Extensive oro-maxillary defects may result from surgical treatment of advanced oro-maxillary pathologies such as oral cancers, benign tumors, osteomyelitis/osteonecrosis, congenital oro-maxillofacial malformations such as cleft lip and palate, or oral-maxillofacial trauma, leading to segmental or large partial defects of the maxillary and/or mandibular bone and alveolus together with successive loss of multiple teeth. These defects can disrupt muscular attachments and impair comprehensive oral functions such as mastication, swallowing, speech, and facial esthetics, decreasing patients’ quality of life. In 2012, the Japanese National Health Insurance system introduced a comprehensive oral-maxillofacial rehabilitation program that includes coverage for oro-maxillary reconstruction and dental-implant-anchored prostheses for patients with extensive oro-maxillary defects resulting from these acquired pathologies, congenital defects, or trauma. The medical insurance has been continuously extended and the associated medical fees have been increased every two years. This report presents an overview of the current situation in terms of the applicability and efficacy of the Japanese National Health Insurance oral-maxillofacial rehabilitation program in terms of its feasibility and contribution to patients’ quality of life, with a focus on future perspectives.

抄録全体を表示

“Bone anchored device placement for wide edentulous areas” and “bone anchored prosthetics for wide edentulous areas” became covered by insurance in April 2012 and attracted attention as implant treatments, although there were many restrictions.
In 2017, the Japanese Academy of Maxillofacial Implants established a committee to create a guideline for treatment using bone anchored devices for wide edentulous areas, and I was selected as a member of the committee. However, the paucity of evidence in this field made it nearly impossible to develop a guideline in compliance with the Minds standard, and so the guideline was eventually published not as a guideline but as a manual for treatment with jaw reconstruction and implants, called “Manual for Treatment Using Bone Anchored Devices for Wide Edentulous Areas.”
This article explains the process toward publication of the manual from the viewpoint of a prosthodontic specialist, and also describes the fusion of surgery and prosthetics that had to be overcome in the process. We hope this will help future collaboration between our Society and the Japanese Academy of Maxillofacial Implants.

抄録全体を表示

Bone anchored devices and prostheses for wide edentulous areas’ have become covered by the public insurance system in Japan, and have brought great benefits to patients with difficulty restoring oral function using conventional prosthetic treatment. However, diagnosis and treatment have been performed without a firm treatment guideline because most of them are difficult cases. The clinical practice guidelines present standard treatments based on high-level clinical data. The content includes a clinical treatment algorithm and clinical questions （CQ） that illustrate the flow of standard treatment, and each treatment method is assigned a recommendation grade to classify the degree of recommendation. Enough evidence is required to establish clinical practice guidelines. However, it is difficult to accumulate high-quality evidence of bone anchored devices and prostheses for wide edentulous areas at a single facility. Therefore, it is desirable to conduct a multicenter study using a common protocol when evaluating it. As a result, it will be possible to collect evidence and create an evidence-based clinical practice guideline. This paper introduces an overview of the clinical treatment algorithm and the multicenter study for bone anchored devices and prostheses for wide edentulous areas.

抄録全体を表示