Kanchan P. Dholam

Bio: Kanchan P. Dholam is an academic researcher from Homi Bhabha National Institute. The author has contributed to research in topics: Rehabilitation & Implant. The author has an hindex of 10, co-authored 44 publications receiving 293 citations. Previous affiliations of Kanchan P. Dholam include Tata Memorial Hospital.

Dental implants in irradiated jaws: A literature review

Abstract: Surgical treatment of head and neck cancer frequently results in defects that challenge conventional prosthetic rehabilitation. Successful rehabilitation using tissue supported dentures in such cases has been reported to be less than 20%. With the loss of jaw bones and thus the support, there is loss of retention to a great deal. Also, teeth loss on the side of the defect adds to failure in retention. Scar tissue formation, deviation of jaw due to muscle pull, decreased mouth opening, loss of sulcus and non vertical force are some of the common adversaries of jaw resection especially mandibular resection which pose great limitation on the stability and success of prospective prosthetic rehabilitation. The advent and application of biologically acceptable implants in clinical dentistry has contributed to restoring the defects of the deficient maxillofacial systems. Surgical intervention in patients who had received head and neck irradiation is preferably avoided as it has been associated with decreased healing and increased potential for development of osteoradionecrosis. Hence an implant as an option when surgical field has received tumerocidal radiation is empirically excluded. The purpose of this article is to review the studies and reports published in various journals related to osseointegrated implant rehabilitation in irradiated bones.

Assessment of quality of life after implant-retained prosthetically reconstructed maxillae and mandibles postcancer treatments.

Abstract: Purpose The aim of this prospective study was to assess treatment outcome and impact on quality of life with implant-retained prosthesis in reconstructed jaws in head and neck cancer patients. Materials and methods Twelve patients were rehabilitated with implant-retained dental prosthesis following free fibular graft after segmental resection. These subjects were evaluated by standardized questionnaires European Organization for Research and Treatment of Cancer QLQ-C30 (version 3) and clinical assessment for quality of life. Objective assessment of speech parameters was done with Dr. Speech Software (Tiger DRS Inc., Seattle, WA). The questionnaire consisting of information on evaluation of deglutition, salivation, status of the mandible and teeth in relation to predisease level was used for subjective judgment of speech. Results Consumption of solid, semisolid, and overcooked food was considerably better with the prosthesis. Drinking ability was not affected. Patients' voice resonance was improved, and they could sustain phonation for longer duration without difficulty. They were able to speak loudly, and their intonation pattern was also slightly better. Failure of the implants to osseointegrate at the end of 18 months was observed in 37% of the patients. This was attributed to radiation before implant insertions and periimplantitis. Despite the observed improvement in some patients, the statistical analysis of speech, swallowing parameters, and quality of life were not significant because of the paucity of numbers in this pilot study. There was no improvement in the symptoms scale scores. Conclusion Reconstruction and rehabilitation of the jaws affected by tumor restores the patient anatomically, esthetically, and functionally to optimum levels. However, a study with larger numbers of patients is necessary to ascertain the benefits of this treatment modality.

Effectiveness of fluoride varnish application as cariostatic and desensitizing agent in irradiated head and neck cancer patients.

Abstract: Objective. To evaluate the effectiveness of three-month fluoride varnish application on radiation caries and dental sensitivity and to assess compliance to three-month fluoride varnish application. Materials and Methods. 190 irradiated head and neck cancer patients were randomly selected and reviewed retrospectively. Oral prophylaxis, fluoride varnish application, and treatment of dental caries were done prior to radiation therapy. Patients were followed up at every three months for dental evaluation and fluoride varnish application. Decayed-missing-filling-teeth indices, dental sensitivity, and compliance to fluoride varnish application were noted for fifteen months and analyzed statistically. Results. Significant increase in decayed-missing-filling-teeth index was seen at nine (P = 0.028), twelve (P = 0.003) and fifteen (P = 0.002) months follow-up. However, the rate of increase in decayed-missing-filling-teeth indices was 1.64/month which is less than the rate mentioned in the literature (2.5/month). There was no significant effect of sex (P = 0.952) and surgery (P = 0.672) on radiation caries, but site of disease (P = 0.038) and radiation dose (P = 0.015) were found to have statistically significant effect. Dental sensitivity decreased from 39% at 3 months to 25% at 15 months followup. 99% compliance to fluoride varnish application was seen till six months followup which decreased to 46% at fifteen months. Conclusion. Three-month fluoride varnish application is effective in decreasing radiation caries and sensitivity and has good compliance.

Impact of oral rehabilitation on patients with head and neck cancer: A study using the Liverpool Oral Rehabilitation Questionnaire and the Oral Health Impact Profile-14.

Abstract: Statement of problem The treatment of oral cancers affects oral functions and quality of life (QOL). Dental rehabilitation is a major step toward enhancing quality of life after controlling the disease. The effects of the disease, treatment, and rehabilitation need to be evaluated to assess oral health-related QOL. The Liverpool Oral Rehabilitation Questionnaire version 3 (LORQv3) and Oral Health Impact Profile-14 (OHIP-14) are specific assessment questionnaires of oral rehabilitation. Purpose The purpose of this study was to assess the impact of oral rehabilitation on patients with head and neck cancer by using the LORQv3 and OHIP-14 questionnaires and to discover and document specific patient-derived problems related to the issues of oral rehabilitation. Material and Methods The LORQv3 and OHIP-14 questionnaires were administered to 60 participants with oral cancer, who were in need of oral rehabilitation. They were asked to rate their dental problems on a Likert scale before fabrication of their prostheses (baseline) and at the 3-month follow-up visit after prosthetic rehabilitation. Paired comparison was done using the Wilcoxon signed rank test according to the distribution, and Cronbach alpha was used to assess internal consistency. Subscale scores were determined by mean value (α=.05). Results For the LORQv3 questionnaire, a 10% to 27% improvement was found in the domain of oral function, and a 20% improvement in orofacial appearance, with improvement in patient satisfaction with the prosthesis. Using the OHIP-14 questionnaire, a 45% to 67% improvement was generally seen in all domains. Conclusions After assessment using the LORQv3 and OHIP-14 questionnaires, prosthetic rehabilitation was seen to contribute to the betterment of patients with head and neck cancer.

Clinical practice guidelines in oncology

Abstract: Ductal carcinoma in situ (DCIS) of the breast represents a heterogeneous group of neoplastic lesions in the breast ducts. The goal for management of DCIS is to prevent the development of invasive breast cancer. This manuscript focuses on the NCCN Guidelines Panel recommendations for the workup, primary treatment, risk reduction strategies, and surveillance specific to DCIS.

Hyperbaric oxygen therapy

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Head and Neck Cancers, Version 2.2020, NCCN Clinical Practice Guidelines in Oncology.

Abstract: Treatment is complex for patients with head and neck (H&N) cancers with specific site of disease, stage, and pathologic findings guiding treatment decision-making. Treatment planning for H&N cancers involves a multidisciplinary team of experts. This article describes supportive care recommendations in the NCCN Guidelines for Head and Neck Cancers, as well as the rationale supporting a new section on imaging recommendations for patients with H&N cancers. This article also describes updates to treatment recommendations for patients with very advanced H&N cancers and salivary gland tumors, specifically systemic therapy recommendations.

Smoking, Radiotherapy, Diabetes and Osteoporosis as Risk Factors for Dental Implant Failure: A Meta-Analysis

Abstract: Background: There are conflicting reports as to the association between smoking, radiotherapy, diabetes and osteoporosis and the risk of dental implant failure. We undertook a meta-analysis to evaluate the association between smoking, radiotherapy, diabetes and osteoporosis and the risk of dental implant failure. Methods: A comprehensive research on MEDLINE and EMBASE, up to January 2013, was conducted to identify potential studies. References of relevant studies were also searched. Screening, data extraction and quality assessment were conducted independently and in duplicate. A random-effects meta-analysis was used to pool estimates of relative risks (RRs) with 95% confidence intervals (CIs). Results: A total of 51 studies were identified in this meta-analysis, with more than 40,000 dental implants placed under riskthreatening conditions. The pooled RRs showed a direct association between smoking (n=33; RR=1.92; 95% CI, 1.67–2.21) and radiotherapy (n=16; RR=2.28; 95% CI, 1.49–3.51) and the risk of dental implant failure, whereas no inverse impact of diabetes (n=5; RR=0.90; 95% CI, 0.62–1.32) on the risk of dental implant failure was found. The influence of osteoporosis on the risk of dental implant failure was direct but not significant (n=4; RR=1.09; 95% CI, 0.79–1.52). The subgroup analysis indicated no influence of study design, geographical location, length of follow-up, sample size, or mean age of recruited patients. Conclusions: Smoking and radiotherapy were associated with an increased risk of dental implant failure. The relationship between diabetes and osteoporosis and the risk of implant failure warrant further study.