**6. Prosthetic and facial reconstruction**

Oral and facial deformity can cause functional and psychological deterioration in oncological patients. The aims of prosthodontic reconstruction are the rehabilitation of the shape, function and esthetics of the lost anatomical structures by means of artificial substitutes. The main facial subunits that require reconstruction due to malignant pathological processes involve the ear, forehead, eyes and brow, nose, check, lips and chin [33].

Currently, there are multiple workflows where they combine conventional prosthetic preparation with the use of facial scanners and custom 3D impressions

**169**

**Figure 6.**

*A Review of Maxillofacial Rehabilitation Using Osseointegrated Implants in Oncological…*

that allow the direct or indirect manufacture of definitive maxillofacial prostheses

In early clinical stages, surgery is the first decision. However, adjuvant radio-

involved (<1 mm), and in suspicion or confirmation of lymph node metastasis with or without extracapsular extension [36]. In general, radiation therapy includes conventional radiation therapy or intensity modulated radiation therapy (IMRT). The latter is more convenient by precisely targeting radiation to a specific area and reducing the dose to nearby anatomical structures such as malar bone, grafts,

Schiegnitz's study suggests that radiation negatively affects implant survival, but there is no statistically significant difference in survival when implants are inserted 12 months before or after radiation therapy [38]. Other authors have shown favorable results. With implantation at least 6 weeks before radiotherapy since there is a surgical area with less hypoxia, hypovascularity and hypocellularity [27, 39] (**Figure 6**).

Systemic antineoplastic therapy includes induction, neoadjuvant, adjuvant, and palliative therapy [40]. The survival rate of osseointegrated implants in the patient with antineoplastic and antiangiogenic therapy has not yet been elucidated. Controlled animal studies have shown negative effects on the osseointegration process with chemotherapeutic regimens with cisplatin, bevacizumab and sunitinib [41–43]. However, retrospective studies in humans have reported that chemotherapy has no detrimental effects on the osseointegration and functional stability of dental implants.

The success rates reported by these studies were 97.6 and 99.1% [44–46].

therapy is sometimes indicated in cases of close excision margins (<5 mm),

The main advantage with dental prosthodontic reconstruction is the adaptation of a retained implant obturator that allows a posterior palatal seal. With this, most patients successfully recover phonation, swallowing, and chewing function. Artificial facial prostheses allow us to better characterize the demanding anatomy of the face. In most cases, the retention of facial prostheses occurs when copying the anatomical defect, on other occasions magnetized attachments can be used in prosthetic reconstruction or protective glasses that also improve the characterization of the face (**Figure 5**)**.**

*DOI: http://dx.doi.org/10.5772/intechopen.93224*

**7. Radiotherapy treatment and implants**

implants, salivary glands, eyes, and spinal cord [37].

**8. Chemotherapy treatment and implants**

*Histogram showing trajectories, dose and volume used for adjuvant radiotherapy.*

from conventional silicone [34, 35].

**Figure 5.** *Photograph showing implant-supported obturator placed and final photograph.*

*A Review of Maxillofacial Rehabilitation Using Osseointegrated Implants in Oncological… DOI: http://dx.doi.org/10.5772/intechopen.93224*

that allow the direct or indirect manufacture of definitive maxillofacial prostheses from conventional silicone [34, 35].

The main advantage with dental prosthodontic reconstruction is the adaptation of a retained implant obturator that allows a posterior palatal seal. With this, most patients successfully recover phonation, swallowing, and chewing function. Artificial facial prostheses allow us to better characterize the demanding anatomy of the face. In most cases, the retention of facial prostheses occurs when copying the anatomical defect, on other occasions magnetized attachments can be used in prosthetic reconstruction or protective glasses that also improve the characterization of the face (**Figure 5**)**.**
