 17 nasal, and 23 auricular
prostheses, completed the questionnaires. High satisfaction scores were noted with
regard to ‘wearing comfort’, ‘fit’ and ‘aesthetics’ of the prostheses. However, implant-
retained prostheses were shown to be statistically significant more advantageous in 8 comparison with adhesive-retained prostheses in terms of enhanced retention and ease
of placement and removal (p=0.01 and p=0.04, respectively). No significant differences were found in peri-implant tissue complications between the various anatomical locations and retentive systems although patients with auricular defects cleaned their prostheses significant less frequently (p=0.01). Patients with prosthetic rehabilitation of nasal defects were shown to be significantly more frequently dissatisfied with the junction of their prosthesis to the surrounding soft tissue and more aware of others noticing their prostheses. In contrast, patients with auricular defects were significantly less embarrassed (p=0.01) by their prostheses.
Summary in English and Dutch
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