216 Chapter 7 that may limit the neutral zone and restrict the area of support for complete dentures. RT can cause lifelong side effects such as fibrosis, xerostomia, dysphagia, osteoradionecrosis (ORN), radiation caries, and trismus [8]. Hyposalivation leads to worsening of the lubrication of the oral cavity, resulting in reduced retention of the prosthesis and increased risk of mucosal damage. Dental implants have been used worldwide for more than 60 years and have proven to be very successful. Implant treatment significantly improves masticatory function and patient satisfaction over a long period of time [2, 9, 10]. These long-lasting successful treatment results have also been achieved in edentulous patients after treatment of oral cavity cancer [11, 12]. The improved masticatory function with implant-retained overdentures (IOD) compared with conventional dentures (CD) and no functional dentures (NFD) is mainly due to the higher maximum bite force of the IODs [13]. Rehabilitation of the edentulous mandible In Chapter 2, we investigated functional treatment outcomes and patient satisfaction using patient-reported outcomes (PROMs) in 51 patients with HNC who received a full mandibular prosthesis with or without implants after completion of RT. Compared with the literature, good results were obtained, with 88.3% of these prostheses functioning at the time of evaluation (range: 1 to 23 years) [14, 15]. Overall satisfaction with the prosthesis was relatively high, with a mean score of 7.3 out of 10. This was comparable to other studies in patients with cancer of the oral cavity as well as healthy patients [15-17]. Patients who received additional treatment, such as surgery, performed worse than patients who received RT alone. Recent publications, mainly in patients with carcinomas of the oral cavity, have clearly demonstrated the additional benefit of implants. Edentulous oral cancer patients with full dentures on implants had higher bite force, reported fewer problems with the dentures, and had less difficulty chewing, especially solid and soft foods [13]. For patients with oral cavity cancer who are scheduled for ablative surgery, it is possible to place implants during ablative surgery, which offers several advantages. During the wound healing phase of tumor surgery, the initial osseointegration of the implants takes place, and if adjuvant RT is required, the onset of RT is not (additionally) delayed by implant placement. The individual cost of implant placement during ablative surgery is lower than deferred implant placement [18]. In addition, earlier prosthetic rehabilitation after cancer treatment is possible, which may also lead to higher bite force and masticatory function [13, 19].
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