239 Summary 8 test (MAT) and the questionnaires were: (1) the Oral Health Impact Profile for EDENTulous People (OHIP-EDENT), (2) the Obturator Function Scale (OFS), and (3) the LORQv3-NL. The nine patients with implant-supported obturator prostheses had a significantly better masticatory and oral function, reported fewer chewing difficulties, and had less discomfort during food intake than did the ten patients with a conventional obturator. A second cross-sectional study (Chapter 4.2) was conducted in collaboration with UMC Utrecht and the University of Alberta, Edmonton, Canada. The masticatory performance and patient reported eating ability of the nine patients with implant-supported obturator prostheses (Maastricht) were compared to 11 surgically reconstructed maxillectomy patients (Edmonton). Again, masticatory performance was measured by the mixing ability test (MAT). Oral health-related QoL was measured with shortened versions of the OHIP questionnaire. Patients with reconstructed maxillae and patients with implant-supported obturator prostheses had similar MAT scores. The seven oral health-related QoL questions also showed no differences in chewing ability between the two groups. In conclusion, supporting prosthetic obturators after maxillectomy with implants improves oral functioning, chewing, and eating comfort. With caution, the results of this study seem to confirm earlier results that implant-supported obturation is a good alternative to surgical reconstruction for all Class II maxillary defects according to Brown’s classification. With both techniques, the masticatory performance is sufficiently restored, with careful planning being highly desirable. The final part of this thesis addressed tooth extractions prior to RT. Patients with HNC who were eligible for RT were seen by a dental team for a comprehensive dental assessment prior to RT. Teeth with a limited prognosis at risk of developing osteoradionecrosis (ORN) during or after RT were extracted. ORN, or radiationinduced osteomyelitis, is a serious and late complication of RT, characterized by irradiated bone that becomes devitalized and is exposed through the overlying skin or mucosa, without tumor recurrence and failing to heal within three months. ORN can lead to pathologic fractures, intra- or extra-oral fistulas and infection and often requires extensive surgery. These procedures are risky and complex, can lead to new side effects, and have a negative impact on QoL. Available evidence on the efficacy of pre-RT tooth extractions in preventing ORN is limited. At the same time, tooth extractions result in a reduced number of functional units and impair the ability to chew and swallow. To allow extraction
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