INTRODUCTION
Treatment of patients with cancer of the upper aerodigestive tract
(UADT) is based on a resective surgery, and/or radio/chemotherapy. The
consequences of such a management are quite serious: they lead to tissue
loss (more or less compensated by fibula or scapula grafts), hyposialia
or asialia, increased carious and periodontal risks, limitation in mouth
opening, and microstomia (1). The prosthetic rehabilitation of this type
of patient may be quite challenging for the clinician, due to a
« clinical paradox ». Indeed, while the tissue loss aggravated by bone
resorption should lead to an increase of the prosthetic space,
limitation of mouth opening and microstomia cause labial inocclusion at
rest, and finally end up with a reduced occlusal vertical dimension
(OVD). Rehabilitation of the occlusal vertical dimension (OVD) is then
achieved with the best possible compromise in terms of esthetics,
phonetics and function, and is most often reduced compared to the intial
pre-trauma situation.
The treatment options allowing to compensate for this tissue loss
include complete removable dental prostheses (RDP) either conventional
or stabilized with dental implants. When the appropriate indication is
selected, the survival rate of a fibula flap would be around 97%, and
the implant survival rate around 78%, according to a retrospective
study with 11 years of follow up (2). Several implant-supported
prosthetic options may be considered according to the clinical
situation : a fixed implant-supported prosthesis, a complete
removable-fixed dental prosthesis supported by a bar and a counterbar,
and a complete removable dental prosthesis stabilized over implants with
ball-attachments or a connecting bar (CB). Several types of bars have
been described in the scientific literature. The purpose of this article
was to present different types of bars and their indications for
patients, illustrated by two clinical cases. The different types of bars
are described in Table 1, and their indications are displayed in a
decision tree in Figure 1.