220 Chapter 7 We reached an overall implant survival of 90.5%, losing 4 of 42 implants, all 4 in irradiated bone. These results are similar to other studies, most of which did not address dental implant survival in extra-maxillary bony structures of the midface or skull base [53, 62-65]. As the patients were able to continue wearing their prosthetic obturators despite single implant loss, we considered this a successful overall outcome of functional rehabilitation. Our OHIP-EDENT, OFS, and LORQv3-NL results did not disclose significant differences in summary scales between the two patient groups. This is probably due to the long-time interval between prosthetic rehabilitation and data acquisition (range: 1 month-7.4 years). Patients tend to adapt over time and under-report deficits, also called response shifts [66]. On the subscale level, the ‘Oral function’ subscale and the ‘Patient Satisfaction’ subscale of the LORQv3-NL showed that implant retainment has an added value for the obturator prostheses. Although these benefits are underlined in response choices by all three questionnaires, the small patient groups should be considered. The same carefully interpretation should be applied for the promising results in the speaking and swallowing domains, which have proven to be important for quality of life [59, 67]. In Chapter 4b we compared the objective and subjective masticatory function of patients with implant-supported obturators with patients with surgically reconstructed maxillae in a collaboration with UMC Utrecht and University of Alberta, Edmonton, Canada. The implant-supported obturator group, consisted of the nine patients with edentulous upper jaws and implant-supported obturators from Chapter 4a [68]. The surgically reconstructed maxillae group consisted of 11 patients: 6 reconstructed according to the Alberta Reconstructive Technique (ART) protocol [69, 70] for malignant tumors and 5 according to the Rohner-protocol [71] for benign tumors from the HREBA.CC-17-0167 study [72]. The results demonstrated comparable masticatory performance and patient reported eating ability for patients with surgically reconstructed maxillae and patients with implant supported obturator prostheses. The mean MAI for both groups (18.2 ± 2.38 resp. 18.7 ± 1.37) remained below the MAI-level of the natural dentition group (15.8 ± 2.0), confirming previous research into chewing performance in maxillectomy patients [27, 73].
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