Comprehensive prosthetic rehabilitation in absence of the maxilla. Clinical case report

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INCAN resident" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Maxillofacial prostheses practice and professor at the Maxillofacial Prosthesis Department, Graduate and Research School, National School of Dentistry, National University of Mexico (UNAM)" "etiqueta" => "b" "identificador" => "aff0010" ] 2 => array:3 [ "entidad" => "Department Head, Maxillofacial Prosthesis Department, Graduate and Research School, National School of Dentistry, National University of Mexico (UNAM)" "etiqueta" => "c" "identificador" => "aff0015" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Rehabilitación protésica integral en ausencia de maxilar. Reporte de un caso" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0040" "etiqueta" => "Figure 8" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr8.jpeg" "Alto" => 714 "Ancho" => 809 "Tamanyo" => 71394 ] ] "descripcion" => array:1 [ "en" => "Upper impression." ] ] ] "textoCompleto" => "INTRODUCTIONIn Mexico, cancer represents a public health problem. This is due to the severe clinical manifestations of the disease, its high mortality rate as well as the variety of associated environmental and individual factors such as ionizing radiation (UV Rays), occupational radiations (X rays), irritants (soldering fumes, ozone, acids, maladjusted prostheses) pneumoconiotic particles (asbestos<a class="elsevierStyleCrossRefs" href="#bib0005">1,2</a> and silicosis) allergens (natural or synthetic) carcinogens (benign or malign caused by arsenical insecticides, sawdust, asbestos, vinyl chloride, aromatic amines, etc) lifestyle (tobacco use, alcoholism, human papilloma virus, poor hygiene),<a class="elsevierStyleCrossRefs" href="#bib0015">3,4</a> genetic factors: (mutations of gene p53, of chromosome 9p21, mutation of gene RB)<a class="elsevierStyleCrossRefs" href="#bib0025">5,6</a> or related to hereditary cancer syndromes (Plummer Vinson)<a class="elsevierStyleCrossRefs" href="#bib0020">4,7</a> which increase the degree of the aforementioned risk.<a class="elsevierStyleCrossRefs" href="#bib0040">8,9</a> They are related to the following factors: increase of older people in the world, decrease of death cases due to communicable diseases, as well as mortality caused by cardio-vascular disease in some countries as well as increase in cancer modalities<a class="elsevierStyleCrossRef" href="#bib0045">9</a> which affect patient susceptibility, even more so in cases when they present some degree of malnutrition (30-50%). In these cases, tumor recurrence might be a factor to consider.<a class="elsevierStyleCrossRefs" href="#bib0040">8,10,11</a>In Mexico, head and neck cancer represents 17.6% of the total malignant neoplasia cases reported by the Histopathological Record of Neoplasia in Mexico (HRNM) in 2002, where 12% corresponded to Upper Aero-digestive Tract (UADT). Out of this, oral cancer represented 37% with a 62.4% mortality rate.<a class="elsevierStyleCrossRefs" href="#bib0045">9,12</a>85 to 90% of UADT cancer cases are due to tobacco exposition. Risk is proportional to exposition intensity. According to INEGI it is an increasing circumstance. It has been reported that 12-17 year old youngsters have increased consumption patterns.<a class="elsevierStyleCrossRefs" href="#bib0045">9,12</a>Alcohol consumption is another important associated factor. It produces synergism. Whilst a heavy smoker or drinker increases risk in direct proportion to consumption, those who smoke and drink increase risk 35 times over.<a class="elsevierStyleCrossRef" href="#bib0045">9</a>Squamous cell carcinoma is the most frequent oral neoplasia in Mexico. It is found at a risk factor of 1.4% in males and 0.9 in females in the head and neck area. In 0.02% of all cases it is found in the palate in males, and 0.009% in females, in a 1.7:1.2 relationship respectively, in 2007.<a class="elsevierStyleCrossRef" href="#bib0060">12</a> At the «20 de Noviembre» National Medical Center, a study was conducted in 2009, in it, a 2:1 male-female relationship was reported. After treatment 46.9% recurrence was observed, 32.2% metastasis and 22.45% mortality.<a class="elsevierStyleCrossRef" href="#bib0065">13</a>General frequency of ganglion metastases ranges between 10 and 40%, few distanced metastases were reported. In the hard palate and retromolar trigone, tumors are normally detected at an early stage since they elicit bleeding and pain in the palate.<a class="elsevierStyleCrossRef" href="#bib0070">14</a>According to the tumors’ histological type, etiological factors and location, epidemiological characteristics symptomatology, progression, therapeutics and prognosis will be modified.<a class="elsevierStyleCrossRef" href="#bib0020">4</a> Squamous cell carcinoma is a malignant neoplasia originating from squamous cells; it represents 92% of all oral cavity neoplasia, it is followed by basal cell carcinoma and melanoma.<a class="elsevierStyleCrossRefs" href="#bib0065">13,15,16</a> It is placed in 12th place of all malignant neoplasia in the whole world. It mainly affects patients in their seventh decade of life, with average age of 68 years.<a class="elsevierStyleCrossRef" href="#bib0065">13</a> This head and neck carcinoma is most frequent in older men, nevertheless, an increase in young people and women has been reported, as well as in pregnant women.<a class="elsevierStyleCrossRef" href="#bib0085">17</a> It can have its onset as a leukoplakia (2-4% invasive) or erythroplasia (80% invasive) in high-risk zones such as floor of the mouth, ventro-lateral side of the tongue soft palate and palatal velum.<a class="elsevierStyleCrossRef" href="#bib0090">18</a> Different locations of the tumor will elicit different behavior patterns and prognoses, which in turn will require different treatment plans.<a class="elsevierStyleCrossRefs" href="#bib0070">14,19</a>Reaction to different types of treatment modify prosthetic rehabilitation times during procedure and after it. These treatments can be adjuvant or concomitant (chemotherapy, radiotherapy, surgery), they are alternative treatments and increase organ preservation, improving thus treatment success.<a class="elsevierStyleCrossRef" href="#bib0040">8</a>Chemotherapy consists on anti-neoplastic drug administration to induce tumor cell destruction though the hindering of cell division. Most used drugs for head and neck treatment are: bleomycin, cisplatin, methotrexate, 5 fluorouracil, vinblastine, cyclophosphamide, carboplatin, gefinitib, erbitux, and cetuximab.<a class="elsevierStyleCrossRefs" href="#bib0100">20–22</a> Certain anti-neoplastic drugs can cause long-term lesions in the hematopoietic system.<a class="elsevierStyleCrossRef" href="#bib0115">23</a> It can be curative (total tumor control), adjuvant (after surgery, decreasing the risk of metastasis), previous (partial tumor reduction to complement surgery or radiotherapy) and palliative (improving patient's quality of life).<a class="elsevierStyleCrossRefs" href="#bib0070">14,20</a> Knowledge of HPV (human papilloma virus) is becoming an important consideration to observe when assessing treatment for patients with head and neck cancer. Patients who are HPV-positive respond better to treatment, Current research is targeting to stratify patients according to their HPV status in clinical trials.<a class="elsevierStyleCrossRef" href="#bib0105">21</a>Ionizing-radiation radiotherapy either destroys cancer cells or decreases their growth. This is a common treatment for head and neck cancer cases, it is used for approximately 50% of all cancer treatments in this area; it can be used by itself, or combined with chemotherapy and/or surgery.<a class="elsevierStyleCrossRefs" href="#bib0070">14,20</a> It can cause oral complications such as mucositis, bacterial or fungal infections, salivary gland dysfunction, fibrosis, dental caries, dysfunction of sense of taste or osteo-radionecroses.<a class="elsevierStyleCrossRefs" href="#bib0070">14,19,22</a>Surgical treatment of head and neck involves a series of functional repercussions of the anatomical structures affected by the tumor. This can appear in neck and scapular region mobility, alterations in healing and lymphatic drainage, as well as deglutition, which would then warrant extirpation surgery of tumor resection and/or lymphatic surgery of tumor-affected areas.<a class="elsevierStyleCrossRef" href="#bib0095">19</a>Therefore, sequels originated from surgical treatment in the bucco-antral area are caused by maxillectomies (limited, partial, medial subtotal, total radical or extended).<a class="elsevierStyleCrossRef" href="#bib0120">24</a> These sequels can be structural (bucal-antral communication)<a class="elsevierStyleCrossRefs" href="#bib0015">3,24</a> functional (breathing, mastication, deglutition, phonation) and psychological.<a class="elsevierStyleCrossRef" href="#bib0015">3</a>Aramany undertook to classify maxillary defects based upon the defect area and remaining teeth<a class="elsevierStyleCrossRef" href="#bib0125">25</a> Classifications I, II and IV (lateral defects with anterior margins close to the midline) are the most frequent.<a class="elsevierStyleCrossRef" href="#bib0130">26</a> It is therefore of the utmost importance to consider that full, wide defects of the soft and hard palate are not considered within this classification (when in the soft palate, they are rather considered hereditary defects).<a class="elsevierStyleCrossRef" href="#bib0130">26</a> Kan-ichi Seto did mention it in 2003 (HS classification), and referred to it as H6SODxT3 (full defect without soft palate involvement, impossible to determine oral opening degree and with no tooth presence).<a class="elsevierStyleCrossRef" href="#bib0015">3</a> It takes into account the fact that not only the upper jaw is involved; hard palate and para-nasal sinuses are equally involved, and due to the loss of support experienced by the upper jaw, there is development of enophthalmos and diplopia.<a class="elsevierStyleCrossRef" href="#bib0135">27</a>Maxillofacial rehabilitation of head and neck cancer patients demands knowledge of the disease, type of resection, margins and post-treatment.<a class="elsevierStyleCrossRefs" href="#bib0035">7,28–30</a> The field of reconstructive surgery has seen great advances with techniques of epithelial, muscle and bone grafts, which target prosthesis support.<a class="elsevierStyleCrossRefs" href="#bib0035">7,28,30</a> Prosthetic rehabilitation encompasses the palatal shutter (obturator)which offers modifications to full prosthodontics.<a class="elsevierStyleCrossRefs" href="#bib0015">3,4,28</a> This techniques takes into consideration defect volume, remaining hard and soft tissues, quality of the mucosa as well as stability and retention of the appliance. All the aforementioned factors will determine the appliance's design. Other factors to be equally considered are: patient's experience with dentures, neuromuscular control and previous therapeutic history (radiotherapy, chemotherapy, surgery).<a class="elsevierStyleCrossRefs" href="#bib0120">24,27</a>The palatal shutter is a prosthesis used to close a congenital or acquired opening, preserving the integrity of oral and nasal compartments. It facilitates speech, deglutition and mastication, either in provisional or final surgical stages.<a class="elsevierStyleCrossRefs" href="#bib0015">3,31</a>Severe cases require rigid obturator extension towards soft tissue areas. This complicates rehabilitation, since it no longer requires only the aforementioned characteristics, it also requires obturator seal on mobile, free margins. Thus, boneintegrated implants (including mini-implants and zygomatic implants) have been considered as those implants providing most retention and requiring sometimes bone distraction. Reaction of bone tissue to implant insertion must be taken into account (boneimplant bonding), cleansing and preparation of implant surface, as well as bone type (area to receive implant) and implant type.<a class="elsevierStyleCrossRefs" href="#bib0135">27,32–34</a>When following this therapeutic approach, patient risk factors such as age, medical circumstances, psycho-social circumstances, habits, presence of osteoporosis, periodontitis or cancer, must<a class="elsevierStyleCrossRef" href="#bib0205">35</a> be taken into consideration. Patients must be referred to special preventive programs. This will bear influence in treatment success or failure.Bone distraction is a process triggered by application of planned and controlled tension on a corticotomy or osteotomy. This process allows for bone neo-formation and elongation based on a bony callus. This elongation is transmitted to soft tissues, it induces their gradual and continuous growth. It develops in four phases: osteotomy, latency, distraction and consolidation.<a class="elsevierStyleCrossRefs" href="#bib0160">32,36</a> It has been shown to be safe and effective, generating histiogenic distraction (masticatory muscles, subcutaneous tissue and skin).<a class="elsevierStyleCrossRef" href="#bib0180">36</a>Use of mini-implants (MDI) is recommended for patients who lack sufficient bone structure to place implants smaller than 3.75mm. These implants have a 1.8mm diameter. Their use provides advantages such as lesser bleeding and lesser post-operative discomfort, faster healing (due to diminished surgical maneuvers) lesser bone loss when compared to the traditional method. In addition to the aforementioned, these implants are of much lower cost. They were first provisionally used for immediate load, along with conventional implants, so as to be retention means of immediate prostheses, and prevent premature loads on the bone and thus avoid compromising final implants. Previous studies report their success as being between 92% and 97%, according to number and surgical zone.<a class="elsevierStyleCrossRef" href="#bib0185">37</a>Since 1990, zygomatic implants created and developed by Dr Branemark have been used as posterior anchorage for implant-supported dentures in patients with severe maxillary atrophy. These implants are indicated in cases of severe maxillary resorption or in patients afflicted with full upper edentulism. Their use eliminates the need for bone grafts or maxillary sinus lifting. They are introduced into the zygomatic bone, and can be joined by other conventional implants in the upper jaw's anterior area, in which place there is normally remaining bone. After implant placement, a provisional denture can be placed. 4 to 6 months must be left to elapse in order to achieve implant boneintegration and then place a final denture.<a class="elsevierStyleCrossRefs" href="#bib0160">32,38–40</a>CLINICAL CASE PRESENTATION69 year old male patient, born and residing in Mexico City. The patient reported he had a commonlaw wife, was catholic and a taxi driver. In 1992, at the Mexico's National Cancer Institute, he was diagnosed with non-differentiated squamous cell carcinoma in the hard palate. Approximate tumor size was 1 x 2 x 1.5. The patient suffered hypertension, gastritis and Type II diabetes. He was under medical treatment (acquired after chemotherapy treatment). The patient equally informed he was a two-pack a day cigarette smoker as well as an alcohol drinker.After diagnosis was established, the patient informed he had been subjected for 5 years to chemotherapy with Cis platinum and 5FU. Results were favorable inasmuch as avoiding tumor growth and preventing metastasis. After the aforementioned treatment, the patient suffered tumor recurrence at the same location. This new tumor spanned into the whole upper jaw. Therefore, surgery was deemed necessary. Surgery was total bilateral maxillectomy with radical neck resection. Surgery sequels were facial collapse of the face's middle third. The patient was not subjected to post-operative radiotherapy (<a class="elsevierStyleCrossRef" href="#fig0005">Figure 1</a>).<elsevierMultimedia ident="fig0005"></elsevierMultimedia>Since rehabilitation was complex, several treatment forms were analyzed (taking into account the fact that the patient had not received radiotherapy). Considered treatment options were: placement of 4 mini-implants (2 in the posterior zone and 2 in the anterior zone). With the help of stereolythography, ideal implant location was planned in order to achieve a surgical guide (<a class="elsevierStyleCrossRefs" href="#fig0010">Figures 2 and 3</a>).<elsevierMultimedia ident="fig0010"></elsevierMultimedia><elsevierMultimedia ident="fig0015"></elsevierMultimedia>Manufactured dentures presented insufficient initial stability and retention. With time, the upper denture required greater functionality and esthetics in concordance with changes and requirements of remaining tissue, therefore, present retention was no longer sufficient (<a class="elsevierStyleCrossRef" href="#fig0020">Figure 4</a>).<elsevierMultimedia ident="fig0020"></elsevierMultimedia>It was decided to place bone distractors, so as to obtain an area of greater support, to later place zygomatic implants. The multi-disciplinary team conducted a previous coordinated analysis of the case targeting the remodeling of that area in order to achieve greater support and stability of the final obturator (<a class="elsevierStyleCrossRefs" href="#fig0025">Figures 5 and 6</a>).<elsevierMultimedia ident="fig0025"></elsevierMultimedia><elsevierMultimedia ident="fig0030"></elsevierMultimedia>Unfortunately, due to bone insufficiency, the implanted zone rejected the implants, even though indicated bone-integration time was observed (between 4 and 6 months) as well as healing period, prevention and infection control.Taking into account bone response to implants it was decided to build modified full dentures. Upon assessing the defect, it was observed there were two posterior mini-implants which afforded some support to the denture, nevertheless, they failed to prevent denture displacement mainly during mastication and phonation procedures. Patient comfort and esthetics were also compromised (<a class="elsevierStyleCrossRef" href="#fig0035">Figure 7</a>).<elsevierMultimedia ident="fig0035"></elsevierMultimedia>METHODOLOGY<ul class="elsevierStyleList" id="lis0005"><li class="elsevierStyleListItem" id="lsti0005">1.Anatomical impression of the defect was taken. Rapid-setting alginate was used. The material was handled according to manufacturer s instructions. Lower arch impression was equally taken (<a class="elsevierStyleCrossRef" href="#fig0040">Figure 8</a>).<elsevierMultimedia ident="fig0040"></elsevierMultimedia></li><li class="elsevierStyleListItem" id="lsti0010">2.Positive models of both arches were taken with type III hard plaster (<a class="elsevierStyleCrossRef" href="#fig0045">Figure 9</a>).<elsevierMultimedia ident="fig0045"></elsevierMultimedia></li><li class="elsevierStyleListItem" id="lsti0015">3.Individual trays were manufactured. Borders were later rectified with type II stick modeling paste material. Defects of border as well as lower arch were recorded.</li><li class="elsevierStyleListItem" id="lsti0020">4.Once the borders were rectified, physiological impression was taken with polysulfide rubber. Impression of upper defect was first taken, followed by impression of the lower arch (<a class="elsevierStyleCrossRef" href="#fig0050">Figure 10</a>).<elsevierMultimedia ident="fig0050"></elsevierMultimedia></li><li class="elsevierStyleListItem" id="lsti0025">5.Impressions were contoured in order to obtain type IV plaster working models (<a class="elsevierStyleCrossRef" href="#fig0055">Figure 11</a>).<elsevierMultimedia ident="fig0055"></elsevierMultimedia></li><li class="elsevierStyleListItem" id="lsti0030">6.Working models were trimmed, recording bases were recorded with relationship rollers, so as to later undertake prosthetic, phonetic and esthetics tests.</li><li class="elsevierStyleListItem" id="lsti0035">7.After establishing cranio-mandibular relationships, plastic braces were taken to proceed to model transfer to a semi-adjustable articulator.</li><li class="elsevierStyleListItem" id="lsti0040">8.Once the models were transferred. Teeth were selected according to established principles, so as to place them and later balance them.</li><li class="elsevierStyleListItem" id="lsti0045">9.Dentures were tested in the mouth (<a class="elsevierStyleCrossRef" href="#fig0060">Figure 12</a>).<elsevierMultimedia ident="fig0060"></elsevierMultimedia></li><li class="elsevierStyleListItem" id="lsti0050">10.Obturator and lower denture were manufactured following the lost wax casting technique. The obturator was hollowed out so as to make it lighter.</li><li class="elsevierStyleListItem" id="lsti0055">11.Dentures were processed with heat-cured acrylic, which was processed according to manufacturer's instructions.</li><li class="elsevierStyleListItem" id="lsti0060">12.Finally, dentures were retrieved from the muffles in order to be trimmed, polished and placed in the patient (<a class="elsevierStyleCrossRefs" href="#fig0065">Figures 13 and 15</a>).<elsevierMultimedia ident="fig0065"></elsevierMultimedia><elsevierMultimedia ident="fig0070"></elsevierMultimedia><elsevierMultimedia ident="fig0075"></elsevierMultimedia></li><li class="elsevierStyleListItem" id="lsti0065">13.Patient was instructed on denture use and preservation, as well as to the need of recurrent visits to assess denture adaptation.</li></ul>The obturator was built in concordance with basic principles of full denture construction. Modifications were executed in order to obtain better results.DISCUSSIONSquamous cell carcinoma is one of the most frequent malignant neoplasia found in the world. In concordance with numerous authors<a class="elsevierStyleCrossRefs" href="#bib0045">9,12–14,16–18</a> we observed that simultaneous smoking and drinking increases the risk of contracting oral cancer.Therefore, satisfactory prosthetic rehabilitation requires multi-disciplinary efforts in order to achieve suitable functional adaptation<a class="elsevierStyleCrossRef" href="#bib0120">24</a> in view of the complexity of diagnosis, therapies and rehabilitation of head and neck cancer patients.<a class="elsevierStyleCrossRef" href="#bib0140">28</a> In cases when the maxillary defect is not surgically reconstructed, a surgical obturator would be recommended to seal the defect, since it will support the surgical site and restore oral function.<a class="elsevierStyleCrossRef" href="#bib0135">27</a>It is important to note the fact that obturator prostheses have been widely modified, since the essential foundation of a full prosthesis is based on the residual ridge and in this case there was no ridge. Classifications such as that of Aramany do not include total loss of the jaw. Kan-ichi Seto did mention it, but did not explain how to rehabilitate a patient with this type of defect.<a class="elsevierStyleCrossRefs" href="#bib0015">3,25</a> Ortegon et al (2008) and Cheng et al(2004) do mention it with different techniques.<a class="elsevierStyleCrossRefs" href="#bib0120">24,27</a>Thus, retention of a bilateral full obturator can be supported following several methods such as (1) remaining structures of the upper jaw along with the posterior third of the soft palate, (2) supporting the obturator on a healed lateral band, (3) extending extra-orally the prosthesis towards the nostrils and (4) based on bone-integrated implants.<a class="elsevierStyleCrossRefs" href="#bib0120">24,32</a>In the present report, obturator manufacture involved two stages: 1) Manufacture of obturator and lower denture, 2) at the moment of being processed, the obturator is emptied using heat-curing acrylic. In situations when the defect is more complex, the obturator must be manufactured in segments.<a class="elsevierStyleCrossRef" href="#bib0135">27</a>During the manufacture of these obturator prostheses, it must be taken into account that there will be modifications and alterations in clinical and laboratory treatments, such as: 1) During manufacturing of provisional prosthesis, 2) during bulb manufacture in the final prosthesis, 3) upper and lower jaw relationship and 4) insertion of final prosthesis, where wide maxillary defects might compromise denture functionality.<a class="elsevierStyleCrossRef" href="#bib0135">27</a>Therefore, a suitable treatment plan for such a wide defect always will require patient pre-surgical acceptance. The patient will be in the hands of a team formed by surgeons, maxillofacial prosthetic specialists, phoniatricians, nutritionists and psychologists.<a class="elsevierStyleCrossRef" href="#bib0135">27</a>It is equally important to note that success of a prosthetic rehabilitation will depend 50% on the physician and 50% on the patient (before, during and after treatment).Finally restoration was achieved as far as possible, impacting deglutition, speech, mastication, esthetic appearance as well as patient's psychological welfare; which will in turn impact on patient's comfort, and security which are necessary to reinsert the patient into society affording thus suitable quality of life.<a class="elsevierStyleCrossRefs" href="#bib0120">24,27</a>CONCLUSIONSThe patient informed of a 5-year ongoing chemotherapy history, with late mini-implant placement, bone distraction procedure and placement of zygomatic implants based on stereolitographs. Patient's clinical experience was negative, as a result of existing poor bone quality. It was therefore decided to manufacture a full lower prosthesis and a modified palatal shutter.When bilateral total maxillectomy was undertaken, prognosis was negative. The patient was fully edentulous in the lower section, therefore, a light, retentive and functional shutter had to be devised, to primarily achieve a barrier between oral and nasal cavities. The shutter provided support and stability, and this, along with a full lower denture, preempted the need to use adhesive material.The patient experienced suitable defect healing, and was of a positive attitude, this was very important in the process.We noticed the fact that the modified palatal prosthesis afforded the patient another treatment alternative. The present one was manufactured with acrylic material and met with patient's expectations for improved quality of life.The patient presently exhibits better adaptation to the palatal shutter. He can now eat, drink liquids and speak better. The restoration is more aesthetic and affords the patient with more self-security to interact in society." "textoCompletoSecciones" => array:1 [ "secciones" => array:10 [ 0 => array:3 [ "identificador" => "xres610939" "titulo" => "ABSTRACT" "secciones" => array:1 [ 0 => array:1 [ "identificador" => "abst0005" ] ] ] 1 => array:2 [ "identificador" => "xpalclavsec624928" "titulo" => "Keywords" ] 2 => array:3 [ "identificador" => "xres610938" "titulo" => "RESUMEN" "secciones" => array:1 [ 0 => array:1 [ "identificador" => "abst0010" ] ] ] 3 => array:2 [ "identificador" => "xpalclavsec624927" "titulo" => "Palabras clave" ] 4 => array:2 [ "identificador" => "sec0005" "titulo" => "INTRODUCTION" ] 5 => array:2 [ "identificador" => "sec0010" "titulo" => "CLINICAL CASE PRESENTATION" ] 6 => array:2 [ "identificador" => "sec0015" "titulo" => "METHODOLOGY" ] 7 => array:2 [ "identificador" => "sec0020" "titulo" => "DISCUSSION" ] 8 => array:2 [ "identificador" => "sec0025" "titulo" => "CONCLUSIONS" ] 9 => array:1 [ "titulo" => "REFERENCES" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "PalabrasClave" => array:2 [ "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec624928" "palabras" => array:7 [ 0 => "Maxillofacial prosthesis" 1 => "maxillectomy" 2 => "squamous cell carcinoma" 3 => "palatal shutter" 4 => "mini-implants" 5 => "distraction osteogenesis" 6 => "zygomatic implants." ] ] ] "es" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Palabras clave" "identificador" => "xpalclavsec624927" "palabras" => array:7 [ 0 => "Prótesis maxilofacial" 1 => "maxilectomía" 2 => "carcinoma epidermoide" 3 => "obturador palatino" 4 => "miniimplantes" 5 => "distracción ósea" 6 => "implantes cigomáticos." ] ] ] ] "tieneResumen" => true "resumen" => array:2 [ "en" => array:2 [ "titulo" => "ABSTRACT" "resumen" => "Maxillofacial Prosthesis studies comprehend two main branches: oral and facial. In the mouth, some defects caused by unilateral or bilateral maxillectomies performed as part of head and neck cancer treatment, leave structural, functional and psychological sequels. This gives rise to the need of a comprehensive prosthetic rehabilitation. To this end, palate prostheses are used, which offer patients’ reinsertion into society as well as better quality of life. In the present clinical case, the shutter was placed in a situation of complete absence of the maxilla, achieving thus function re-establishment and acceptable aesthetics." ] "es" => array:2 [ "titulo" => "RESUMEN" "resumen" => "La prótesis maxilofacial estudia dos importantes ramas; la bucal y la facial. En relación a la bucal, algunos defectos originados por maxilectomías unilaterales o bilaterales ya sean parciales o totales en el tratamiento del cáncer de cabeza y cuello; dejan secuelas estructurales, funcionales y psicológicas; estableciendo así la necesidad de una rehabilitación protésica integral; para lo cual son utilizadas las prótesis obturadoras de paladar, que ofrecen así al paciente su reintegración a la sociedad con una mejor calidad de vida. En el presente caso clínico, el obturador es colocado en ausencia completa de maxilar, obteniendo como resultados el restablecimiento de las funciones y estética aceptables." ] ] "multimedia" => array:15 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 876 "Ancho" => 635 "Tamanyo" => 67078 ] ] "descripcion" => array:1 [ "en" => "Facial collapse of middle third of the face." ] ] 1 => array:7 [ "identificador" => "fig0010" "etiqueta" => "Figure 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 635 "Ancho" => 1002 "Tamanyo" => 66560 ] ] "descripcion" => array:1 [ "en" => "Miniimplants in place." ] ] 2 => array:7 [ "identificador" => "fig0015" "etiqueta" => "Figure 3" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true 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(first result)." ] ] 14 => array:7 [ "identificador" => "fig0075" "etiqueta" => "Figure 15" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr15.jpeg" "Alto" => 911 "Ancho" => 640 "Tamanyo" => 80955 ] ] "descripcion" => array:1 [ "en" => "Final denture (second result)." ] ] ] "bibliografia" => array:2 [ "titulo" => "REFERENCES" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:40 [ 0 => array:3 [ "identificador" => "bib0005" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Asbestos de México" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "C. García" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Bol Soc Geol Mexicana" "fecha" => "1978" "volumen" => "39" "numero" => "2" "paginaInicial" => "154" "paginaFinal" => "161" ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0010" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Asbesto: un peligro latente para la salud Rev del Centro de Inv (Méx)" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "F.R. Concepción" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Universidad La Salle" "fecha" => "2006" "volumen" => "7" "numero" => "25" "paginaInicial" => "91108" ] ] ] ] ] ] 2 => array:3 [ "identificador" => "bib0015" "etiqueta" => "3" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Atlas of oral and maxillofacial rehabilitation" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "Seto. Kan-ichi" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Libro" => array:5 [ "fecha" => "2003" "paginaInicial" => "2" "paginaFinal" => "50" "editorial" => "Quintessence Books" "editorialLocalizacion" => "Tokyo (Japón)" ] ] ] ] ] ] 3 => array:3 [ "identificador" => "bib0020" "etiqueta" => "4" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Supervivencia en el carcinoma epidermoide de cavidad oral" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:1 [ 0 => "H. Muñoz" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Acta Otorrinolaringol Esp" "fecha" => "2001" "volumen" => "52" "paginaInicial" => "381" "paginaFinal" => "386" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/11526644" "web" => "Medline" ] ] ] ] ] ] ] ] 4 => array:3 [ "identificador" => "bib0025" "etiqueta" => "5" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Retinoblastoma" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:1 [ 0 => "N. Martín" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Annals d Oftalmologia" "fecha" => "2001" "volumen" => "9" "numero" => "2" "paginaInicial" => "74" "paginaFinal" => "92" ] ] ] ] ] ] 5 => array:3 [ "identificador" => "bib0030" "etiqueta" => "6" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Prevalencia de retinoblastoma del 2002 al 2006 en una unidad médica de alta especialidad" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:1 [ 0 => "C.B. Alvarado" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:7 [ "tituloSerie" => "Rev Mex Oftalmol" "fecha" => "2007" "volumen" => "81" "numero" => "6" "paginaInicial" => "336" "paginaFinal" => "339" "itemHostRev" => array:3 [ "pii" => "S0168827812008100" "estado" => "S300" "issn" => "01688278" ] ] ] ] ] ] ] 6 => array:3 [ "identificador" => "bib0035" "etiqueta" => "7" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Reconstrucción en cirugía oncológica de cabeza y cuello: Perspectivas" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "B. Rivas" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Cancerología" "fecha" => "2007" "volumen" => "2" "paginaInicial" => "39" "paginaFinal" => "46" ] ] ] ] ] ] 7 => array:3 [ "identificador" => "bib0040" "etiqueta" => "8" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "DeVita Hellman, and Rosenberg's Cancer: Principles & Practice of Oncology." "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:3 [ 0 => "V. Devita" 1 => "T. Lawrence" 2 => "S. Rosenberg" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Libro" => array:3 [ "edicion" => "8th edition." "fecha" => "April 22 2008" "editorial" => "Philadelphia: Lippincott Williams and Wilkins" ] ] ] ] ] ] 8 => array:3 [ "identificador" => "bib0045" "etiqueta" => "9" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Epidemiología y etiología del cáncer de cabeza y cuello" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "G.G. Tirado" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Revista de Cancerología" "fecha" => "2007" "volumen" => "2" "numero" => "3" "paginaInicial" => "9" "paginaFinal" => "17" ] ] ] ] ] ] 9 => array:3 [ "identificador" => "bib0050" "etiqueta" => "10" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "El estado nutricional en pacientes con cáncer de cabeza y cuello: Implicaciones pronósticas" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:1 [ 0 => "M.C. Villares" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:7 [ "tituloSerie" => "Nutr Hosp" "fecha" => "2003" "volumen" => "18" "numero" => "2" "paginaInicial" => "91" "paginaFinal" => "94" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/12723380" "web" => "Medline" ] ] ] ] ] ] ] ] 10 => array:3 [ "identificador" => "bib0055" "etiqueta" => "11" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Valoración del estado de nutrición en el paciente con cáncer" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "V.R. Martínez" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Libro" => array:5 [ "fecha" => "2007" "paginaInicial" => "315" "paginaFinal" => "326" "editorial" => "Revista del Instituto Nacional de Cancerología de" "editorialLocalizacion" => "México" ] ] ] ] ] ] 11 => array:3 [ "identificador" => "bib0060" "etiqueta" => "12" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Registro hospitalario de cáncer: compendio de cáncer 2000-2004" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:1 [ 0 => "R. Rizo" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Revista del Instituto Nacional de Cancerología de México" "fecha" => "2007" "volumen" => "2" "numero" => "3" "paginaInicial" => "203" "paginaFinal" => "287" ] ] ] ] ] ] 12 => array:3 [ "identificador" => "bib0065" "etiqueta" => "13" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Carcinoma de células escamosas de cavidad bucal en un centro de tercer nivel de atención social en la Ciudad de México" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "G.G. Meza" 1 => "I.J.J. Muñoz" 2 => "V.C. Páez" 3 => "L.B. Cruz" 4 => "B.B. Aldape" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Experiencia de cinco años Avances en Odontoestomatología" "fecha" => "2009" "volumen" => "25" "numero" => "1" "paginaInicial" => "19" "paginaFinal" => "28" ] ] ] ] ] ] 13 => array:3 [ "identificador" => "bib0070" "etiqueta" => "14" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Cáncer de cabeza cuello" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "A.R. Villar" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Libro" => array:5 [ "fecha" => "1989" "paginaInicial" => "1" "paginaFinal" => "111" "editorial" => "Doyma" "editorialLocalizacion" => "España" ] ] ] ] ] ] 14 => array:3 [ "identificador" => "bib0075" "etiqueta" => "15" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Prótesis faciales retenidas con implantes e imanes: presentación de tres casos clínicos en pacientes oncológicos" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "O.S. Sosa" 1 => "T.J.F. Torres" 2 => "G.E. Medrano" 3 => "C.V. González" 4 => "L.J.C. García" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Cancerología" "fecha" => "2008" "volumen" => "3" "paginaInicial" => "71" "paginaFinal" => "76" ] ] ] ] ] ] 15 => array:3 [ "identificador" => "bib0080" "etiqueta" => "16" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Management of oral squamous cell carcinoma treated with inadequate excisional biosy" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:1 [ 0 => "J.S. Bailey" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1053/joms.2001.25826" "Revista" => array:6 [ "tituloSerie" => "J Oral Maxillofac Surg" "fecha" => "2001" "volumen" => "59" "paginaInicial" => "1007" "paginaFinal" => "1010" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/11526566" "web" => "Medline" ] ] ] ] ] ] ] ] 16 => array:3 [ "identificador" => "bib0085" "etiqueta" => "17" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Squamous cell carcinoma of the maxilla during pregnancy: report of case" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "A.G. García" 1 => "J.L. Antunez" 2 => "J.R. Gándara" 3 => "M.C. Pombar" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "J Oral Maxillofacial Surg" "fecha" => "2001" "volumen" => "59" "paginaInicial" => "456" "paginaFinal" => "461" ] ] ] ] ] ] 17 => array:3 [ "identificador" => "bib0090" "etiqueta" => "18" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Carcinoma epidermoide de cavidad oral" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:1 [ 0 => "M. López" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:4 [ "tituloSerie" => "Casos clínicos" "fecha" => "2007" "volumen" => "4" "numero" => "2" ] ] ] ] ] ] 18 => array:3 [ "identificador" => "bib0095" "etiqueta" => "19" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Physicaltherapy and swallowing reeducation in surgery of head and neck neoplasm" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:1 [ 0 => "C. Souto" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Fisioterapia" "fecha" => "2003" "volumen" => "25" "numero" => "5" "paginaInicial" => "311" "paginaFinal" => "327" ] ] ] ] ] ] 19 => array:3 [ "identificador" => "bib0100" "etiqueta" => "20" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Dental management of the complications of radio and chemotherapy in oral cancer" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "F. Caribé-Gomes" 1 => "E. Chimenos-Küstner" 2 => "J. López-López" 3 => "F. Finestres-Zubeldia" 4 => "B. Guiux-Melcior" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Med Oral" "fecha" => "2003" "volumen" => "8" "paginaInicial" => "178" "paginaFinal" => "187" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/12730652" "web" => "Medline" ] ] ] ] ] ] ] ] 20 => array:3 [ "identificador" => "bib0105" "etiqueta" => "21" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Clinical cancer advances 2009: major research advances in clinical treatment prevention and screening-a report from the American Society of Clinical Oncology (ASCO)" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:1 [ 0 => "N.J. 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Awidi" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Eur J Cancer" "fecha" => "2001" "volumen" => "37" "paginaInicial" => "2010" "paginaFinal" => "2014" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/11597378" "web" => "Medline" ] ] ] ] ] ] ] ] 22 => array:3 [ "identificador" => "bib0115" "etiqueta" => "23" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Lowitz. Oncología clínica." "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "A. Dennis" 1 => "B. Casciato-Barry" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Libro" => array:5 [ "fecha" => "2001" "paginaInicial" => "61" "paginaFinal" => "62" "editorial" => "Editorial Marbán" "editorialLocalizacion" => "España" ] ] ] ] ] ] 23 => array:3 [ "identificador" => "bib0120" "etiqueta" => "24" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "A hollow delayed surgical obturator for a bilateral subtotal maxillectomy patient: a clinical report" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "S.M. Ortegon" 1 => "J.W. Martin" 2 => "J.S. Lewin" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/S0022-3913(08)60003-7" "Revista" => array:6 [ "tituloSerie" => "J Prosthet Dent" "fecha" => "2008" "volumen" => "99" "paginaInicial" => "14" "paginaFinal" => "18" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/18182180" "web" => "Medline" ] ] ] ] ] ] ] ] 24 => array:3 [ "identificador" => "bib0125" "etiqueta" => "25" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Basic principles of obturator design for partially edentulous patients" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "M. Aramany" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:7 [ "tituloSerie" => "Part I: Classification J Prosthet Dent" "fecha" => "2001" "volumen" => "86" "numero" => "6" "paginaInicial" => "559" "paginaFinal" => "561" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/11753302" "web" => "Medline" ] ] ] ] ] ] ] ] 25 => array:3 [ "identificador" => "bib0130" "etiqueta" => "26" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Prostodoncia parcial removible." "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "K. Stewart" 1 => "K. Rudd" 2 => "W. Kuebker" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Libro" => array:6 [ "edicion" => "2da edición." "fecha" => "1993" "paginaInicial" => "635" "paginaFinal" => "665" "editorial" => "Actualidades MédicoOdontológicas Latinoamericana" "editorialLocalizacion" => "Caracas (Venezuela)" ] ] ] ] ] ] 26 => array:3 [ "identificador" => "bib0135" "etiqueta" => "27" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Altered prosthodontic treatment approach for bilateral complete maxillectomy: a clinical report" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "A.C. Cheng" 1 => "D.A. Somerville" 2 => "A.G. Wee" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "J Prosthetic Dent" "fecha" => "2004" "volumen" => "92" "paginaInicial" => "120" "paginaFinal" => "124" ] ] ] ] ] ] 27 => array:3 [ "identificador" => "bib0140" "etiqueta" => "28" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Tumores de cabeza y cuello." "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "R.A. Sergio" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Libro" => array:4 [ "edicion" => "2da. Edición" "fecha" => "2003" "editorial" => "Manual Moderno" "editorialLocalizacion" => "México" ] ] ] ] ] ] 28 => array:3 [ "identificador" => "bib0145" "etiqueta" => "29" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Clinical maxillofacial prosthetics" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "T. Taylor" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Libro" => array:3 [ "fecha" => "2000" "editorial" => "Quintessence Books" "editorialLocalizacion" => "China" ] ] ] ] ] ] 29 => array:3 [ "identificador" => "bib0150" "etiqueta" => "30" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Maxillofacial prosthetic rehabilitation combined with plastic and reconstructive surgery" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:1 [ 0 => "C. Robert" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Oncology, MD Anderson" "fecha" => "1993" "volumen" => "6" "numero" => "2" "paginaInicial" => "1" "paginaFinal" => "11" ] ] ] ] ] ] 30 => array:3 [ "identificador" => "bib0155" "etiqueta" => "31" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Prótesis parcial removible." "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "G.P. McGivney" 1 => "B.A. Carr" 2 => "T.D. Brown" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Libro" => array:6 [ "edicion" => "10 ed" "fecha" => "2004" "paginaInicial" => "495" "paginaFinal" => "513" "editorial" => "Médica-Panamericana" "editorialLocalizacion" => "México" ] ] ] ] ] ] 31 => array:3 [ "identificador" => "bib0160" "etiqueta" => "32" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Eugenio. Rehabilitación implanto soportada en casos complejos." "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "Chiapasco" 1 => "Matteo Romeo" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Libro" => array:6 [ "edicion" => "Editorial" "fecha" => "2006" "paginaInicial" => "319" "paginaFinal" => "462" "editorial" => "AMOLCA" "editorialLocalizacion" => "Colombia" ] ] ] ] ] ] 32 => array:3 [ "identificador" => "bib0165" "etiqueta" => "33" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Nuevas tendencias 5 implantodoncia" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "A. Bottino" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Libro" => array:5 [ "fecha" => "2008" "paginaInicial" => "123" "paginaFinal" => "137" "editorial" => "Artes Médicas Latinoamericana" "editorialLocalizacion" => "Brasil" ] ] ] ] ] ] 33 => array:3 [ "identificador" => "bib0170" "etiqueta" => "34" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Color atlas and text of dental and maxillofacial implantology" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "John Hobkirk" 1 => "Roger Watson" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Libro" => array:4 [ "fecha" => "1995" "paginaInicial" => "3552" "editorial" => "Mosby-Wolfe" "editorialLocalizacion" => "Spain" ] ] ] ] ] ] 34 => array:3 [ "identificador" => "bib0205" "etiqueta" => "35" "referencia" => array:1 [ 0 => array:1 [ "referenciaCompleta" => "Gutiérrez JL, García M. Integración de la implantología en la práctica Odontológica. Madrid: Ergon; Madrid. pp. 29-41" ] ] ] 35 => array:3 [ "identificador" => "bib0180" "etiqueta" => "36" "referencia" => array:1 [ 0 => array:1 [ "referenciaCompleta" => "Domínguez NM, et al. Distracción osteogénica maxilar con uso de máscara facial y minitornillos en pacientes de fisuras faciales. Reporte de un caso. Hospital General “Dr. Manuel Gea González”. México, D.F. 2010." ] ] ] 36 => array:3 [ "identificador" => "bib0185" "etiqueta" => "37" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Efectividad de los mini-implantes dentales como medio de retención de prótesis transitorias de carga inmediata en pacientes edéntulos" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:1 [ 0 => "A. Sierra" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Odous Científica" "fecha" => "2008" "volumen" => "9" "numero" => "2" "paginaInicial" => "33" "paginaFinal" => "39" ] ] ] ] ] ] 37 => array:3 [ "identificador" => "bib0190" "etiqueta" => "38" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Nueva indicación de implantes cigomáticos para la rehabilitación fija de desdentados parciales: reporte de un caso" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:1 [ 0 => "W. Pintor" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Rev Esp Cir Oral y Maxilofac" "fecha" => "2007" "volumen" => "29" "numero" => "4" "paginaInicial" => "279" "paginaFinal" => "282" ] ] ] ] ] ] 38 => array:3 [ "identificador" => "bib0195" "etiqueta" => "39" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Oseointegración: serendipia o razonamiento científico" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:1 [ 0 => "A. Zerón" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Revista Mexicana de Implantología Bucal y Maxilofacial" "fecha" => "2006" "volumen" => "2" "numero" => "3" "paginaInicial" => "11" "paginaFinal" => "16" ] ] ] ] ] ] 39 => array:3 [ "identificador" => "bib0200" "etiqueta" => "40" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Reconstruction of extensive maxillary defects using zygomaticus implants" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:1 [ 0 => "B. Schmidt" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:8 [ "tituloSerie" => "J Oral Maxillofac Surg" "fecha" => "2004" "volumen" => "62" "numero" => "Suppl 2" "paginaInicial" => "82" "paginaFinal" => "89" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/15332185" "web" => "Medline" ] ] "itemHostRev" => array:3 [ "pii" => "S0016508513004897" "estado" => "S300" "issn" => "00165085" ] ] ] ] ] ] ] ] ] ] ] ] "idiomaDefecto" => "en" "url" => "/1870199X/0000001900000003/v2_201602290913/S1870199X16000446/v2_201602290913/en/main.assets" "Apartado" => array:4 [ "identificador" => "46120" "tipo" => "SECCION" "en" => array:2 [ "titulo" => "Case reports" "idiomaDefecto" => true ] "idiomaDefecto" => "en" ] "PDF" => "https://static.elsevier.es/multimedia/1870199X/0000001900000003/v2_201602290913/S1870199X16000446/v2_201602290913/en/main.pdf?idApp=UINPBA00004N&text.app=https://www.elsevier.es/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1870199X16000446?idApp=UINPBA00004N"]

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CASE REPORT

Rehabilitación protésica integral en ausencia de maxilar. Reporte de un caso

María de Lourdes Mendoza Ugaldea,

Corresponding author

lulapmf@hotmail.com

Corresponding author.

, José Federico Torres Teránb, René Jiménez Castilloc

a Graduate, Maxillofacial Prosthesis, Graduate and Research School, National School of Dentistry, National University of Mexico (UNAM). INCAN resident

b Maxillofacial prostheses practice and professor at the Maxillofacial Prosthesis Department, Graduate and Research School, National School of Dentistry, National University of Mexico (UNAM)

c Department Head, Maxillofacial Prosthesis Department, Graduate and Research School, National School of Dentistry, National University of Mexico (UNAM)

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          "en" => "<p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">Upper impression&#46;</p>"
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    "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">INTRODUCTION</span><p id="par0005" class="elsevierStylePara elsevierViewall">In Mexico&#44; cancer represents a public health problem&#46; This is due to the severe clinical manifestations of the disease&#44; its high mortality rate as well as the variety of associated environmental and individual factors such as ionizing radiation &#40;UV Rays&#41;&#44; occupational radiations &#40;X rays&#41;&#44; irritants &#40;soldering fumes&#44; ozone&#44; acids&#44; maladjusted prostheses&#41; pneumoconiotic particles &#40;asbestos<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1&#44;2</span></a> and silicosis&#41; allergens &#40;natural or synthetic&#41; carcinogens &#40;benign or malign caused by arsenical insecticides&#44; sawdust&#44; asbestos&#44; vinyl chloride&#44; aromatic amines&#44; etc&#41; lifestyle &#40;tobacco use&#44; alcoholism&#44; human papilloma virus&#44; poor hygiene&#41;&#44;<a class="elsevierStyleCrossRefs" href="#bib0015"><span class="elsevierStyleSup">3&#44;4</span></a> genetic factors&#58; &#40;mutations of gene p53&#44; of chromosome 9p21&#44; mutation of gene RB&#41;<a class="elsevierStyleCrossRefs" href="#bib0025"><span class="elsevierStyleSup">5&#44;6</span></a> or related to hereditary cancer syndromes &#40;Plummer Vinson&#41;<a class="elsevierStyleCrossRefs" href="#bib0020"><span class="elsevierStyleSup">4&#44;7</span></a> which increase the degree of the aforementioned risk&#46;<a class="elsevierStyleCrossRefs" href="#bib0040"><span class="elsevierStyleSup">8&#44;9</span></a> They are related to the following factors&#58; increase of older people in the world&#44; decrease of death cases due to communicable diseases&#44; as well as mortality caused by cardio-vascular disease in some countries as well as increase in cancer modalities<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">9</span></a> which affect patient susceptibility&#44; even more so in cases when they present some degree of malnutrition &#40;30-50&#37;&#41;&#46; In these cases&#44; tumor recurrence might be a factor to consider&#46;<a class="elsevierStyleCrossRefs" href="#bib0040"><span class="elsevierStyleSup">8&#44;10&#44;11</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">In Mexico&#44; head and neck cancer represents 17&#46;6&#37; of the total malignant neoplasia cases reported by the Histopathological Record of Neoplasia in Mexico &#40;HRNM&#41; in 2002&#44; where 12&#37; corresponded to Upper Aero-digestive Tract &#40;UADT&#41;&#46; Out of this&#44; oral cancer represented 37&#37; with a 62&#46;4&#37; mortality rate&#46;<a class="elsevierStyleCrossRefs" href="#bib0045"><span class="elsevierStyleSup">9&#44;12</span></a></p><p id="par0015" class="elsevierStylePara elsevierViewall">85 to 90&#37; of UADT cancer cases are due to tobacco exposition&#46; Risk is proportional to exposition intensity&#46; According to INEGI it is an increasing circumstance&#46; It has been reported that 12-17 year old youngsters have increased consumption patterns&#46;<a class="elsevierStyleCrossRefs" href="#bib0045"><span class="elsevierStyleSup">9&#44;12</span></a></p><p id="par0020" class="elsevierStylePara elsevierViewall">Alcohol consumption is another important associated factor&#46; It produces synergism&#46; Whilst a heavy smoker or drinker increases risk in direct proportion to consumption&#44; those who smoke and drink increase risk 35 times over&#46;<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">9</span></a></p><p id="par0025" class="elsevierStylePara elsevierViewall">Squamous cell carcinoma is the most frequent oral neoplasia in Mexico&#46; It is found at a risk factor of 1&#46;4&#37; in males and 0&#46;9 in females in the head and neck area&#46; In 0&#46;02&#37; of all cases it is found in the palate in males&#44; and 0&#46;009&#37; in females&#44; in a 1&#46;7&#58;1&#46;2 relationship respectively&#44; in 2007&#46;<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">12</span></a> At the &#171;20 de Noviembre&#187; National Medical Center&#44; a study was conducted in 2009&#44; in it&#44; a 2&#58;1 male-female relationship was reported&#46; After treatment 46&#46;9&#37; recurrence was observed&#44; 32&#46;2&#37; metastasis and 22&#46;45&#37; mortality&#46;<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">13</span></a></p><p id="par0030" class="elsevierStylePara elsevierViewall">General frequency of ganglion metastases ranges between 10 and 40&#37;&#44; few distanced metastases were reported&#46; In the hard palate and retromolar trigone&#44; tumors are normally detected at an early stage since they elicit bleeding and pain in the palate&#46;<a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">14</span></a></p><p id="par0035" class="elsevierStylePara elsevierViewall">According to the tumors&#8217; histological type&#44; etiological factors and location&#44; epidemiological characteristics symptomatology&#44; progression&#44; therapeutics and prognosis will be modified&#46;<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a> Squamous cell carcinoma is a malignant neoplasia originating from squamous cells&#59; it represents 92&#37; of all oral cavity neoplasia&#44; it is followed by basal cell carcinoma and melanoma&#46;<a class="elsevierStyleCrossRefs" href="#bib0065"><span class="elsevierStyleSup">13&#44;15&#44;16</span></a> It is placed in 12<span class="elsevierStyleSup">th</span> place of all malignant neoplasia in the whole world&#46; It mainly affects patients in their seventh decade of life&#44; with average age of 68 years&#46;<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">13</span></a> This head and neck carcinoma is most frequent in older men&#44; nevertheless&#44; an increase in young people and women has been reported&#44; as well as in pregnant women&#46;<a class="elsevierStyleCrossRef" href="#bib0085"><span class="elsevierStyleSup">17</span></a> It can have its onset as a leukoplakia &#40;2-4&#37; invasive&#41; or erythroplasia &#40;80&#37; invasive&#41; in high-risk zones such as floor of the mouth&#44; ventro-lateral side of the tongue soft palate and palatal velum&#46;<a class="elsevierStyleCrossRef" href="#bib0090"><span class="elsevierStyleSup">18</span></a> Different locations of the tumor will elicit different behavior patterns and prognoses&#44; which in turn will require different treatment plans&#46;<a class="elsevierStyleCrossRefs" href="#bib0070"><span class="elsevierStyleSup">14&#44;19</span></a></p><p id="par0040" class="elsevierStylePara elsevierViewall">Reaction to different types of treatment modify prosthetic rehabilitation times during procedure and after it&#46; These treatments can be adjuvant or concomitant &#40;chemotherapy&#44; radiotherapy&#44; surgery&#41;&#44; they are alternative treatments and increase organ preservation&#44; improving thus treatment success&#46;<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">8</span></a></p><p id="par0045" class="elsevierStylePara elsevierViewall">Chemotherapy consists on anti-neoplastic drug administration to induce tumor cell destruction though the hindering of cell division&#46; Most used drugs for head and neck treatment are&#58; bleomycin&#44; cisplatin&#44; methotrexate&#44; 5 fluorouracil&#44; vinblastine&#44; cyclophosphamide&#44; carboplatin&#44; gefinitib&#44; erbitux&#44; and cetuximab&#46;<a class="elsevierStyleCrossRefs" href="#bib0100"><span class="elsevierStyleSup">20&#8211;22</span></a> Certain anti-neoplastic drugs can cause long-term lesions in the hematopoietic system&#46;<a class="elsevierStyleCrossRef" href="#bib0115"><span class="elsevierStyleSup">23</span></a> It can be curative &#40;total tumor control&#41;&#44; adjuvant &#40;after surgery&#44; decreasing the risk of metastasis&#41;&#44; previous &#40;partial tumor reduction to complement surgery or radiotherapy&#41; and palliative &#40;improving patient&#39;s quality of life&#41;&#46;<a class="elsevierStyleCrossRefs" href="#bib0070"><span class="elsevierStyleSup">14&#44;20</span></a> Knowledge of HPV &#40;human papilloma virus&#41; is becoming an important consideration to observe when assessing treatment for patients with head and neck cancer&#46; Patients who are HPV-positive respond better to treatment&#44; Current research is targeting to stratify patients according to their HPV status in clinical trials&#46;<a class="elsevierStyleCrossRef" href="#bib0105"><span class="elsevierStyleSup">21</span></a></p><p id="par0050" class="elsevierStylePara elsevierViewall">Ionizing-radiation radiotherapy either destroys cancer cells or decreases their growth&#46; This is a common treatment for head and neck cancer cases&#44; it is used for approximately 50&#37; of all cancer treatments in this area&#59; it can be used by itself&#44; or combined with chemotherapy and&#47;or surgery&#46;<a class="elsevierStyleCrossRefs" href="#bib0070"><span class="elsevierStyleSup">14&#44;20</span></a> It can cause oral complications such as mucositis&#44; bacterial or fungal infections&#44; salivary gland dysfunction&#44; fibrosis&#44; dental caries&#44; dysfunction of sense of taste or osteo-radionecroses&#46;<a class="elsevierStyleCrossRefs" href="#bib0070"><span class="elsevierStyleSup">14&#44;19&#44;22</span></a></p><p id="par0055" class="elsevierStylePara elsevierViewall">Surgical treatment of head and neck involves a series of functional repercussions of the anatomical structures affected by the tumor&#46; This can appear in neck and scapular region mobility&#44; alterations in healing and lymphatic drainage&#44; as well as deglutition&#44; which would then warrant extirpation surgery of tumor resection and&#47;or lymphatic surgery of tumor-affected areas&#46;<a class="elsevierStyleCrossRef" href="#bib0095"><span class="elsevierStyleSup">19</span></a></p><p id="par0060" class="elsevierStylePara elsevierViewall">Therefore&#44; sequels originated from surgical treatment in the bucco-antral area are caused by maxillectomies &#40;limited&#44; partial&#44; medial subtotal&#44; total radical or extended&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0120"><span class="elsevierStyleSup">24</span></a> These sequels can be structural &#40;bucal-antral communication&#41;<a class="elsevierStyleCrossRefs" href="#bib0015"><span class="elsevierStyleSup">3&#44;24</span></a> functional &#40;breathing&#44; mastication&#44; deglutition&#44; phonation&#41; and psychological&#46;<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a></p><p id="par0065" class="elsevierStylePara elsevierViewall">Aramany undertook to classify maxillary defects based upon the defect area and remaining teeth<a class="elsevierStyleCrossRef" href="#bib0125"><span class="elsevierStyleSup">25</span></a> Classifications I&#44; II and IV &#40;lateral defects with anterior margins close to the midline&#41; are the most frequent&#46;<a class="elsevierStyleCrossRef" href="#bib0130"><span class="elsevierStyleSup">26</span></a> It is therefore of the utmost importance to consider that full&#44; wide defects of the soft and hard palate are not considered within this classification &#40;when in the soft palate&#44; they are rather considered hereditary defects&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0130"><span class="elsevierStyleSup">26</span></a> Kan-ichi Seto did mention it in 2003 &#40;HS classification&#41;&#44; and referred to it as H6SODxT3 &#40;full defect without soft palate involvement&#44; impossible to determine oral opening degree and with no tooth presence&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a> It takes into account the fact that not only the upper jaw is involved&#59; hard palate and para-nasal sinuses are equally involved&#44; and due to the loss of support experienced by the upper jaw&#44; there is development of enophthalmos and diplopia&#46;<a class="elsevierStyleCrossRef" href="#bib0135"><span class="elsevierStyleSup">27</span></a></p><p id="par0070" class="elsevierStylePara elsevierViewall">Maxillofacial rehabilitation of head and neck cancer patients demands knowledge of the disease&#44; type of resection&#44; margins and post-treatment&#46;<a class="elsevierStyleCrossRefs" href="#bib0035"><span class="elsevierStyleSup">7&#44;28&#8211;30</span></a> The field of reconstructive surgery has seen great advances with techniques of epithelial&#44; muscle and bone grafts&#44; which target prosthesis support&#46;<a class="elsevierStyleCrossRefs" href="#bib0035"><span class="elsevierStyleSup">7&#44;28&#44;30</span></a> Prosthetic rehabilitation encompasses the palatal shutter &#40;obturator&#41;which offers modifications to full prosthodontics&#46;<a class="elsevierStyleCrossRefs" href="#bib0015"><span class="elsevierStyleSup">3&#44;4&#44;28</span></a> This techniques takes into consideration defect volume&#44; remaining hard and soft tissues&#44; quality of the mucosa as well as stability and retention of the appliance&#46; All the aforementioned factors will determine the appliance&#39;s design&#46; Other factors to be equally considered are&#58; patient&#39;s experience with dentures&#44; neuromuscular control and previous therapeutic history &#40;radiotherapy&#44; chemotherapy&#44; surgery&#41;&#46;<a class="elsevierStyleCrossRefs" href="#bib0120"><span class="elsevierStyleSup">24&#44;27</span></a></p><p id="par0075" class="elsevierStylePara elsevierViewall">The palatal shutter is a prosthesis used to close a congenital or acquired opening&#44; preserving the integrity of oral and nasal compartments&#46; It facilitates speech&#44; deglutition and mastication&#44; either in provisional or final surgical stages&#46;<a class="elsevierStyleCrossRefs" href="#bib0015"><span class="elsevierStyleSup">3&#44;31</span></a></p><p id="par0080" class="elsevierStylePara elsevierViewall">Severe cases require rigid obturator extension towards soft tissue areas&#46; This complicates rehabilitation&#44; since it no longer requires only the aforementioned characteristics&#44; it also requires obturator seal on mobile&#44; free margins&#46; Thus&#44; boneintegrated implants &#40;including mini-implants and zygomatic implants&#41; have been considered as those implants providing most retention and requiring sometimes bone distraction&#46; Reaction of bone tissue to implant insertion must be taken into account &#40;boneimplant bonding&#41;&#44; cleansing and preparation of implant surface&#44; as well as bone type &#40;area to receive implant&#41; and implant type&#46;<a class="elsevierStyleCrossRefs" href="#bib0135"><span class="elsevierStyleSup">27&#44;32&#8211;34</span></a></p><p id="par0085" class="elsevierStylePara elsevierViewall">When following this therapeutic approach&#44; patient risk factors such as age&#44; medical circumstances&#44; psycho-social circumstances&#44; habits&#44; presence of osteoporosis&#44; periodontitis or cancer&#44; must<a class="elsevierStyleCrossRef" href="#bib0205"><span class="elsevierStyleSup">35</span></a> be taken into consideration&#46; Patients must be referred to special preventive programs&#46; This will bear influence in treatment success or failure&#46;</p><p id="par0090" class="elsevierStylePara elsevierViewall">Bone distraction is a process triggered by application of planned and controlled tension on a corticotomy or osteotomy&#46; This process allows for bone neo-formation and elongation based on a bony callus&#46; This elongation is transmitted to soft tissues&#44; it induces their gradual and continuous growth&#46; It develops in four phases&#58; osteotomy&#44; latency&#44; distraction and consolidation&#46;<a class="elsevierStyleCrossRefs" href="#bib0160"><span class="elsevierStyleSup">32&#44;36</span></a> It has been shown to be safe and effective&#44; generating histiogenic distraction &#40;masticatory muscles&#44; subcutaneous tissue and skin&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0180"><span class="elsevierStyleSup">36</span></a></p><p id="par0095" class="elsevierStylePara elsevierViewall">Use of mini-implants &#40;MDI&#41; is recommended for patients who lack sufficient bone structure to place implants smaller than 3&#46;75<span class="elsevierStyleHsp" style=""></span>mm&#46; These implants have a 1&#46;8<span class="elsevierStyleHsp" style=""></span>mm diameter&#46; Their use provides advantages such as lesser bleeding and lesser post-operative discomfort&#44; faster healing &#40;due to diminished surgical maneuvers&#41; lesser bone loss when compared to the traditional method&#46; In addition to the aforementioned&#44; these implants are of much lower cost&#46; They were first provisionally used for immediate load&#44; along with conventional implants&#44; so as to be retention means of immediate prostheses&#44; and prevent premature loads on the bone and thus avoid compromising final implants&#46; Previous studies report their success as being between 92&#37; and 97&#37;&#44; according to number and surgical zone&#46;<a class="elsevierStyleCrossRef" href="#bib0185"><span class="elsevierStyleSup">37</span></a></p><p id="par0100" class="elsevierStylePara elsevierViewall">Since 1990&#44; zygomatic implants created and developed by Dr Branemark have been used as posterior anchorage for implant-supported dentures in patients with severe maxillary atrophy&#46; These implants are indicated in cases of severe maxillary resorption or in patients afflicted with full upper edentulism&#46; Their use eliminates the need for bone grafts or maxillary sinus lifting&#46; They are introduced into the zygomatic bone&#44; and can be joined by other conventional implants in the upper jaw&#39;s anterior area&#44; in which place there is normally remaining bone&#46; After implant placement&#44; a provisional denture can be placed&#46; 4 to 6 months must be left to elapse in order to achieve implant boneintegration and then place a final denture&#46;<a class="elsevierStyleCrossRefs" href="#bib0160"><span class="elsevierStyleSup">32&#44;38&#8211;40</span></a></p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0030">CLINICAL CASE PRESENTATION</span><p id="par0105" class="elsevierStylePara elsevierViewall">69 year old male patient&#44; born and residing in Mexico City&#46; The patient reported he had a commonlaw wife&#44; was catholic and a taxi driver&#46; In 1992&#44; at the Mexico&#39;s National Cancer Institute&#44; he was diagnosed with non-differentiated squamous cell carcinoma in the hard palate&#46; Approximate tumor size was 1 x 2 x 1&#46;5&#46; The patient suffered hypertension&#44; gastritis and Type II diabetes&#46; He was under medical treatment &#40;acquired after chemotherapy treatment&#41;&#46; The patient equally informed he was a two-pack a day cigarette smoker as well as an alcohol drinker&#46;</p><p id="par0110" class="elsevierStylePara elsevierViewall">After diagnosis was established&#44; the patient informed he had been subjected for 5 years to chemotherapy with Cis platinum and 5FU&#46; Results were favorable inasmuch as avoiding tumor growth and preventing metastasis&#46; After the aforementioned treatment&#44; the patient suffered tumor recurrence at the same location&#46; This new tumor spanned into the whole upper jaw&#46; Therefore&#44; surgery was deemed necessary&#46; Surgery was total bilateral maxillectomy with radical neck resection&#46; Surgery sequels were facial collapse of the face&#39;s middle third&#46; The patient was not subjected to post-operative radiotherapy <span class="elsevierStyleItalic">&#40;</span><a class="elsevierStyleCrossRef" href="#fig0005"><span class="elsevierStyleItalic">Figure 1</span></a><span class="elsevierStyleItalic">&#41;</span>&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0115" class="elsevierStylePara elsevierViewall">Since rehabilitation was complex&#44; several treatment forms were analyzed &#40;taking into account the fact that the patient had not received radiotherapy&#41;&#46; Considered treatment options were&#58; placement of 4 mini-implants &#40;2 in the posterior zone and 2 in the anterior zone&#41;&#46; With the help of stereolythography&#44; ideal implant location was planned in order to achieve a surgical guide <span class="elsevierStyleItalic">&#40;</span><a class="elsevierStyleCrossRefs" href="#fig0010"><span class="elsevierStyleItalic">Figures 2 and 3</span></a><span class="elsevierStyleItalic">&#41;</span>&#46;</p><elsevierMultimedia ident="fig0010"></elsevierMultimedia><elsevierMultimedia ident="fig0015"></elsevierMultimedia><p id="par0120" class="elsevierStylePara elsevierViewall">Manufactured dentures presented insufficient initial stability and retention&#46; With time&#44; the upper denture required greater functionality and esthetics in concordance with changes and requirements of remaining tissue&#44; therefore&#44; present retention was no longer sufficient <span class="elsevierStyleItalic">&#40;</span><a class="elsevierStyleCrossRef" href="#fig0020"><span class="elsevierStyleItalic">Figure 4</span></a><span class="elsevierStyleItalic">&#41;</span>&#46;</p><elsevierMultimedia ident="fig0020"></elsevierMultimedia><p id="par0125" class="elsevierStylePara elsevierViewall">It was decided to place bone distractors&#44; so as to obtain an area of greater support&#44; to later place zygomatic implants&#46; The multi-disciplinary team conducted a previous coordinated analysis of the case targeting the remodeling of that area in order to achieve greater support and stability of the final obturator <span class="elsevierStyleItalic">&#40;</span><a class="elsevierStyleCrossRefs" href="#fig0025"><span class="elsevierStyleItalic">Figures 5 and 6</span></a><span class="elsevierStyleItalic">&#41;</span>&#46;</p><elsevierMultimedia ident="fig0025"></elsevierMultimedia><elsevierMultimedia ident="fig0030"></elsevierMultimedia><p id="par0130" class="elsevierStylePara elsevierViewall">Unfortunately&#44; due to bone insufficiency&#44; the implanted zone rejected the implants&#44; even though indicated bone-integration time was observed &#40;between 4 and 6 months&#41; as well as healing period&#44; prevention and infection control&#46;</p><p id="par0135" class="elsevierStylePara elsevierViewall">Taking into account bone response to implants it was decided to build modified full dentures&#46; Upon assessing the defect&#44; it was observed there were two posterior mini-implants which afforded some support to the denture&#44; nevertheless&#44; they failed to prevent denture displacement mainly during mastication and phonation procedures&#46; Patient comfort and esthetics were also compromised <span class="elsevierStyleItalic">&#40;</span><a class="elsevierStyleCrossRef" href="#fig0035"><span class="elsevierStyleItalic">Figure 7</span></a><span class="elsevierStyleItalic">&#41;</span>&#46;</p><elsevierMultimedia ident="fig0035"></elsevierMultimedia></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">METHODOLOGY</span><p id="par0140" class="elsevierStylePara elsevierViewall"><ul class="elsevierStyleList" id="lis0005"><li class="elsevierStyleListItem" id="lsti0005"><span class="elsevierStyleLabel">1&#46;</span><p id="par0145" class="elsevierStylePara elsevierViewall">Anatomical impression of the defect was taken&#46; Rapid-setting alginate was used&#46; The material was handled according to manufacturer s instructions&#46; Lower arch impression was equally taken <span class="elsevierStyleItalic">&#40;</span><a class="elsevierStyleCrossRef" href="#fig0040"><span class="elsevierStyleItalic">Figure 8</span></a><span class="elsevierStyleItalic">&#41;</span>&#46;</p><elsevierMultimedia ident="fig0040"></elsevierMultimedia></li><li class="elsevierStyleListItem" id="lsti0010"><span class="elsevierStyleLabel">2&#46;</span><p id="par0150" class="elsevierStylePara elsevierViewall">Positive models of both arches were taken with type III hard plaster <span class="elsevierStyleItalic">&#40;</span><a class="elsevierStyleCrossRef" href="#fig0045"><span class="elsevierStyleItalic">Figure 9</span></a><span class="elsevierStyleItalic">&#41;</span>&#46;</p><elsevierMultimedia ident="fig0045"></elsevierMultimedia></li><li class="elsevierStyleListItem" id="lsti0015"><span class="elsevierStyleLabel">3&#46;</span><p id="par0155" class="elsevierStylePara elsevierViewall">Individual trays were manufactured&#46; Borders were later rectified with type II stick modeling paste material&#46; Defects of border as well as lower arch were recorded&#46;</p></li><li class="elsevierStyleListItem" id="lsti0020"><span class="elsevierStyleLabel">4&#46;</span><p id="par0160" class="elsevierStylePara elsevierViewall">Once the borders were rectified&#44; physiological impression was taken with polysulfide rubber&#46; Impression of upper defect was first taken&#44; followed by impression of the lower arch <span class="elsevierStyleItalic">&#40;</span><a class="elsevierStyleCrossRef" href="#fig0050"><span class="elsevierStyleItalic">Figure 10</span></a><span class="elsevierStyleItalic">&#41;</span>&#46;</p><elsevierMultimedia ident="fig0050"></elsevierMultimedia></li><li class="elsevierStyleListItem" id="lsti0025"><span class="elsevierStyleLabel">5&#46;</span><p id="par0165" class="elsevierStylePara elsevierViewall">Impressions were contoured in order to obtain type IV plaster working models <span class="elsevierStyleItalic">&#40;</span><a class="elsevierStyleCrossRef" href="#fig0055"><span class="elsevierStyleItalic">Figure 11</span></a><span class="elsevierStyleItalic">&#41;</span>&#46;</p><elsevierMultimedia ident="fig0055"></elsevierMultimedia></li><li class="elsevierStyleListItem" id="lsti0030"><span class="elsevierStyleLabel">6&#46;</span><p id="par0170" class="elsevierStylePara elsevierViewall">Working models were trimmed&#44; recording bases were recorded with relationship rollers&#44; so as to later undertake prosthetic&#44; phonetic and esthetics tests&#46;</p></li><li class="elsevierStyleListItem" id="lsti0035"><span class="elsevierStyleLabel">7&#46;</span><p id="par0175" class="elsevierStylePara elsevierViewall">After establishing cranio-mandibular relationships&#44; plastic braces were taken to proceed to model transfer to a semi-adjustable articulator&#46;</p></li><li class="elsevierStyleListItem" id="lsti0040"><span class="elsevierStyleLabel">8&#46;</span><p id="par0180" class="elsevierStylePara elsevierViewall">Once the models were transferred&#46; Teeth were selected according to established principles&#44; so as to place them and later balance them&#46;</p></li><li class="elsevierStyleListItem" id="lsti0045"><span class="elsevierStyleLabel">9&#46;</span><p id="par0185" class="elsevierStylePara elsevierViewall">Dentures were tested in the mouth <span class="elsevierStyleItalic">&#40;</span><a class="elsevierStyleCrossRef" href="#fig0060"><span class="elsevierStyleItalic">Figure 12</span></a><span class="elsevierStyleItalic">&#41;</span>&#46;</p><elsevierMultimedia ident="fig0060"></elsevierMultimedia></li><li class="elsevierStyleListItem" id="lsti0050"><span class="elsevierStyleLabel">10&#46;</span><p id="par0190" class="elsevierStylePara elsevierViewall">Obturator and lower denture were manufactured following the lost wax casting technique&#46; The obturator was hollowed out so as to make it lighter&#46;</p></li><li class="elsevierStyleListItem" id="lsti0055"><span class="elsevierStyleLabel">11&#46;</span><p id="par0195" class="elsevierStylePara elsevierViewall">Dentures were processed with heat-cured acrylic&#44; which was processed according to manufacturer&#39;s instructions&#46;</p></li><li class="elsevierStyleListItem" id="lsti0060"><span class="elsevierStyleLabel">12&#46;</span><p id="par0200" class="elsevierStylePara elsevierViewall">Finally&#44; dentures were retrieved from the muffles in order to be trimmed&#44; polished and placed in the patient <span class="elsevierStyleItalic">&#40;</span><a class="elsevierStyleCrossRefs" href="#fig0065"><span class="elsevierStyleItalic">Figures 13 and 15</span></a><span class="elsevierStyleItalic">&#41;</span>&#46;</p><elsevierMultimedia ident="fig0065"></elsevierMultimedia><elsevierMultimedia ident="fig0070"></elsevierMultimedia><elsevierMultimedia ident="fig0075"></elsevierMultimedia></li><li class="elsevierStyleListItem" id="lsti0065"><span class="elsevierStyleLabel">13&#46;</span><p id="par0205" class="elsevierStylePara elsevierViewall">Patient was instructed on denture use and preservation&#44; as well as to the need of recurrent visits to assess denture adaptation&#46;</p></li></ul></p><p id="par0210" class="elsevierStylePara elsevierViewall">The obturator was built in concordance with basic principles of full denture construction&#46; Modifications were executed in order to obtain better results&#46;</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">DISCUSSION</span><p id="par0215" class="elsevierStylePara elsevierViewall">Squamous cell carcinoma is one of the most frequent malignant neoplasia found in the world&#46; In concordance with numerous authors<a class="elsevierStyleCrossRefs" href="#bib0045"><span class="elsevierStyleSup">9&#44;12&#8211;14&#44;16&#8211;18</span></a> we observed that simultaneous smoking and drinking increases the risk of contracting oral cancer&#46;</p><p id="par0220" class="elsevierStylePara elsevierViewall">Therefore&#44; satisfactory prosthetic rehabilitation requires multi-disciplinary efforts in order to achieve suitable functional adaptation<a class="elsevierStyleCrossRef" href="#bib0120"><span class="elsevierStyleSup">24</span></a> in view of the complexity of diagnosis&#44; therapies and rehabilitation of head and neck cancer patients&#46;<a class="elsevierStyleCrossRef" href="#bib0140"><span class="elsevierStyleSup">28</span></a> In cases when the maxillary defect is not surgically reconstructed&#44; a surgical obturator would be recommended to seal the defect&#44; since it will support the surgical site and restore oral function&#46;<a class="elsevierStyleCrossRef" href="#bib0135"><span class="elsevierStyleSup">27</span></a></p><p id="par0225" class="elsevierStylePara elsevierViewall">It is important to note the fact that obturator prostheses have been widely modified&#44; since the essential foundation of a full prosthesis is based on the residual ridge and in this case there was no ridge&#46; Classifications such as that of Aramany do not include total loss of the jaw&#46; Kan-ichi Seto did mention it&#44; but did not explain how to rehabilitate a patient with this type of defect&#46;<a class="elsevierStyleCrossRefs" href="#bib0015"><span class="elsevierStyleSup">3&#44;25</span></a> Ortegon et al &#40;2008&#41; and Cheng et al&#40;2004&#41; do mention it with different techniques&#46;<a class="elsevierStyleCrossRefs" href="#bib0120"><span class="elsevierStyleSup">24&#44;27</span></a></p><p id="par0230" class="elsevierStylePara elsevierViewall">Thus&#44; retention of a bilateral full obturator can be supported following several methods such as &#40;1&#41; remaining structures of the upper jaw along with the posterior third of the soft palate&#44; &#40;2&#41; supporting the obturator on a healed lateral band&#44; &#40;3&#41; extending extra-orally the prosthesis towards the nostrils and &#40;4&#41; based on bone-integrated implants&#46;<a class="elsevierStyleCrossRefs" href="#bib0120"><span class="elsevierStyleSup">24&#44;32</span></a></p><p id="par0235" class="elsevierStylePara elsevierViewall">In the present report&#44; obturator manufacture involved two stages&#58; 1&#41; Manufacture of obturator and lower denture&#44; 2&#41; at the moment of being processed&#44; the obturator is emptied using heat-curing acrylic&#46; In situations when the defect is more complex&#44; the obturator must be manufactured in segments&#46;<a class="elsevierStyleCrossRef" href="#bib0135"><span class="elsevierStyleSup">27</span></a></p><p id="par0240" class="elsevierStylePara elsevierViewall">During the manufacture of these obturator prostheses&#44; it must be taken into account that there will be modifications and alterations in clinical and laboratory treatments&#44; such as&#58; 1&#41; During manufacturing of provisional prosthesis&#44; 2&#41; during bulb manufacture in the final prosthesis&#44; 3&#41; upper and lower jaw relationship and 4&#41; insertion of final prosthesis&#44; where wide maxillary defects might compromise denture functionality&#46;<a class="elsevierStyleCrossRef" href="#bib0135"><span class="elsevierStyleSup">27</span></a></p><p id="par0245" class="elsevierStylePara elsevierViewall">Therefore&#44; a suitable treatment plan for such a wide defect always will require patient pre-surgical acceptance&#46; The patient will be in the hands of a team formed by surgeons&#44; maxillofacial prosthetic specialists&#44; phoniatricians&#44; nutritionists and psychologists&#46;<a class="elsevierStyleCrossRef" href="#bib0135"><span class="elsevierStyleSup">27</span></a></p><p id="par0250" class="elsevierStylePara elsevierViewall">It is equally important to note that success of a prosthetic rehabilitation will depend 50&#37; on the physician and 50&#37; on the patient &#40;before&#44; during and after treatment&#41;&#46;</p><p id="par0255" class="elsevierStylePara elsevierViewall">Finally restoration was achieved as far as possible&#44; impacting deglutition&#44; speech&#44; mastication&#44; esthetic appearance as well as patient&#39;s psychological welfare&#59; which will in turn impact on patient&#39;s comfort&#44; and security which are necessary to reinsert the patient into society affording thus suitable quality of life&#46;<a class="elsevierStyleCrossRefs" href="#bib0120"><span class="elsevierStyleSup">24&#44;27</span></a></p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">CONCLUSIONS</span><p id="par0260" class="elsevierStylePara elsevierViewall">The patient informed of a 5-year ongoing chemotherapy history&#44; with late mini-implant placement&#44; bone distraction procedure and placement of zygomatic implants based on stereolitographs&#46; Patient&#39;s clinical experience was negative&#44; as a result of existing poor bone quality&#46; It was therefore decided to manufacture a full lower prosthesis and a modified palatal shutter&#46;</p><p id="par0265" class="elsevierStylePara elsevierViewall">When bilateral total maxillectomy was undertaken&#44; prognosis was negative&#46; The patient was fully edentulous in the lower section&#44; therefore&#44; a light&#44; retentive and functional shutter had to be devised&#44; to primarily achieve a barrier between oral and nasal cavities&#46; The shutter provided support and stability&#44; and this&#44; along with a full lower denture&#44; preempted the need to use adhesive material&#46;</p><p id="par0270" class="elsevierStylePara elsevierViewall">The patient experienced suitable defect healing&#44; and was of a positive attitude&#44; this was very important in the process&#46;</p><p id="par0275" class="elsevierStylePara elsevierViewall">We noticed the fact that the modified palatal prosthesis afforded the patient another treatment alternative&#46; The present one was manufactured with acrylic material and met with patient&#39;s expectations for improved quality of life&#46;</p><p id="par0280" class="elsevierStylePara elsevierViewall">The patient presently exhibits better adaptation to the palatal shutter&#46; He can now eat&#44; drink liquids and speak better&#46; The restoration is more aesthetic and affords the patient with more self-security to interact in society&#46;</p></span></span>"
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                        "tituloSerie" => "Bol Soc Geol Mexicana"
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                        "numero" => "2"
                        "paginaInicial" => "154"
                        "paginaFinal" => "161"
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                        "tituloSerie" => "Universidad La Salle"
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                        "volumen" => "7"
                        "numero" => "25"
                        "paginaInicial" => "91108"
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                    ]
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                        "tituloSerie" => "Acta Otorrinolaringol Esp"
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                        "paginaInicial" => "381"
                        "paginaFinal" => "386"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/11526644"
                            "web" => "Medline"
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                        "numero" => "2"
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                        "paginaFinal" => "92"
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                          "autores" => array:1 [
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                          ]
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                    0 => array:1 [
                      "Revista" => array:7 [
                        "tituloSerie" => "Rev Mex Oftalmol"
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                        "numero" => "6"
                        "paginaInicial" => "336"
                        "paginaFinal" => "339"
                        "itemHostRev" => array:3 [
                          "pii" => "S0168827812008100"
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                          "issn" => "01688278"
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                      "titulo" => "Reconstrucci&#243;n en cirug&#237;a oncol&#243;gica de cabeza y cuello&#58; Perspectivas"
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                          "autores" => array:1 [
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                      "titulo" => "DeVita Hellman&#44; and Rosenberg&#39;s Cancer&#58; Principles &#38; Practice of Oncology&#46;"
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                          "autores" => array:3 [
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                            2 => "S&#46; Rosenberg"
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                            0 => "G&#46;G&#46; Tirado"
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                        "paginaFinal" => "17"
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                      "titulo" => "El estado nutricional en pacientes con c&#225;ncer de cabeza y cuello&#58; Implicaciones pron&#243;sticas"
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                          "autores" => array:1 [
                            0 => "M&#46;C&#46; Villares"
                          ]
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                    ]
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                    0 => array:1 [
                      "Revista" => array:7 [
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                        "fecha" => "2003"
                        "volumen" => "18"
                        "numero" => "2"
                        "paginaInicial" => "91"
                        "paginaFinal" => "94"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/12723380"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            10 => array:3 [
              "identificador" => "bib0055"
              "etiqueta" => "11"
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                      "titulo" => "Valoraci&#243;n del estado de nutrici&#243;n en el paciente con c&#225;ncer"
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                          "etal" => false
                          "autores" => array:1 [
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                          "etal" => true
                          "autores" => array:1 [
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                  ]
                ]
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              "identificador" => "bib0065"
              "etiqueta" => "13"
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                0 => array:2 [
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                    0 => array:2 [
                      "titulo" => "Carcinoma de c&#233;lulas escamosas de cavidad bucal en un centro de tercer nivel de atenci&#243;n social en la Ciudad de M&#233;xico"
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                        0 => array:2 [
                          "etal" => false
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                            1 => "I&#46;J&#46;J&#46; Mu&#241;oz"
                            2 => "V&#46;C&#46; P&#225;ez"
                            3 => "L&#46;B&#46; Cruz"
                            4 => "B&#46;B&#46; Aldape"
                          ]
                        ]
                      ]
                    ]
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                        "tituloSerie" => "Experiencia de cinco a&#241;os Avances en Odontoestomatolog&#237;a"
                        "fecha" => "2009"
                        "volumen" => "25"
                        "numero" => "1"
                        "paginaInicial" => "19"
                        "paginaFinal" => "28"
                      ]
                    ]
                  ]
                ]
              ]
            ]
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              "identificador" => "bib0070"
              "etiqueta" => "14"
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                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "C&#225;ncer de cabeza cuello"
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                          "etal" => false
                          "autores" => array:1 [
                            0 => "A&#46;R&#46; Villar"
                          ]
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                      ]
                    ]
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                  "host" => array:1 [
                    0 => array:1 [
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                        "paginaInicial" => "1"
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                        "editorial" => "Doyma"
                        "editorialLocalizacion" => "Espa&#241;a"
                      ]
                    ]
                  ]
                ]
              ]
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              "etiqueta" => "15"
              "referencia" => array:1 [
                0 => array:2 [
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                    0 => array:2 [
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                        0 => array:2 [
                          "etal" => false
                          "autores" => array:5 [
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                            1 => "T&#46;J&#46;F&#46; Torres"
                            2 => "G&#46;E&#46; Medrano"
                            3 => "C&#46;V&#46; Gonz&#225;lez"
                            4 => "L&#46;J&#46;C&#46; Garc&#237;a"
                          ]
                        ]
                      ]
                    ]
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                  "host" => array:1 [
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                        "paginaFinal" => "76"
                      ]
                    ]
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                ]
              ]
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            15 => array:3 [
              "identificador" => "bib0080"
              "etiqueta" => "16"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Management of oral squamous cell carcinoma treated with inadequate excisional biosy"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:1 [
                            0 => "J&#46;S&#46; Bailey"
                          ]
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                    0 => array:2 [
                      "doi" => "10.1053/joms.2001.25826"
                      "Revista" => array:6 [
                        "tituloSerie" => "J Oral Maxillofac Surg"
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                        "volumen" => "59"
                        "paginaInicial" => "1007"
                        "paginaFinal" => "1010"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/11526566"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
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              "identificador" => "bib0085"
              "etiqueta" => "17"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Squamous cell carcinoma of the maxilla during pregnancy&#58; report of case"
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                        0 => array:2 [
                          "etal" => false
                          "autores" => array:4 [
                            0 => "A&#46;G&#46; Garc&#237;a"
                            1 => "J&#46;L&#46; Antunez"
                            2 => "J&#46;R&#46; G&#225;ndara"
                            3 => "M&#46;C&#46; Pombar"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
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                        "volumen" => "59"
                        "paginaInicial" => "456"
                        "paginaFinal" => "461"
                      ]
                    ]
                  ]
                ]
              ]
            ]
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              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Carcinoma epidermoide de cavidad oral"
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                          "etal" => true
                          "autores" => array:1 [
                            0 => "M&#46; L&#243;pez"
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              ]
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              "referencia" => array:1 [
                0 => array:2 [
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                    0 => array:2 [
                      "titulo" => "Physicaltherapy and swallowing reeducation in surgery of head and neck neoplasm"
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                            0 => "C&#46; Souto"
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                    ]
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                        "tituloSerie" => "Fisioterapia"
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                        "numero" => "5"
                        "paginaInicial" => "311"
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                      ]
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                  ]
                ]
              ]
            ]
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              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Dental management of the complications of radio and chemotherapy in oral cancer"
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                            3 => "F&#46; Finestres-Zubeldia"
                            4 => "B&#46; Guiux-Melcior"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Med Oral"
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                        "volumen" => "8"
                        "paginaInicial" => "178"
                        "paginaFinal" => "187"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/12730652"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
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              "identificador" => "bib0105"
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              "referencia" => array:1 [
                0 => array:2 [
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                    0 => array:2 [
                      "titulo" => "Clinical cancer advances 2009&#58; major research advances in clinical treatment prevention and screening-a report from the American Society of Clinical Oncology &#40;ASCO&#41;"
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                        0 => array:2 [
                          "etal" => true
                          "autores" => array:1 [
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                    ]
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                    0 => array:2 [
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                        "tituloSerie" => "J Clin Oncol"
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                        "numero" => "35"
                        "paginaInicial" => "6052"
                        "paginaFinal" => "6069"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/19901123"
                            "web" => "Medline"
                          ]
                        ]
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                    ]
                  ]
                ]
              ]
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              "identificador" => "bib0110"
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                0 => array:2 [
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                    0 => array:2 [
                      "titulo" => "Double-blind&#44; placebo-controlled cross-over study of oral pilocarpine for the prevention of chemotherapy-induced oral mucositis in adult patients with cancer"
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                        0 => array:2 [
                          "etal" => true
                          "autores" => array:1 [
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                      ]
                    ]
                  ]
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                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Eur J Cancer"
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                        "volumen" => "37"
                        "paginaInicial" => "2010"
                        "paginaFinal" => "2014"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/11597378"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
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                    0 => array:2 [
                      "titulo" => "Lowitz&#46; Oncolog&#237;a cl&#237;nica&#46;"
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                          "etal" => false
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                ]
              ]
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              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "A hollow delayed surgical obturator for a bilateral subtotal maxillectomy patient&#58; a clinical report"
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                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
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                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/S0022-3913(08)60003-7"
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                        "tituloSerie" => "J Prosthet Dent"
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                        "paginaInicial" => "14"
                        "paginaFinal" => "18"
                        "link" => array:1 [
                          0 => array:2 [
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                            "web" => "Medline"
                          ]
                        ]
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                    ]
                  ]
                ]
              ]
            ]
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                0 => array:2 [
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                    0 => array:2 [
                      "titulo" => "Basic principles of obturator design for partially edentulous patients"
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                          "autores" => array:1 [
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                    ]
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                    0 => array:1 [
                      "Revista" => array:7 [
                        "tituloSerie" => "Part I&#58; Classification J Prosthet Dent"
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                        "paginaInicial" => "559"
                        "paginaFinal" => "561"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/11753302"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
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              "etiqueta" => "26"
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                0 => array:2 [
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                    0 => array:2 [
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                            0 => "K&#46; Stewart"
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                            2 => "W&#46; Kuebker"
                          ]
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                      ]
                    ]
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                    0 => array:1 [
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                    0 => array:2 [
                      "titulo" => "Altered prosthodontic treatment approach for bilateral complete maxillectomy&#58; a clinical report"
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                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "A&#46;C&#46; Cheng"
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                            2 => "A&#46;G&#46; Wee"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
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                        "paginaInicial" => "120"
                        "paginaFinal" => "124"
                      ]
                    ]
                  ]
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                            0 => "R&#46;A&#46; Sergio"
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                ]
              ]
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                0 => array:2 [
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                    0 => array:2 [
                      "titulo" => "Clinical maxillofacial prosthetics"
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                        0 => array:2 [
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                          "autores" => array:1 [
                            0 => "T&#46; Taylor"
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                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
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                        "editorial" => "Quintessence Books"
                        "editorialLocalizacion" => "China"
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                  ]
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              ]
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                      "titulo" => "Maxillofacial prosthetic rehabilitation combined with plastic and reconstructive surgery"
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                        0 => array:2 [
                          "etal" => true
                          "autores" => array:1 [
                            0 => "C&#46; Robert"
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                        "tituloSerie" => "Oncology&#44; MD Anderson"
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                      ]
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                      "titulo" => "Eugenio&#46; Rehabilitaci&#243;n implanto soportada en casos complejos&#46;"
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                          "etal" => false
                          "autores" => array:2 [
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              "etiqueta" => "33"
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                      "titulo" => "Nuevas tendencias 5 implantodoncia"
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                          "autores" => array:1 [
                            0 => "A&#46; Bottino"
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                0 => array:2 [
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                    0 => array:2 [
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                          "etal" => false
                          "autores" => array:2 [
                            0 => "John Hobkirk"
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                  ]
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                          "autores" => array:1 [
                            0 => "B&#46; Schmidt"
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Article information

ISSN: 1870199X
Original language: English

DOI:10.1016/j.rodmex.2016.02.026

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Year/Month	Html	Pdf	Total

2024 November	3	0	3
2024 October	22	3	25
2024 September	30	2	32
2024 August	48	4	52
2024 July	16	0	16
2024 June	21	6	27
2024 May	19	5	24
2024 April	14	6	20
2024 March	43	6	49
2024 February	27	11	38
2024 January	19	5	24
2023 December	21	13	34
2023 November	29	1	30
2023 October	29	10	39
2023 September	18	4	22
2023 August	19	7	26
2023 July	20	11	31
2023 June	33	6	39
2023 May	67	7	74
2023 April	58	4	62
2023 March	70	2	72
2023 February	30	2	32
2023 January	26	5	31
2022 December	19	4	23
2022 November	34	3	37
2022 October	29	9	38
2022 September	37	11	48
2022 August	38	5	43
2022 July	23	6	29
2022 June	26	4	30
2022 May	47	6	53
2022 April	61	12	73
2022 March	65	14	79
2022 February	64	6	70
2022 January	76	9	85
2021 December	54	9	63
2021 November	42	9	51
2021 October	57	11	68
2021 September	32	13	45
2021 August	52	8	60
2021 July	46	7	53
2021 June	21	7	28
2021 May	50	12	62
2021 April	147	33	180
2021 March	73	20	93
2021 February	57	11	68
2021 January	56	9	65
2020 December	81	8	89
2020 November	69	6	75
2020 October	39	5	44
2020 September	52	14	66
2020 August	37	8	45
2020 July	34	9	43
2020 June	27	7	34
2020 May	52	15	67
2020 April	38	6	44
2020 March	29	3	32
2020 February	34	6	40
2020 January	29	4	33
2019 December	37	9	46
2019 November	17	2	19
2019 October	32	5	37
2019 September	39	9	48
2019 August	25	3	28
2019 July	40	9	49
2019 June	95	10	105
2019 May	210	31	241
2019 April	102	3	105
2019 March	15	1	16
2019 February	20	3	23
2019 January	12	1	13
2018 December	16	3	19
2018 November	12	2	14
2018 October	26	16	42
2018 September	9	4	13
2018 August	10	1	11
2018 July	5	1	6
2018 June	9	2	11
2018 May	10	8	18
2018 April	11	1	12
2018 March	3	0	3
2018 February	9	0	9
2018 January	12	0	12
2017 December	3	0	3
2017 November	11	1	12
2017 October	7	0	7
2017 September	10	1	11
2017 August	9	1	10
2017 July	11	0	11
2017 June	22	2	24
2017 May	14	2	16
2017 April	9	0	9
2017 March	9	31	40
2017 February	71	2	73
2017 January	8	0	8
2016 December	15	0	15
2016 November	16	0	16
2016 October	21	1	22
2016 September	17	1	18
2016 August	8	1	9
2016 July	5	0	5

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