Implant reconstructive prostheses in the mandible after ablative surgery:A rationale for treatment planning

Surgical treatment of malignancies of the tongue, floor of the mouth, or mandible leads in most cases to an unfavorable anatomic situation for prosthodontic rehabilitation. The result is severe functional oral disturbances despite improved surgical techniques for reconstruction. Radiotherapy, often applied postsurgically, even worsens these conditions. Main problems consist of the severe reduction of the neutral zone, which influences the stability of the prosthesis, and the poor load-bearing capacity of the remaining soft tissues and underlying bone. Many of these problems can be diminished through the use of an oral implant as these implants can contribute to the stabilization of the prostheses and intercept the main part of the occlusal loading. Surgical interventions after radiotherapy are preferably avoided to prevent healing problems, such as the development of radionecrosis. Therefore, implantation during ablative surgery must be considered if postoperative radiotherapy might be applied. A thorough presurgical examination and multidisciplinary consultation are needed for a well-established indication. Besides the primary curative intent of the oncological treatment, the prognosis for later prosthodontic rehabilitation must also be taken into account.