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Program Number: B128
Session Name: Poster Session

Access Denied: Disparities in Dental Implants

Amanda Bastien, MD; Allen Ho; Evan Walgama; Jay Lee, MD, DMD; Steven Kupferman; Jon Mallen-St.Clair, MD, PhD; Cedars Sinai

Introduction: Prior to 1988 breast reconstruction after mastectomy was recognized as purely cosmetic until the Women’s Health and Cancer Rights Act required insurance companies to cover breast reconstruction following mastectomies and its complications. Despite research supporting dental rehabilitation (DR), access to a multi-disciplinary team but also the ability to afford the dental prosthesis, raises concern that access is uneven especially in the oncologic population. The objective of this study was to investigate patient characteristics including socioeconomic status to DR following fibula free flap (FFF).

Methods: This is a retrospective chart review of patients who underwent FFF after jaw reconstruction between September 2017 and January 2024 with at least 6 months follow-up. In this cohort, patients had no DR, insertion of implants, or insertion of an implant-retained dental prosthesis (JIAD) at time of surgery. Area deprivation index (ADI) is a multidimensional evaluation of a region's socioeconomic conditions, including income, education, employment, and housing quality. The ADI score was calculated for each patient’s region and an ADI ranking of 1 indicates the lowest level of "disadvantage" within the nation and an ADI with a ranking of 100 indicates the highest level of "disadvantage.”

Results: In total 67 patients underwent FFF: 19 with implants and 14 JIAD procedures were performed. In total 0 of the 34 patients with oncologic pathology who underwent FFF with no implants placed at time of surgery went on to receive DR. In total, 32.4% of these patients had an ADI >40.

In the DR cohort, 11 patients (33.3%) had cancer pathology.  Primary patient residence included California, Nevada, Arizona, and Florida. Of these 6.1% of these patients had an ADI >40. Patients who had an ADI >40 were less likely to receive implants (p= 0.01).

Dental rehabilitation with a final prosthesis (DPR) was most consistently achieved in patients undergoing surgery for benign disease and medication related osteonecrosis (100%).  However successful DPR was achieved in 62.5% of patients with osteoradionecrosis and in total 40% of cancer patients. There was no significant difference between implant success for cancer versus other etiologies (p=0.7)

Conclusion: Our data confirms the safety of DR across a range of conditions, including benign, osteoradionecrotic, and malignant diseases. Our study highlights that access to DR remains limited, likely due to factors related to accessibility and cost. We suggest that all patients deserve comprehensive care, making it imperative that we advocate for policy changes so targeted interventions can be implemented—such as expanding insurance coverage for DR just as coverage was expanded for breast reconstruction—so we can effectively meet patient needs.

 

 

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