Prof. Chris Butterworth, Speaker and Chairman at Edentulism2023
Episode summary
Prof. Chris Butterworth, a maxillofacial prosthodontist at the Liverpool Head & Neck Centre and Honorary Professor at the University of Liverpool, explains how zygomatic implants have revolutionized dental and facial rehabilitation for patients with maxillary and midfacial tumors. Because zygomatic implants draw remote cortical anchorage from the zygomas, pterygoids, nasion and other facial skeleton, they let surgeons remove large parts of the maxilla and midface while still supporting a prosthesis. Butterworth helped develop the ZIP flap, which perforates vascularized soft-tissue free flaps with zygomatic implant abutments, enabling immediate loading and prosthetic care before radiotherapy. He notes that these cancer patients have worse survival outcomes than other oral-cavity sites, yet most achieve good rehabilitation outcomes. He warns against over-indicating invasive treatment, urging a full treatment algorithm and thorough consent about eventual failure.
Key takeaways
- Zygomatic implants provide remote cortical anchorage from the zygomas, pterygoids and nasion, allowing prosthetic support even after large parts of the maxilla and midface are removed.
- The ZIP flap technique perforates vascularized soft-tissue free flaps with zygomatic implant abutments, combining palate and facial reconstruction with immediate implant support.
- Maxillary and midfacial tumor patients have worse survival outcomes than patients with tumors at other oral-cavity sites.
- Immediate loading of implants allows cancer patients to receive prosthetic rehabilitation before undergoing radiotherapy.
- Radiotherapy causes devastating damage to tissues and to prosthetic treatments, driving some patient complications.
- Clinicians should maintain a full treatment algorithm and avoid over-indicating invasive surgery, preserving less invasive options for young or straightforward edentulous cases.
- Patients must be consented not only for a treatment's immediate implications but for what happens when it fails, which is especially difficult once teeth have been extracted.
What you'll learn
- Why a full treatment algorithm prevents over-indication of invasive surgery
- Consenting patients for what happens when a treatment fails, not only its immediate outcome
- How zygomatic implants provide remote cortical anchorage after maxillectomy
- The ZIP flap technique combining zygomatic implants with vascularized soft-tissue free flaps
- Immediate loading of implants to rehabilitate cancer patients before radiotherapy
About the guest
Prof. Chris Butterworth
Chris Butterworth is a maxillofacial prosthodontist who has worked at the Liverpool Head & Neck Centre for almost 20 years, treating high-priority NHS patients with cancer, severe trauma, extreme jaw atrophy, congenital conditions and hypodontia. He trained in restorative dentistry in the UK, encompassing prosthodontics, periodontics and endodontic surgery, and later specialized in surgical maxillofacial prosthodontics. He is an Honorary Professor at the University of Liverpool and helped pioneer the ZIP flap technique for maxillary and midfacial cancer reconstruction. He served as co-organizer and chairman of Edentulism2023.
Credentials: Honorary Professor of Maxillofacial Prosthodontics, University of Liverpool; Consultant, Liverpool Head & Neck Centre
