14 Chapter 1 are made based on the expected radiation dose. Because the risk of developing ORN begins at an RT dose of approximately 40Gy [27], it is desirable to eliminate oral sources of infection that are likely to be within the radiation field and receive a cumulative dose of ≥40Gy [43, 57]. Ideally, the dentition should be preserved as much as possible to allow optimal rehabilitation of masticatory function and QoL, but treatment plans should be based on basic principles of prosthodontics, including a philosophy of preventive and conservative restorative dentistry [17]. This includes the role of natural teeth as an anchor point for a removable partial denture or as a pillar for (semi)fixed prosthetic rehabilitation [49]. The edentulous patient In a completely edentulous patient, successful prosthetic rehabilitation depends on the existing anatomical base. The hard palate in the upper jaw provides a stable base for this prosthetic rehabilitation. In de mandible, only a horseshoeshaped base is available, so the tongue, lips and cheeks play an important role in stabilizing the prosthesis. When oral anatomy changes due to HNC treatment, it can be very difficult to place a stable and retentive prosthesis. In addition, altered lubrication of the oral cavity may cause the prosthesis to damage the mucosa [23]. Implant-retained dentures (IODs) are a standard treatment for patients with HNC and appear to contribute to successful overall treatment [58-60]. However, the percentage of patients in HNC therapy who receive dental implants varies widely from 22% to 91% [25]. In the maxilla, the stable prosthetic base of the hard palate may be lost due to trauma, infection or tumor resection. This can lead to leakage through the nose, impaired speech intelligibility due to loss of air and inability to chew resulting in enormous limitations in daily life [21, 22, 61]. Reconstruction of these defects remains a challenge for both surgeons and prosthodontists due to the complex three-dimensional anatomy of the maxilla and midface and is controversial [62-65]. Valid arguments have been presented for choosing the best reconstruction and rehabilitation method based on parameters such as QoL and functional outcomes [66-69]. Regardless of the rehabilitation method, defects that encompass a significant portion of the alveolus must be rehabilitated to allow optimal masticatory behavior and appearance of teeth [64]. A significant number of surgically reconstructed patients will remain excluded from dental rehabilitation and will not return to normal eating [70].
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