Dentures and Dental Implants in Treating Patients Undergoing Surgery for Mouth Cancer

Jonsson Comprehensive Cancer Center

Status and phase: Completed; Phase 2

Conditions: Head and Neck Cancer

Treatments: Other: Implant

Study type: Interventional

Funder types: Other

Identifiers

NCT00006341

CDR0000066588

UCLA-DEN-1R01DE11255

UCLA-HSPC-940205411

NCI-V00-1606

UCLA-HSPC-940205413

Details and patient eligibility

About

RATIONALE: The use of dentures and dental implants may help maintain chewing and speaking ability following surgery to remove tumors in the mouth.

PURPOSE: Phase II trial to study the effectiveness of dentures and dental implants in maintaining the ability to chew and speak in patients undergoing surgery for mouth cancer.

Full description

OBJECTIVES:

• Determine whether conventional or implant supported dental prostheses and current surgical reconstructive procedures restore oral function and quality of life to pre-cancer surgery levels in patients with early oral cancer.

OUTLINE: Patients complete a series of objective and subjective functional tests, questionnaires, and baseline examinations. Within 1-5 days, patients undergo the composite resection, including reconstructive surgery for the mandibulectomy group. Patients in the maxillectomy group receive an immediate maxillary surgical obturator. Approximately 6 weeks after ablative surgery, some patients receive radiotherapy for 5-7 weeks.

Patients receive 2-4 implants at 12-16 weeks after completion of radiotherapy or 8-16 weeks after ablative surgery. Patients then receive conventional dentures at 4-22 weeks after implant surgery. Implants are exposed during 27-48 weeks after placement and abutments connected for fabricating dental prostheses. Approximately 8 weeks are needed to fabricate the implant supported prosthesis.

Patients complete quality of life and other questionnaires prior to and at 8-21 weeks after surgery, 16 weeks after conventional denture insertion, and then 16 weeks after implant supported prosthesis insertion.

Patients are followed every 6 months for at least 3 years.

PROJECTED ACCRUAL: A total of 62 patients (22 requiring maxillectomy and 40 requiring mandibulectomy) will be accrued for this study within 42 months.

Enrollment: 46 patients

Sex: All

Ages: 35 to 80 years old

Volunteers: No Healthy Volunteers

Inclusion and exclusion criteria

DISEASE CHARACTERISTICS:

• Diagnosis of early oral cancer lesions requiring one of the following:

  • Partial or total unilateral maxillectomy OR
  • Partial lateral mandibulectomy with or without partial glossectomy

• Edentulous or edentulous in the maxillary arch prior to or after ablative surgery (maxillectomy group)

• Partial mandibulectomy leaving the condyles intact bilaterally (mandibulectomy group)

• Must have sufficient bone in the selected implant sites to accommodate 2-4 implants of at least 10 mm in length

• No temporomandibular dysfunction and/or functionally restrictive opening

• No requirement for total glossectomy, reconstructive maxillary surgery, or maxillary sinus lift

• No requirement for radiotherapy after mandibular reconstructive surgery

PATIENT CHARACTERISTICS:

Age:

• 35 to 80

Performance status:

• Not specified

Life expectancy:

• Not specified

Hematopoietic:

• Not specified

Hepatic:

• Not specified

Renal:

• Not specified

Other:

• No oral discomfort that would preclude study
• No complications after ablative or reconstructive surgery that would preclude dental rehabilitation with implants

PRIOR CONCURRENT THERAPY:

Biologic therapy:

• Not specified

Chemotherapy:

• Not specified

Endocrine therapy:

• Not specified

Radiotherapy:

• See Disease Characteristics
• No prior or concurrent radiotherapy of greater than 5,500 cGY to potential implant site

Surgery:

• See Disease Characteristics

Trial design

Primary purpose: Supportive Care

Allocation: N/A

Interventional model: Single Group Assignment

Masking: None (Open label)

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46 participants in 1 patient group

Implant

Experimental group

Description:

A total of 62 patients with early oral cancer will be recruited; in addition, 22 patients requiring a partial maxillectomy and 40 requiring a partial lateral mandibulectomy will be enrolled. The mandibular defects will be reconstructed with fibula free flap surgery. Following a healing period, implants will be placed and permitted to heal unloaded for six months. Conventional dental prostheses will be fabricated and used by patients for at least 16 weeks during Phase I healing before the implants are exposed and loaded. A few weeks after Phase II surgery, the patients will receive implant-supported dental prostheses.

Treatment:

Other: Implant