Oral cancer is a particularly difficult and morbid malignancy, often resulting in marked functional and aesthetic alterations post-treatment [1,2,3,4]. Individuals undergoing such therapy often experience severe morbid consequences, such as facial disfigurement, loss of speech, difficulties in eating, and social avoidance, among other factors, ultimately impairing their quality of life. Prosthodontic management, using a combination of fixed and removable solutions, is progressively believed to be an important part of the management of these patients. This editorial will discuss the recent developments related to the use of prosthodontic management within oral cancer patients, based on the recent literature in this Special Issue.
One of the issues that often arises for patients with head and neck cancers is the large extent of the ablative surgery that leads to substantial anatomical changes [5,6]. This often leads to difficulties with conventional prosthetic rehabilitation methods in patients undergoing radiotherapy as well. However, current developments in implant prosthetics and material science have made significant improvements to the extent of rehabilitative results for patients with head and neck cancers. One of the most well-established methods of prosthetic replacement has been implant overdentures. For example, Malgaj et al. show that implant overdentures work well for patients with maxillary defects [7].
The use of digital technology in prosthetic rehabilitation has significantly changed this area as well and improved the precision of planning and its results. Ta et al. discuss the use of digital techniques in the fabrication of immediate obturator prosthetics and mention cone beam computed tomography (CBCT) scans, intraoral scans, CAD-CAM designs, and 3D printing in the fabrication of prosthetics intended for immediate use following surgery [8]. Immediate rehabilitation can reduce pain and hasten the healing process and returns vital functions such as speech and mastication to the patient in the early postoperative period; this is critical for the patient’s psychological and social rehabilitation.
Besides digital planning, implant placement with a prosthesis-driven approach always remains a core concern. The point in time for implant placement, either immediate or delayed, becomes a central factor for the success of prosthodontic rehabilitation. Patel et al. emphasize the implant success rate in irradiated and non-irradiated tissues, thereby providing evidence that in irradiated tissues, implants can achieve high success rates in spite of radiotherapy despite its complications [9]. Patel et al.’s opinion supports Tousidonis et al.’s view that there has been a growing success with implant placement in primary surgery for cancer, thereby enabling a shorter patient rehabilitation period without a functional prosthesis [2].
The effect of radiotherapy on the survivability and osseointegration of implants, as well as the integrity of the soft tissue, continues to be of interest to the profession. Although there have been suggestions of the detrimental effect of radiotherapy on osseointegration, developments in treatment protocols, such as intensity-modulated radiation therapy (IMRT), have increased the success rate in patients who undergo radiotherapy. The results of Tousidonis et al. highlight the strong success rate of implants in patients undergoing primary resection, whether irradiated or not, suggesting effective outcomes in challenging patients with proper technique [2].
Prosthetic reconstruction in patients with jaw reconstruction remains a challenge. According to Manju et al., in maxillomandibular reconstruction post-ablative surgery, prosthetic reconstruction is associated with several challenges. These include the need for meticulous planning in the placement of dental implants in a reconstructed jaw with procedures such as fibula flaps in bone reconstruction [3]. The availability of bone in adequate quantity and the soft tissue status is important in the integration of the implant.
Aside from the technical aspect, it is also important to consider the psychological implications of recovering through a prosthesis [10]. A study by Silvestri et al. investigated the effect of rehabilitative treatment utilizing a prosthesis on OHRQoL in patients who have undergone irradiation for head and neck cancer and reported impressive results indicating improvements in psychosocial aspects of patients after rehabilitation, thus justifying that not only physical but also psychosocial improvements are ensured by having an optimal prosthesis [11]. This was in line with Quadri et al., who suggested more investigation on OHRQoL changes after long-term rehabilitative treatment using a prosthesis, specifically in terms of psychosocial aspects [10].
Furthermore, Bhadel et al. studied the role of facial parameters in determining the vertical relation in full mouth rehabilitation. The study proves its relevance in illuminating the role of precise facial parameters in ensuring proper prosthesis fitting in cases involving significant facial surgery [12]. The finding can enhance existing knowledge on the importance of adequate dental design in facilitating reconstructive success in oral cancer patients.
Finally, when considering patients with head and neck cancer, it is essential for implant-prosthetic services in these patients to assess survival and complication rates in determining success in rehabilitation. To establish the benefits of these services, a retrospective study by Laverty et al. on implant-retained prostheses in oncology patients revealed high survival and low complication rates, specifically when using fixed prostheses [13].
Conclusion: The current state of prosthesis and rehabilitative techniques in patients with oral cancer is a field in which there is immense progress being made in the light of advancements in digital technology, implantology, and materials science, although there is still a lot of difficulty involved, especially in irradiated patients and in those in which complex reconstructive work is to be completed. Research is required in this field to ensure optimal outcomes for patients with oral cancer.
Author Contributions
Conceptualization, M.M.M. and G.M.; methodology, G.M.; data curation, M.M.M. and H.U.; writing—original draft preparation, H.U. and M.M.M.; writing—review and editing, G.M.; supervision, G.M.; project administration, G.M. All authors have read and agreed to the published version of the manuscript.
Funding
This research received no external funding.
Institutional Review Board Statement
Not applicable.
Informed Consent Statement
Not applicable.
Data Availability Statement
The data presented in this study are available within the article. No additional data are available.
Acknowledgments
During the preparation of this manuscript, the authors used DeepL Translate, web version, for language checking/grammar correction. After its use, the authors thoroughly reviewed, verified, and revised all content to ensure accuracy and originality. The authors take full responsibility for the integrity and final content of the published article. The manuscript was additionally reviewed for scientific English before submission.
Conflicts of Interest
The authors declare no conflicts of interest.
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