252 Chapter 9 this group, the prostheses were implant-retained, resulting in significantly better masticatory performance. The statistical power calculation of this study showed the strength of our results. We would therefore strongly recommend that any edentulous patient with a maxillary defect who is rehabilitated with an obturator prosthesis consider implant placement. This recommendation is opposed to surgical reconstruction of maxillary defects as well. Surgical reconstruction of maxillary defects is morbidity prone, costs time, resources and leads to masticatory functional rehabilitation much later than the recommendation we make. Chewing is the prerequisite for being able to swallow and digest adequately. Future research should not be limited to chewing. The inclusion of other functions, such as swallowing and speech, as well as the maintenance of healthy nutrition through peroral food intake should be the focus of masticatory functional rehabilitation. The combination of objective testing methods supplemented by subjective research through questionnaires or interviews will provide a more complete picture. Questionnaires should be available and validated in different languages to facilitate subjective multinational studies. By translating the Liverpool Oral Rehabilitation Questionnaire Version 3 (LORQv3) into Dutch and adapting it to Dutch conditions, we made this questionnaire available to the Dutch population. This questionnaire was developed to provide a more sophisticated measurement of the impact of prosthetic treatment on the quality of life of patients with HNC. Together with the validated Turkish and German versions and the original English version, international research with the same questionnaire on the effects of prosthetic care is now possible. Reducing tooth extractions prior to HNC-induced RT results in improved quality of life. With 61% (based on maximum dose) to 74% (based on mean dose) of teeth removed at sites that ultimately received a dose of <40Gy, we limited the chewing ability of the 358 patients more than absolutely necessary. We provided tools for initial de-escalation steps in patients with tumors in the head and neck region. However, further research is needed to de-escalate current guidelines based on valid data without increasing other risks to patients. Future research should preferably be directed to the threshold RT dose for dental extractions prior to RT to prevent ORN to gain evidence-based data.
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