Digital Fabrication of Customized Intraoral Appliances for Head and Neck Radiotherapy

Overview

Journal Heliyon

Specialty Social Sciences

Date 2023 May 8

PMID 37153386

Authors

Anussara Prayongrat

Sarin Kitpanit

Chawalit Lertbutsayanukul

Pipop Saikaew

Thirayu Boonrueng

Trakol Mekayarajjananonth

Anjalee Vacharaksa

Affiliations

Soon will be listed here.

Abstract

Introduction: The radiotherapy received by head and neck cancer patients commonly has adverse effects on oral tissue and the muscles of mastication. This short communication describes the digital fabrication of intraoral appliances for radiotherapy and muscle exercises.

Methods: Three patients diagnosed with tongue squamous carcinoma were treatment-planned for radiotherapy using different radiation techniques. The patients were referred for oral scanning and digital bite records, and the appliance was collaboratively designed by a radiation oncologist, dentist, and laboratory technician. The appliance covered the occlusal surface of the remaining teeth with a 1-mm engagement. The lingual plate was 2-mm below the occlusal plane, and extended 4-mm distally, and the jaws were opened by 20-mm. The appliances were printed overnight using a rigid and biocompatible 3D printing material.

Results: Requiring minimal chair-time, the appliance was easily inserted and adjusted to comfortably fit in the mouth. The patients were trained to insert it themselves. The tongue was at a pre-determined position during daily radiotherapy, and the healthy tissues were separated from the radiation field. The patients had mild adverse effects on their oral mucosa. Additionally, the appliances were used for muscle exercises after the radiation courses to prevent trismus.

Conclusions: The interprofessional collaboration to fabricate customized intraoral appliances using digital workflow to maximize patients' benefits is feasible.

Clinical Significance: The use of intraoral appliances is potentially increased when the fabrication process is facilitated. Using an intraoral appliance precisely targets the tumor are for better treatment outcomes, and the healthy adjacent tissues will be preserved to maintain the patient's quality of life.

References

Goel A, Tripathi A, Chand P, Singh S, Pant M, Nagar A . Use of positioning stents in lingual carcinoma patients subjected to radiotherapy. Int J Prosthodont. 2010; 23(5):450-2. View

Scherpenhuizen A, van Waes A, Janssen L, Van Cann E, Stegeman I . The effect of exercise therapy in head and neck cancer patients in the treatment of radiotherapy-induced trismus: A systematic review. Oral Oncol. 2015; 51(8):745-50. DOI: 10.1016/j.oraloncology.2015.05.001. View

Sciubba J, Goldenberg D . Oral complications of radiotherapy. Lancet Oncol. 2006; 7(2):175-83. DOI: 10.1016/S1470-2045(06)70580-0. View

Zaid M, Bajaj N, Burrows H, Mathew R, Dai A, Wilke C . Creating customized oral stents for head and neck radiotherapy using 3D scanning and printing. Radiat Oncol. 2019; 14(1):148. PMC: 6701083. DOI: 10.1186/s13014-019-1357-2. View

Pauli N, Svensson U, Karlsson T, Finizia C . Exercise intervention for the treatment of trismus in head and neck cancer - a prospective two-year follow-up study. Acta Oncol. 2016; 55(6):686-92. DOI: 10.3109/0284186X.2015.1133928. View

Verrone J, Alves F, Prado J, Marcicano A, Pellizzon A, Damascena A . Benefits of an intraoral stent in decreasing the irradiation dose to oral healthy tissue: dosimetric and clinical features. Oral Surg Oral Med Oral Pathol Oral Radiol. 2014; 118(5):573-8. DOI: 10.1016/j.oooo.2014.08.008. View

Nutting C, Morden J, Harrington K, Urbano T, Bhide S, Clark C . Parotid-sparing intensity modulated versus conventional radiotherapy in head and neck cancer (PARSPORT): a phase 3 multicentre randomised controlled trial. Lancet Oncol. 2011; 12(2):127-36. PMC: 3033533. DOI: 10.1016/S1470-2045(10)70290-4. View

Fregnani E, Parahyba C, Morais-Faria K, Fonseca F, Ramos P, de Moraes F . IMRT delivers lower radiation doses to dental structures than 3DRT in head and neck cancer patients. Radiat Oncol. 2016; 11(1):116. PMC: 5015339. DOI: 10.1186/s13014-016-0694-7. View

Wilke C, Zaid M, Chung C, Fuller C, Mohamed A, Skinner H . Design and fabrication of a 3D-printed oral stent for head and neck radiotherapy from routine diagnostic imaging. 3D Print Med. 2018; 3(1):12. PMC: 5954788. DOI: 10.1186/s41205-017-0021-4. View

10.

Strub J, Rekow E, Witkowski S . Computer-aided design and fabrication of dental restorations: current systems and future possibilities. J Am Dent Assoc. 2006; 137(9):1289-96. DOI: 10.14219/jada.archive.2006.0389. View

11.

van der Geer S, Kamstra J, Roodenburg J, van Leeuwen M, Reintsema H, Langendijk J . Predictors for trismus in patients receiving radiotherapy. Acta Oncol. 2016; 55(11):1318-1323. DOI: 10.1080/0284186X.2016.1223341. View

12.

Turner L, Mupparapu M, Akintoye S . Review of the complications associated with treatment of oropharyngeal cancer: a guide for the dental practitioner. Quintessence Int. 2013; 44(3):267-79. PMC: 3773981. DOI: 10.3290/j.qi.a29050. View

13.

Inoue Y, Yamagata K, Nakamura M, Ohnishi K, Tabuchi K, Bukawa H . Are Intraoral Stents Effective for Reducing the Severity of Oral Mucositis During Radiotherapy for Maxillary and Nasal Cavity Cancer?. J Oral Maxillofac Surg. 2020; 78(7):1214.e1-1214.e8. DOI: 10.1016/j.joms.2020.02.009. View

14.

Chochlidakis K, Papaspyridakos P, Geminiani A, Chen C, Feng I, Ercoli C . Digital versus conventional impressions for fixed prosthodontics: A systematic review and meta-analysis. J Prosthet Dent. 2016; 116(2):184-190.e12. DOI: 10.1016/j.prosdent.2015.12.017. View

15.

Lee S, Betensky R, Gianneschi G, Gallucci G . Accuracy of digital versus conventional implant impressions. Clin Oral Implants Res. 2014; 26(6):715-9. PMC: 4428303. DOI: 10.1111/clr.12375. View

16.

Ikawa H, Koto M, Ebner D, Takagi R, Hayashi K, Tsuji H . A custom-made mouthpiece incorporating tongue depressors and elevators to reduce radiation-induced tongue mucositis during carbon-ion radiation therapy for head and neck cancer. Pract Radiat Oncol. 2018; 8(2):e27-e31. DOI: 10.1016/j.prro.2017.10.009. View

17.

Nayar S, Brett R, Clayton N, Marsden J . The Effect of a Radiation Positioning Stent (RPS) in the Reduction of Radiation Dosage to the Opposing Jaw and Maintenance of Mouth opening after Radiation Therapy. Eur J Prosthodont Restor Dent. 2016; 24(2):71-7. View

18.

Chen D, Chen X, Chen X, Jiang N, Jiang L . The efficacy of positioning stents in preventing Oral complications after head and neck radiotherapy: a systematic literature review. Radiat Oncol. 2020; 15(1):90. PMC: 7189514. DOI: 10.1186/s13014-020-01536-0. View

19.

Mall P, Chand P, Singh B, Rao J, Siddarth R, Srivastava K . Effectiveness of Positioning Stents in Radiation-Induced Xerostomia in Patients with Tongue Carcinoma: A Randomized Controlled Trial. Int J Prosthodont. 2016; 29(5):455-60. DOI: 10.11607/ijp.4499. View

20.

Joda T, Bragger U . Digital vs. conventional implant prosthetic workflows: a cost/time analysis. Clin Oral Implants Res. 2014; 26(12):1430-5. DOI: 10.1111/clr.12476. View