78 Chapter 4 or not. In our study, the implant sites of the lost implants had been irradiated with more than 50Gy. Nevertheless, the patients could continue to wear their prosthetic obturators despite singular implant loss, which we considered a successful overall result of functional rehabilitation. In addition to objective results such as MAI scores, functional aspects must be assessed subjectively using the OHRQoL. The OHIP-EDENT is a modified shorted version of the OHIP-49 questionnaire which, in contrast to the more commonly used OHIP-14, includes items related to chewing and denture problems [24]. The OHIP-EDENT showed significantly better results after implant-retained prosthetic rehabilitation in a study on five edentulous hemi-maxillectomy patients [18]. The Memorial Sloan Kettering Cancer Centre Obturator Functioning Scale (OFS) has proven to be a viable questionnaire to assess self-reported obturator functioning and to predict quality of life in maxillectomy patients [7, 41, 42]. It has shown the negative impact of (adjuvant) radiotherapy [15, 16, 42, 43] and defect size on obturator functioning [16, 35]. The LORQv3 is a health-related questionnaire assessing the impact of oral rehabilitation on patients’ OHRQoL [26-28]. It has recently been translated and validated into the Dutch language, resulting in the LORQv3-NL [25]. This questionnaire has shown the added value of prosthetic rehabilitation in improving HRQoL of patients treated for head and neck cancer, including maxillectomy patients rehabilitated with obturator prostheses [44-46]. 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 [47]. 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 [7, 41].
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