219 General discussion 7 [42]. Valid arguments have been made for choosing the best reconstruction and rehabilitation method based on parameters such as quality of life and functional outcomes [43-46]. The most appropriate reconstruction is ultimately determined by many factors, such as defect size, dental status, patient motivation for oral rehabilitation, comorbidities, facility experience, and clinician preferences [47]. Regardless of the rehabilitation method, defects that encompass a significant portion of the alveolus must be rehabilitated to allow for optimal masticatory behavior and appearance of the teeth [39, 48]. Low-level defects are less detrimental to facial appearance and primarily require treatment of the oronasal defect and dental rehabilitation. In many parts of the world, prosthetic obturation of these defects is still the treatment of choice, allowing the patient to speak, swallow, and chew. The obturator also continues to play a useful role for patients who cannot undergo complex autogenous reconstruction or in whom access to the surgical site is considered important for monitoring [35, 49-51]. However, inadequate retention makes this prosthetic rehabilitation of the maxilla challenging [50] where, as in the mandible, implant retention, especially in edentulous patients, has also proven useful [39, 52-56]. In Chapter 4a, we evaluated the potential benefits of implant placement on masticatory function and QoL of edentulous maxillectomy patients after prosthetic obturation. We evaluated both objective outcomes from the mixing ability test (MAT) and subjective outcomes from the OHRQoL questionnaires, as objective information of oral functioning may be different from personal experiences [57]. We used the oral health impact profile for edentulous people (OHIP-EDENT) [58], the Memorial Sloan Kettering Cancer Centre obturator functioning scale (OFS) [59] and the Dutch version of the Liverpool oral rehabilitation questionnaire version 3 (LORQv3-NL) [60]. The results of the nine patients with implant supported obturator prostheses showed a significantly better mixing ability index (MAI) score outcome, notwithstanding the larger and more ventral defects. These MAI score results (18.7 ± 1.37) were similar to dentate obturator patients (18.4 ± 4.2) and healthy edentulous non-maxillectomy individuals with conventional maxillary dentures and implant-supported mandibular overdentures (MAI 18.5 ± 3.1). The mean MAI score of the ten patients with conventional obturator prostheses (22.4 ± 3.16) were comparable to healthy full denture patients (21.2 ± 3.6) and other edentulous obturator patients (25.1 ± 5.3) [27, 61].
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