The gold standard for the reconstruction of the mandible is a free bony flap, the fibula being commonly used. Following reconstruction optimal function and aesthetic rehabilitation is the goal. There is no doubt that patients consider chewing, swallowing and speech to be of paramount importance. Following surgery suboptimal rehabilitation leads to a fall in quality of life and can induce depression and reduced social interaction. The purpose of this study was to assess the Quality of Life (QoL) and denture satisfaction in patients. This is an excellent prospective randomised study across two maxillofacial hospitals in India. All patients had mandibular resections and reconstruction with a fibula free flap. Participants were randomly allocated into two groups, either two or four implant supported dentures, from July 2012 until July 2013. Fifty-two patients were divided equally. Implants were placed in the neo mandible. As most would have expected, patients with implant supported prosthesis had significantly improved QoL, as opposed to conventional dentures. However, interestingly there was no significant difference in the two implant groups. The main shortcoming of the study, as acknowledged by the authors is the short post rehabilitation time. Also, the questionnaire used was in English; for patients that could not understand, a translation was provided by the evaluator. Notwithstanding this is still an excellent study with a sound scientific background and methodology. It would be interesting to learn if patients with the two implants fared any worse in the long-term with increased force placed on the implants.

Implant supported dental rehabilitation following segmental mandibular reconstruction – quality of life outcomes of a prospective randomised trial.
Kumar V, Jacob PC, Ebenezer S, et al.
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Sunil K Bhatia

Royal Shrewsbury Hospital, Shrewsbury, UK.

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