Article

Long-term success of dental implants in patients with head and neck cancer after radiation therapy

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Abstract

The purpose of this study was to analyze the long-term success and factors potentially influencing the success of dental implants placed in patients with head and neck cancer who underwent radiation therapy with a minimum total dose of 50Gy during the years 1995-2010. Thirty-five patients (169 dental implants) were included in this study. Data on demographic characteristics, tumour type, radiation therapy, implant sites, implant dimensions, and hyperbaric oxygen therapy (HBOT) were obtained from the medical records and analyzed. Implant survival was estimated using Kaplan-Meier survival curves. Seventy-nine dental implants were placed in the maxilla and 90 in the mandible. The mean follow-up after implant installation was 7.4 years (range 0.3-14.7 years). The overall 5-year survival rate for all implants was 92.9%. Sex (P<0.001) and the mode of radiation therapy delivery (P=0.005) had a statistically significant influence on implant survival. Age, time of implantation after irradiation, implant brand and dimensions, and HBOT had no statistically significant influence on implant survival. Osseointegrated dental implants can be used successfully in the oral rehabilitation of patients with head and neck cancer with a history of radiation therapy. Risk factors such as sex and the mode of radiation therapy delivery can affect implant survival.

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... Patients with head and neck tumors often smoke and drink alcohol more frequently and have poorer oral hygiene than patients without tumors [17]. Smoking is associated with a higher prevalence of peri-implantitis [18]. ...
... Some patients also received adjuvant radiotherapy or radiochemotherapy. Radiation impairs bone healing capacity and may cause altered microflora, xerostomia, mucositis and mucosal atrophy [17,20,21]. These factors can potentially negatively affect implant outcomes. ...
... Studies have demonstrated that the risk of implant loss increases with the number of cigarettes and pack years [39,40] Regarding sex and age, no difference in implant outcome was found in studies involving healthy individuals or patients with vascularized grafts [3,10,29,41]. Thus, the results presented here are consistent with those reported in the literature, although individual authors have reported better implant outcomes in men [17], others in women, and at lower ages [25]. ...
Article
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Purpose Reconstruction with vascularized bone grafts after ablative surgery and subsequent dental rehabilitation with implants is often challenging; however, it helps improve the patient’s quality of life. This retrospective case–control study aimed to determine the implant survival/success rates in different vascularized bone grafts and potential risk factors. Methods Only patients who received implants in free vascularized bone grafts between 2012 and 2020 were included. The free flap donor sites were the fibula, iliac crest, and scapula. The prosthetic restoration had to be completed, and the observation period had to be over one year after implantation. Implant success was defined according to the Health Scale for Dental Implants criteria. Results Sixty-two patients with 227 implants were included. The implant survival rate was 86.3% after an average of 48.7 months. The causes of implant loss were peri-implantitis ( n = 24), insufficient osseointegration ( n = 1), removal due to tumor recurrence ( n = 1), and osteoradionecrosis ( n = 5). Of all implants, 52.4% were classified as successful, 19.8% as compromised, and 27.8% as failed. Removal of osteosynthesis material prior to or concurrent with implant placement resulted in significantly better implant success than material not removed ( p = 0.035). Localization of the graft in the mandibular region was associated with a significantly better implant survival ( p = 0.034) and success ( p = 0.002), also a higher Karnofsky Performance Status Scale score with better implant survival ( p = 0.014). Conclusion Implants placed in vascularized grafts showed acceptable survival rates despite the potential risk factors often present in these patient groups. However, peri-implantitis remains a challenge. Graphical abstract
... However, 18 studies investigated in the current literature research were not used for meta-analysis. Besides the reasoning of too short of a follow-up (Alberga et al., 2020;Burgess et al., 2017;Ch'ng et al., 2016;Gander et al., 2014;Hessling et al., 2015;Moore et al., 2019;Pompa et al., 2015;Woods et al., 2019), the second reason for exclusion was that the studies only assessed implants placed in irradiated bone, which means they were lacking a non-irradiated control group (Buurman et al., 2013;Curi et al., 2018;Di Carlo et al., 2019;Nack et al., 2015;Papi et al., 2019;Rana et al., 2016;Sandoval et al., 2020). Ettl et al. (2020) were reporting implant success using a modified version of the Albrektsson criteria (Albrektsson et al., 1986), and their study was therefore excluded. ...
... Squamous cell carcinoma (n = 35), adenocarcinoma (n = 4), non-Hodgkin-lymphoma (n = 1), angiosarcoma (n = 1), multifocal plasmacytoma (n = 1), verrucous carcinoma (n = 1), esthesioneuroblastoma (n = 1), uncertain/metastases (n = 2) (Teoh et al., 2011)) as radiation modality for at least some or even all patients (Alberga et al., 2020;Ch'ng et al., 2016;Curi et al., 2018;Ernst et al., 2016;Gander et al., 2014;Papi et al., 2019;Pieralli et al., 2021;Sandoval et al., 2020). In fact, the literature found on this subject strongly recommends the use of IMRT as it shows good rates of locoregional control and has positive effects on the quality of life (Anand et al., 2008;Graff et al., 2007;Nutting et al., 2011;Peponi et al., 2011;Setton et al., 2012). ...
... eason, no information can be given about the irradiation field and its effect on the outcome. IMRT is a radiation technique which allows dose distribution to minimize the delivery of radiation on the normal tissues to spare organs at risk such as the parotid glands(Hansen et al., 2012;Owosho et al., 2016;Petrovic et al., 2019;Vergeer et al., 2009).Curi et al. (2018) examined the outcomes of implants placed in irradiated patients comparing patients treated with conventional radiotherapy to a cohort that received intensitymodulated radiotherapy and found a significant difference in favour of IMRT (p = .005). However, this result does not correspond to the findings observed by other authors. Neckel et ...
Article
Purpose: The purpose of this meta-analysis was to compare implant survival in irradiated and non-irradiated bone and to investigate potential risk factors for implant therapy in oral cancer patients. Material and methods: An extensive search in the electronic databases of the National Library of Medicine was performed. Systematic review and meta-analysis were conducted according to PRISMA statement. The meta-analysis was performed for studies with a mean follow-up of at least three and five years, respectively. Results: The systematic review resulted in a mean overall implant survival of 87.8% (34-100%). The meta-analysis revealed a significantly higher rate of implant failure in irradiated bone compared to non-irradiated bone (p<0.00001, OR 1.97, CI [1.63, 2.37]). The studies also showed that implants placed into irradiated grafted bone were more likely to fail than those in irradiated native bone (p<0.0001, OR 2.26, CI [1.50, 3.40]). Conclusion: Even though overall implant survival was high, radiotherapy proves to be a significant risk factor for implant loss. Augmentation procedures may also increase the risk of an adverse outcome, especially in combination with radiotherapy.
... Most head and neck oncology centres place implants after a disease-free period of at least 6-12 months following oncological treatment, on the condition that conventional dentures could not be made or when patients report significant functional problems with their dentures. This protocol of postponed implant placement is reported to have a high rate of successful rehabilitation and high implant survival, ranging between 93% and 96% [13][14][15] . Even higher implant survival is reported when implants are placed in the mandible versus the maxilla, or in native bone versus autologous bone grafts 16,17 . ...
... This is in accordance with another study on immediate implant placement 11 . Studies on postponed implant placement show a markedly slower prosthodontic rehabilitation, ranging from 24 to 60 months after surgery 5,14,25 . The main reason for this is that in most head and neck oncology centres, implants are placed after a disease-free period of at least 6-12 months. ...
... However, in all of these patients, functioning dentures could still be made. Implant survival was 90.7% in the total follow-up period, which is comparable to both another study on immediate placement 11 and to studies on postponed placement, which report survival rates between 83% and 96% 14,15,18,24 . Some of these studies report that survival is lower in irradiated bone 20 or in the maxilla compared to the mandible 13,16 , although our study found no significant differences between these groups. ...
Article
Full-text available
Although the functional benefits of implants in the rehabilitation of edentulous cancer patients are well-known, most studies report on postponed implant placement. The outcome of immediate implant placement regarding successful rehabilitation, implant loading and survival is unclear. Two hundred and seven edentulous oral cancer patients that received implants during ablative surgery at the Radboud University Medical Centre between 2000 and 2011 were included. Data regarding the oncological treatment, implant placement, follow-up and prosthodontic rehabilitation were recorded retrospectively with a follow-up period of 5–17 years. Functioning implant-retained dentures were made in 73.9% of the patients. Of the surviving patients, 81.9% had functioning dentures after 2 years and 86.3% after 10 years. Patients with ASA score 1 and younger patients were rehabilitated more frequently. The median time of functioning denture placement was 336 days after surgery, with a negative influence of postoperative radiotherapy. Implant survival was 90.7%, and was lower when the implant was placed in a jaw involved in the tumour. Immediate implant placement during oral cancer surgery led to a high number of edentulous patients rehabilitated with implant-retained dentures, which are placed at an early time.
... Treatment planning varies depending on factors such as the location of the primary tumor, the stage of cancer, age and the general health of the patient. However, oncology patients are usually treated with ablative surgery, radiotherapy (RT), chemotherapy or a combination of these (10,(12)(13)(14)(15). Surgical treatment of HNC causes deformity and changes in the anatomy of the region. ...
... In order to obtain a positive prognosis from ISP in patients who have received RT; many risk factors should be taken into consideration such as age, gender, total radiation dose received, type of RT applied, the time between RT and implant surgery. Technical aspects such as the surgeon's experience, bone quality and topography in the region where the implant will be placed, implant length, diameter, and primary stability also play an important role in implant success (15,18,37). Dental implants can be placed in the mandible, maxilla or free bone flaps. ...
... Linsen et al. reported IS rates as 96.6%, 96.6% and 86.9%, respectively, in the 1, 5 and 10-year follow-up of patients treated with a combination of surgery and RT (18). Curi et al. reported that osteointegration occurred in patients undergoing implants after 50 to 70 Gy (mean 62 Gy) RT and that they were satisfied with their ISP in terms of function, phonetics, chewing and aesthetics (15). ...
... Treatment planning varies depending on factors such as the location of the primary tumor, the stage of cancer, age and the general health of the patient. However, oncology patients are usually treated with ablative surgery, radiotherapy (RT), chemotherapy or a combination of these (10,(12)(13)(14)(15). Surgical treatment of HNC causes deformity and changes in the anatomy of the region. ...
... In order to obtain a positive prognosis from ISP in patients who have received RT; many risk factors should be taken into consideration such as age, gender, total radiation dose received, type of RT applied, the time between RT and implant surgery. Technical aspects such as the surgeon's experience, bone quality and topography in the region where the implant will be placed, implant length, diameter, and primary stability also play an important role in implant success (15,18,37). Dental implants can be placed in the mandible, maxilla or free bone flaps. ...
... Linsen et al. reported IS rates as 96.6%, 96.6% and 86.9%, respectively, in the 1, 5 and 10-year follow-up of patients treated with a combination of surgery and RT (18). Curi et al. reported that osteointegration occurred in patients undergoing implants after 50 to 70 Gy (mean 62 Gy) RT and that they were satisfied with their ISP in terms of function, phonetics, chewing and aesthetics (15). ...
Article
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The aim of this review is to evaluate the timing of dental implants placement and long-term survival rates in patients who have had prosthetic rehabilitation with dental implants after ablative surgery and radiotherapy (RT), and have had head and neck cancer (HNC). For this purpose; implant survival (IS) rates placed as primary/secondary or placed in bones with/without RT were evaluated. The literature published between 2000-2020 has been reviewed for the evaluation of dental implant treatment in patients with HNC. The search terms used in PubMed scans were "head and neck cancer", "oral cancer", "dental implant" and "radiotherapy". 134 related articles have been defined in PubMed database searches and 16 were included in the final analysis. Dental implant applications have gained importance in the prosthetic treatment of patients with oral cancer. In cases where conventional prosthetic treatments are insufficient, dental implants provide retention and stability to dentures. However, before starting treatment, whether the patient is receiving chemotherapy, RT and the use of bisphosphonate should be taken into consideration and the timing of the surgical procedures should be adjusted correctly. In addition, these patients should be followed up regularly for a long time.
... 8 At the present time, factors are being debated that could influence the survival of implants placed in irradiated patients, such as the type of radiotherapy, radiation dosage, location of implant placement (maxillary or mandibular) and the use of hyperbaric oxygen therapy (HBOT). [9][10][11] HBOT is used as a surgical adjunct for the healing of wounds due to angiogenesis and the increase in oxygen tension in hypoxic tissue. 12 In addition, it accelerates the rate of osteoblast differentiation due to the increase in alkaline phosphatase activity and the expression of type 1 collagen. ...
... In the end, observing the process of eligibility and quality evaluation, three studies were included (Curi et al, 9 August et al, 10 Cotic et al 11 ) as described in Fig. 1 and Table 1. ...
... The number of implants that survived in each group (case and control) was calculated for the articles by August et al 10 and Curi et al. 9 The study by August et al 10 did not report any implant failures: all the implants survived in the two groups. ...
Article
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Purpose To perform a systematic review with meta-analysis to evaluate the influence of hyperbaric oxygen therapy (HBOT) on the survival of dental implants placed in irradiated head and neck cancer patients. Materials and Methods A systematic literature search was conducted using the PubMed/Medline, Science Direct, Embase and the Cochrane Library, between January 1985 and July 2018. The study observed the PRISMA (Preferred Reporting Items for Systematic review and Meta-Analysis) declaration and norms, and the systematic review was duly recorded in the PROSPERO (International prospective register of systematic reviews) database. Inclusion and exclusion criteria were applied, and all articles were selected on the basis of PICO questions. Results The process of eligibility and quality evaluation yielded 3 studies for statistical analysis. Based on the survival rates, there was no evidence that the risk of an implant failing was different between the patients who received HBOT or not. Taking into consideration the number of implant failures, there was no evidence that the risk of an implant failing is different between the two groups. Moreover, the risk of an implant failing did not depend on the anatomic site. Conclusion HBOT exerts no beneficial influence on the survival rates of implants placed in irradiated patients, and the risk of an implant failing does not depend on its location.
... In cases of prior osteoradionecrosis, dental implants are a viable alternative for oral rehabilitation (5-year survival rate of 48.3%) (de la Plata et al. 2012). When implants are inserted before or after radiotherapy is administered for 12 months, there is no difference in the survival rates (Curi et al. 2018). ...
... Additionally, according to Curi et al.'s retrospective cohort study, osseointegrated dental implants are successfully used for the oral rehabilitation of head and neck cancer patients with a history of RT. The delivery method of radiation therapy and sex are risk factors that affect implant survival (Curi et al. 2018). Chrcanovic et al. determined that irradiation affects implant survival and implant site negatively (maxilla vs. mandible), but there is no discernible difference in survival rate when implants are inserted before or after 12 months of RT. ...
... Although not signi cant, there seems to be a tendency of a better long-term outcome of implant survival in women. This is in contrast to the indications of Curi et al. [12], which described osteoporosis as possible reason for a worse female long-term outcome. The in uence of osteoporosis on implant health is still unclear, although it doesn't seem to affect implant survival in a signi cant way [13]. ...
... Implant loss was statistically more frequent in the upper jaw. This result con rms data of other studies [12,23,24,25]. Differences in bone quality and characteristics between mandible and maxilla may be an explanation for the different failure rate. ...
Preprint
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Objective: The primary treatment strategy of oral cancer is represented by ablative surgery, often combined to radiochemotherapy. Therefore, oral cancer patients are mostly in the need of dental rehabilitation. Implant procedures play an important role of such rehabilitations despite possible complications related to oncologic treatment and patients’ conditions. The main objective of the present study was the evaluation of survival of dental implants inserted after oncologic treatment of oral cancer patients with additional investigation of possible risk factors. Material and methods: Data of 38 oral cancer patients, who underwent dental implant rehabilitation with a total of 157 implants inserted after oncologic treatment at the Medical University of Innsbruck from 2008 to 2016, was analyzed retrospectively. Results: Cumulative 8-year survival rate for all included implants after a mean follow-up of 84 months was 86%. 22 out of 157 implants failed during the observation period, whereby radiotherapy (p=0.007) and maxillary implant insertion (p=0.04) were significantly correlated with a worse implant survival. Tendency of worse outcomes in men and in implants restored with fixed prosthesis were registered, although statistically not significant (p=0.064 resp. p=0.082), whereas chemotherapy didn’t influence implant survival (p=0.607) at all. Conclusion: The present study confirms promising long-term implant survival in oral cancer patients after oncologic therapy. The main risk factor for implant survival seems to be radiotherapy, which has to be taken into account in implant planning. Clinical relevance: Given a correct treatment planning, implant rehabilitations seem to be a feasible option for oral cancer patients.
... But with improved survival [6], cancer survivors living longer, the focus has been shifted to the quality of life. Dental rehabilitation would certainly improve the masticatory, speech functions, and aesthetic quotient of the patient [7]. ...
... A study by Linsen et al. [25] 2009 (n = 66) showed a 98% survival rate on maxilla which can be due to increased vascularity in the maxillary area thus proving secondary stability. Non-significant results were obtained by two studies: Chang et al. [15] and Curi et al. [7], whereas our meta-analysis has included four retrospective studies exhibiting a significant success rate of implants when placed on the mandible. Better survival on the mandible can be explained due to its anatomy and bone density accordingly providing primary stability. ...
Article
Full-text available
Objectives Dental implants play a significant role in functional rehabilitation of the oral cavity after debilitating jaw surgeries for oral cavity cancers followed by radiotherapy. Design The meta-analysis was done using Preferred Reporting Items for Systematic Review (PRISMA) guidelines published from January 1947 till August 2020. Twenty three articles consisting of 1246 participants with 4838 implants were included in our analysis. Results The mean age of the included participants was 51.4 years. 2186 and 1685 implants were placed on irradiated and non-irradiated jaws and showed a success rate of 82.47% and 89.37% respectively. Correspondingly, publication bias of p value = 0.2129 and p-value = 0.6525 was found by Egger’s and Begg’s test respectively for pooled data of 16 studies. The implant success rate of 70.4% on maxillary bone and 94.5% were observed on mandibular bone. Timing of implant placement and its influence on survival rate have resulted in a 75.5% survival rate of dental implants when placed primarily in comparison with 87.7% on delayed placement. The waiting interval of 14 months in delayed implant placement has shown better results. Conclusion Presence of radiotherapy does not play a significant role in the success rate of dental implants in oral cavity cancers. However, delayed implant placement may have a better chance of survival.
... But with improved survival [6], cancer survivors living longer, the focus has been shifted to the quality of life. Dental rehabilitation would certainly improve the masticatory, speech functions, and aesthetic quotient of the patient [7]. ...
... A study by Linsen et al. [25] 2009 (n = 66) showed a 98% survival rate on maxilla which can be due to increased vascularity in the maxillary area thus proving secondary stability. Non-significant results were obtained by two studies: Chang et al. [15] and Curi et al. [7], whereas our meta-analysis has included four retrospective studies exhibiting a significant success rate of implants when placed on the mandible. Better survival on the mandible can be explained due to its anatomy and bone density accordingly providing primary stability. ...
Article
Full-text available
Objectives Dental implants play a significant role in functional rehabilitation of the oral cavity after debilitating jaw surgeries for oral cavity cancers followed by radiotherapy.DesignThe meta-analysis was done using Preferred Reporting Items for Systematic Review (PRISMA) guidelines published from January 1947 till August 2020. Twenty three articles consisting of 1246 participants with 4838 implants were included in our analysis.ResultsThe mean age of the included participants was 51.4 years. 2186 and 1685 implants were placed on irradiated and non-irradiated jaws and showed a success rate of 82.47% and 89.37% respectively. Correspondingly, publication bias of p value = 0.2129 and p-value = 0.6525 was found by Egger’s and Begg’s test respectively for pooled data of 16 studies. The implant success rate of 70.4% on maxillary bone and 94.5% were observed on mandibular bone. Timing of implant placement and its influence on survival rate have resulted in a 75.5% survival rate of dental implants when placed primarily in comparison with 87.7% on delayed placement. The waiting interval of 14 months in delayed implant placement has shown better results.Conclusion Presence of radiotherapy does not play a significant role in the success rate of dental implants in oral cavity cancers. However, delayed implant placement may have a better chance of survival.
... Dental implant placement in patients with oral cancer results in improvement of oral function after oncological treatment [7][8][9]. Lower implant survival rates have been associated with radiotherapy; however, with appropriate perioperative measurements and strict monitoring, irradiated patients can also benefit from dental implant placement [10][11][12][13][14][15]. ...
... A history of radiation therapy is not considered a contraindication for implant placement as long as strict monitoring is provided to prevent complications [12]. Previous studies on implant placement in irradiated patients do not regard immediate implant placement, making a comparison between our study and previously published studies not entirely reliable [10][11][12][13][14][15]. But as all implant losses in our study occurred in irradiated patients, it can be stated that radiotherapy also has a negative effect on survival of immediately placed implants. ...
Article
Full-text available
Background Little is known about immediate implant placement in head and neck cancer patients. We studied implant survival and functional outcomes of overdentures fabricated on implants placed immediately after removal of the lower dentition during ablative surgery or preceding primary radiotherapy (RT).Methods Inclusion criteria were primary head and neck cancer, dentate lower jaw, and indication for removal of remaining teeth. Two implants to support a mandibular overdenture were placed immediately after extraction of the dentition during ablative surgery, or prior to starting primary radiotherapy. Standardized questionnaires and clinical assessments were conducted (median follow-up 18.5 months, IQR 13.3).ResultsFifty-eight implants were placed in 29 patients. Four implants were lost (implant survival rate 93.1%). In 9 patients, no functional overdenture could be made. All patients were satisfied with their dentures.Conclusions Combining dental implant placement with removal of remaining teeth preceding head neck oncology treatment results in a favorable treatment outcome.
... In a review by Teoh et al., 2005 the survival rate of implants placed in nonirradiated fibula free flaps was 99%, whereas the rate for those placed in irradiated flaps was 92% [30]. Hyperbaric oxygen therapy does not appear to improve implant survival in irradiated patients [27,31]. The use of intensity-modulated radiation therapy (IMRT) may be associated with reduced risk of implant failure, however, further research is needed to confirm this [31]. ...
... Hyperbaric oxygen therapy does not appear to improve implant survival in irradiated patients [27,31]. The use of intensity-modulated radiation therapy (IMRT) may be associated with reduced risk of implant failure, however, further research is needed to confirm this [31]. These findings have driven surgeons to consider immediate implant placement at the time of primary reconstructive surgery. ...
Article
Rehabilitation post reconstruction in head and neck cancer surgery is a vital component to improving quality of life. In this paper we discuss the current approaches to reconstruction of the maxilla and mandible and how they pertain to rehabilitation. There is a detailed discussion of dental rehabilitative challenges with different composite flaps and ways to solve those challenges. We conclude with a discussion about future approaches to reconstruction and how they will impact on improving rehabilitative outcomes and ultimately improve the quality of life of our patients.
... Radiation exposure to PET has shown degradation of the polymer with changes to its microstructure [24,25], but no studies were found to have evaluated mechanical property changes in relation to RT. As for the liquid monomer, several studies have investigated the survival of dental implants following RT to treat head and neck cancers [26][27][28][29]. Interestingly, the majority of these studies do not evaluate the intrinsic biomechanical properties of the dental implant itself but rather examine the survivability of the implant through the context of RT affecting the surrounding native bone. ...
Article
Full-text available
Photodynamic implants are an increasingly popular minimally invasive option for the surgical treatment of metastatic bone disease. Following surgery, adjuvant radiation therapy (RT) is frequently administered to achieve better disease control and improve patient quality of life, but the role of RT in implant failures associated with photodynamic implants remains unclear. The aim of this study is to determine if the therapeutic RT range of 10–50 Gy affects the biomechanical properties of photodynamic implants. For the experimental group, 15 photodynamic implants were divided evenly into 5 groups that were exposed to different doses of RT (10, 20, 30, 40 and 50 Gy). The control group consisted of 14 non-irradiated photodynamic implants. Four-point bending tests were conducted on all implants to determine bending stiffness. One-way ANOVA was conducted. Bending stiffness (N/mm) mean ± standard deviation for the non-irradiated control group was 38.0 ± 1.2. Bending stiffness (N/mm) mean ± standard deviation for the irradiated experimental groups was 39.2 ± 1.0. No significant difference was found between any groups. RT doses at a range of 10–50 Gy do not affect the bending stiffness of photodynamic implants. The yield and ultimate failure loads were 263.4 ± 5.2 (N) and 305.9 ± 5.5 (N) in the non-irradiated group vs. 266.8 ± 6.4 (N) and 306.8 ± 6.4 (N) in the irradiated group, respectively. The lack of statistical significance in the difference in stiffness, yield, and ultimate load properties among the groups means that it is less likely that RT at the evaluated doses contributes to intrinsic implant failure. Further studies need to be conducted to conclude the potential effect of RT on other mechanical properties of photodynamic implants.
... The type of irradiation, radiation dose, position of the implant (maxillary or mandibular), and use of HBO have been discussed as factors that may affect the survival of dental implants placed in irradiated patients [97][98][99]. According to the survival rates of dental implants reported by the work by Benites Condezo et al., there was no evidence that irradiated patients, who underwent HBO treatment before implant placement as an adjuvant treatment, had a lower failure risk than those who did not [100]. ...
Article
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Osteoradionecrosis (ORN) is a serious long-term complication of head and neck radiotherapy (RT), which is often triggered by dental extractions. It results from avascular aseptic necrosis due to irradiated bone damage. ORN is challenging to treat and can lead to severe complications. Furthermore, ORN causes pain and distress, significantly reducing the patient’s quality of life. There is currently no established preventive strategy. This narrative review aims to provide an update for the clinicians on the risk of ORN associated with oral surgery in head and neck RT patients, with a focus on the timing suitable for the oral surgery and possible ORN preventive treatments. An electronic search of articles was performed by consulting the PubMed database. Intervention and observational studies were included. A multidisciplinary approach to the patient is highly recommended to mitigate the risk of RT complications. A dental visit before commencing RT is highly advised to minimize the need for future dental extractions after irradiation, and thus the risk of ORN. Post-RT preventive strategies, in case of dento-alveolar surgery, have been proposed and include antibiotics, hyperbaric oxygen (HBO), and the combined use of pentoxifylline and tocopherol (“PENTO protocol”), but currently there is a lack of established standards of care. Some limitations in the use of HBO involve the low availability of HBO facilities, its high costs, and specific clinical contraindications; the PENTO protocol, on the other hand, although promising, lacks clinical trials to support its efficacy. Due to the enduring risk of ORN, removable prostheses are preferable to dental implants in these patients, as there is no consensus on the appropriate timing for their safe placement. Overall, established standards of care and high-quality evidence are lacking concerning both preventive strategies for ORN as well as the timing of the dental surgery. There is an urgent need to improve research for more efficacious clinical decision making.
... The present study reveals a 100% rate of both cumulative survival and cumulative success after 5 years for dental implants in patients who received VP, with a mean observation period of 58.5 months (follow-up continued for up to 105 months). These results show a high survival rate for implants, unlike numerous other studies with low implant survival rates and comparable follow-up periods [22,[29][30][31]. Laverty et al. demonstrated a 95.5% long-term survival of dental implants after 5 years [32], which is in line with our findings concerning patients without VP (survival rate of 93.1% after 5 years). ...
Article
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Objectives This study aimed to evaluate the influence of vestibuloplasty on the clinical success and survival of dental implants in head and neck tumor patients. Materials and methods A retrospective single-center study was conducted. All patients received surgical therapy of a tumor in the head or neck and underwent surgical therapy and, if necessary, radiotherapy/radiochemotherapy. Patients with compromised soft tissue conditions received vestibuloplasty using a split thickness skin graft and an implant-retained splint. Implant survival and success and the influence of vestibuloplasty, gender, radiotherapy, and localizations were evaluated. Results A total of 247 dental implants in 49 patients (18 women and 31 men; mean age of 63.6 years) were evaluated. During the observation period, 6 implants were lost. The cumulative survival rate was 99.1% after 1 year and 3 years and 93.1% after 5 years for patients without vestibuloplasty, compared to a survival and success rate of 100% after 5 years in patients with vestibuloplasty. Additionally, patients with vestibuloplasty showed significantly lower peri-implant bone resorption rates after 5 years (mesial: p = 0.003; distal: p = 0.001). Conclusion This study demonstrates a high cumulative survival and success rate of dental implants after 5 years in head and neck tumor patients, irrespective of irradiation. Patients with vestibuloplasty showed a significantly higher rate of implant survival and significantly lower peri-implant bone resorption after 5 years. Clinical relevance Vestibuloplasty should always be considered and applied if required by the anatomical situations to achieve high implant survival/success rates in head and neck tumor patients.
... Another study [18] was made to analyze the longterm success and factors that might potentially influence the success of dental implants placed in irradiated patients with a minimum total dose of 50 Gy during the years 1995 to 2010. The study included Thirty-five patients (169 dental implants). ...
Article
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Radiotherapy is used to treat patients with head and neck cancers as a primary therapy or as an adjuvant to surgery or chemotherapy. Irradiation results in several complications that can be very overwhelming to the patient. Frequently there is loss of function due to tooth loss, compromised aesthetics, pain and discomfort from xerostomia and mucositis, it also significantly impacts the quality of life. A major advance in dentistry is the successful rehabilitation and replacement of lost teeth by osseointegrated implants. However, the risk of osteoradionecrosis and failure of osseointegration are barriers to implant therapy for those irradiated patients. The aim of this review article is to primarily find out whether the radiotherapy used in the treatment of head and neck cancer patients can affect the success and survival of dental implants according to different studies, and also, to highlight some other pertinent factors that may concurrently influence these implantation. The primary outcome measure shows implants survival in irradiated patients. Most of the studies reported that dental implants can osseointegrate and remain functionally stable in irradiated patients following oral cancer surgery. Accordingly, rehabilitation using dental implants is a viable option for head and neck cancer patients receiving radiotherapy. However, all studies included indicated that survival was significantly higher in non-irradiated patients. Factors such as the mode of radiation therapy delivery, gender, age, implant site and radiation dose at the implant site can affect the survival of dental implant. More research and randomized controlled trails are needed for more accurate judgment.
... The frequency of loss of 7% observed for implants in the present study is in agreement with the findings reported in previous studies [32][33][34]. ...
Article
Full-text available
During prosthetic rehabilitation after tumor therapy (TT) in the head and neck region, the dentist must assess whether the prognosis of the remaining teeth is sufficiently good or whether implants should be used to anchor dentures. Thus, the aim of the present study was to compare the survival rate of teeth and implants after TT and to evaluate factors potentially influencing implant survival. One hundred fifteen patients (male: 70.3%; mean age: 63.2 ± 12.4 years) having received dental treatment before and after TT at the Martin Luther University Halle-Wittenberg were enrolled in the study. Clinical examination including assessment of dental status and stimulated salivary flow rate was performed. Information about disease progression and therapy was retrieved from medical records. After TT, from a total of 1262 teeth, 27.2% had to be extracted. Of 308 implants inserted after TT, 7.0% were lost. Teeth exhibited lower 5-year survival probability (76.8%) than implants (89.9%; p = 0.001). The risk of loss (RL) of implants increased with age, nicotine use, intraoral defects, and RCT. Radiotherapy did not independently increase the RL. Thus, implants seem to be a reliable treatment option in case of progressive tooth decay after TT, particularly after RT.
... Few studies on craniofacial implant placement mentioned the development of osteoradionecrosis and, when reported, the incidence was low. 5,13,15,[28][29][30] This could imply that osteoradionecrosis is not a significant issue in craniofacial implant therapy. In all the current study's patients with osteoradionecrosis, the exposed bone did not originate from the region with the implants and the implants were not loss. ...
Article
Full-text available
Objectives: To retrospectively assess the treatment outcomes of endosseous implants placed to retain craniofacial prostheses. Material and methods: Patients with craniofacial defects resulting from congenital disease, trauma, or oncologic treatment had implant retained prostheses placed in the mastoid, orbital, or nasal region and then assessed over a period of up to 30 years. Implant survival rates were calculated with the Kaplan-Meier method. Clinical assessments consisted of scoring skin reactions under the prosthesis and the peri-implant skin reactions. Possible risk factors for implant loss were identified. Patient satisfaction was evaluated using a 10-point VAS-scale. Results: A total of 525 implants placed in 201 patients were included. The median follow up was 71 months (IQR 28-174 months). Implants placed in the mastoid and nasal region showed the highest overall implant survival rates (10-year implant survival rates of 93.7% and 92.5%, respectively), while the orbital implants had the lowest overall survival rate (84.2%). Radiotherapy was a significant risk factor for implant loss (HR 3.14, p < 0.001). No differences in implant loss were found between pre- and post-operative radiotherapy (p = 0.89). Soft tissue problems were not frequently encountered, and the patients were highly satisfied with their implant-retained prosthesis. Conclusion: Implants used to retain craniofacial prostheses have high survival and patient satisfaction rates and can thus be considered as a predictable treatment option. Radiation is the most important risk factor for implant loss.
... A relatively lower survival rate of implants was observed in patients with a malignant tumor and osteoradionecrosis, which could have been due to the administration of radiotherapy in a majority of the patients [35]. Previous studies have also observed a detrimental impact of radiotherapy at both reconstructed and native bone sites, which leads to a higher implant failure and patients suffer from an increased risk of post-implant surgery complications [36]. Therefore, the key for having a high implant survival rate following reconstructive surgery is to devise a patient-specific treatment plan considering the influence of the aforementioned risk factors at both individual and accumulative levels. ...
Article
Full-text available
Aim The aim of the study was to assess the 5-year cumulative survival rate of implant-based dental rehabilitation following maxillofacial reconstruction with a vascularized bone flap and to investigate the potential risk factors which might influence the survival rate. Materials and methods A retrospective cohort study was designed. Inclusion criteria involved 18 years old or above patients with the availability of clinical and radiological data and a minimum follow-up 1 year following implant placement. The cumulative survival rate was analyzed by Kaplan–Meier curves and the influential risk factors were assessed using univariate log-rank tests and multivariable Cox-regression analysis. Results 151 implants were assessed in 40 patients with a mean age of 56.43 ± 15.28 years at the time of implantation. The mean number of implants placed per patient was 3.8 ± 1.3 with a follow-up period of 50.0 ± 32.0 months. The cumulative survival at 1-, 2- and 5-years was 96%, 87%, and 81%. Patients with systemic diseases (HR = 3.75, 95% CI 1.65–8.52; p = 0.002), irradiated flap (HR = 2.27, 95% CI 1.00–5.17; p = 0.05) and poor oral hygiene (HR = 11.67; 95% CI 4.56–29.88; p < 0.0001) were at a significantly higher risk of implant failure. Conclusion The cumulative implant survival rate was highest at 1st year followed by 2nd and 5th year, indicating that the risk of implant failure increased over time. Risk indicators that seem to be detrimental to long-term survival include poor oral hygiene, irradiated flap and systemic diseases.
... One day before surgery antibiotics were prescribed: Augmentin (amoxicillin and clavulanate potassium) at a dosage of 1 g, or Azithromycin 500 mg as an alternative in case of dental implants is estimated to be superior to 90% in the medium-long term for most implant systems, and the implant success can be affected by a variety of patient-implant-, surgery-, prosthesis-related factors like age, gender, implant size, implant shape, material of implant, length and diameter, location of implant, and bone quality (2)(3). Some studies have estimated the rate of failure of dental implants (2)(3)(4)(5)(6)(7)(8)(9) in evidence-based studies, in different clinical situations and surgical protocols, and found to be 0.8% when assessed for individuals and 0.5% at implant level. Again, these figures can vary when different factors are considered, for example, 1.0% is the rate of implant failure in patients who are >40yrs of age, 1.3% is the rate of failure among smokers, which is much higher than non-smokers 0.3% (10). ...
Article
The aim of this retrospective case series was to evaluate the clinical and radiographic outcomes of the patients that underwent implant surgery with a modification of the sinus lift summers protocol. Forty healthy patients in need for oral rehabilitation with dental implants were included in this study. Inclusion criterion was the need for extraction of one compromised tooth due to persistent abscess/ periodontitis/cyst in the atrophic posterior maxilla region. The treatment consisted of two stage surgery for all patients. In the first stage, after tooth extraction, the sockets were preserved with allogenic bone graft and equine collagen membrane. After 4-5 months, 40 implants with a sandblasted surface, were inserted with osseodensification technique and a modification of the Summers sinus lift protocol for fracturing the sinus floor. The implant survival rate was the primary outcome. Intra- and postoperative complications were additional criteria for success. The mean follow-up from implant surgery was 28.0±7.3 (standard deviation) months (range 17.8-43.4 months). One implant was lost before the delivery of the prosthesis. The overall implant survival rate was 97.5%. The overall mean peri-implant marginal bone level change after 6 and 12 months of function was, respectively, 0.26±0.24 mm (95% CI: 0.19, 0.34 mm) and 0.71±0.36 mm (95% CI: 0.60, 0.82 mm). Marginal bone loss was statistically significant at both time frames respect to implant placement, and also the difference between 6 and 12 months was significant (p<0.001 in both cases). No biological nor mechanical complications were recorded throughout the observation period. As a conclusion, the technique presented in this cohort study can be an effective and safe alternative to standard maxillary sinus floor augmentation procedures and immediate implant insertion protocol, especially in cases of periodontitis and infected sites, which can represent a high risk for implant failure in patients with atrophic posterior maxilla.
... placed after radiotherapy was found to be 92.9% (7). The author suggested that factors like age of the patients, and time of implantation after radiation therapy had no significant impact on implant survival. ...
Article
Full-text available
Radiotherapy to head and neck has always been considered as a risk factor for rehabilitation with dental implants. Nevertheless, recent data suggest that overall, 5-year implant survival in irradiated patients can be greater than 90%. The purpose of this review was to compare the implant survival rates of irradiated and non-radiated head and neck cancer sites, and discuss the outcomes, through a systematic review approach of prospective and retrospective studies. Electronic searches were performed in the EMBASE, Cochrane, and PubMed/Medline databases up to 2019 Dec, to identify retrospective and prospective clinical studies addressing the subject. This systematic review was conducted according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. The primary variables collected from the studies were the site of tumor, age and sex of the patient, site of implant placement, radiation dosage, frequency and duration of radiotherapy, follow-up duration, implant survival and stability, hard and soft tissue changes after implant placement, any type of biological and mechanical complication, and oral health quality of life (QOL). Fifteen studies including 1097 patients and a total of 4637 implants placed in irradiated and non-irradiated sites, with a follow up duration varying from 6 to 120 months, were selected for the systematic review. The results of the quantitative synthesis suggested statistically significantly better survival rate of implants placed in nonradiated sites, as compared to irradiated sites (p<0.00001). However, the cumulative survival rates over a period of 7-10 years were reported to be comparable. Quality of life (QOL) after implant rehabilitation was not found to be significantly different between the compared groups. Due to the limited number of information, insufficient data was available to draw conclusion on peri-implant complication rate. No relationship was found between age, gender, and implant survival rates. Implant placement in irradiated sites is challenging and often warrants protocol modifications. Although statistically the survival rates at irradiated sites were lower in comparison to non-radiated sites, a strict inclusion criterion in patient selection, timing of implant placement after radiotherapy, radiation dosage and regular oral hygiene maintenance could minimize the chances of implant failure in irradiated patients
... placed after radiotherapy was found to be 92.9% (7). The author suggested that factors like age of the patients, and time of implantation after radiation therapy had no significant impact on implant survival. ...
Preprint
Head and neck cancer" is a term used to describe several different malignant tumours that develop in or around the throat, larynx, nose, sinuses, and mouth. These account for 4% of all the cancers Radiotherapy to head and neck has always been considered as a risk factor for rehabilitation with dental implants. Nevertheless, recent data suggest that overall, 5-year implant survival in irradiated patients can be greater than 90%. The purpose of this review was to compare the implant survival rates of irradiated and non-radiated head and neck cancer sites, and discuss the outcomes, through a systematic review approach of prospective and retrospective studies. Electronic searches were performed in the EMBASE, Cochrane, and PubMed/Medline databases up to 2019 Dec, to identify retrospective and prospective clinical studies addressing the subject. This systematic review was conducted according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. The primary variables collected from the studies were the site of tumor, age and sex of the patient, site of implant placement, radiation dosage, frequency and duration of radiotherapy, follow-up duration, implant survival and stability, hard and soft tissue changes after implant placement, any type of biological and mechanical complication, and oral health quality of life (QOL). Fifteen studies including 1097 patients and a total of 4637 implants placed in irradiated and non-irradiated sites, with a follow up duration varying from 6 to 120 months, were selected for the systematic review. The results of the quantitative synthesis suggested statistically significantly better survival rate of implants placed in non-radiated sites, as compared to irradiated sites (p<0.00001). However, the cumulative survival rates over a period of 7-10 years were reported to be comparable. Quality of life (QOL) after implant rehabilitation was not found to be significantly different between the compared groups. Due to the limited number of information, insufficient data was available to draw conclusion on peri-implant complication rate. No relationship was found between age, gender, and implant survival rates. Implant placement in irradiated sites is challenging and often warrants protocol modifications. Although statistically the survival rates at irradiated sites were lower in comparison to non-radiated sites, a strict inclusion criterion in patient selection, timing of implant placement after radiotherapy, radiation dosage and regular oral hygiene maintenance could minimize the chances of implant failure in irradiated patients.
... Particularité de la réhabilitation par prothèse adjointe partielle métallique (PAPM : Les même principes décrits ci-dessus par rapport aux empreinte, rapport intermaxillaire, choix des dents et insertion et maintenance sont valables pour la réhabilitation par PAPM, la différence est en rapport avec le choix du concept occlusal (réalisé au cas par cas) et à l'adaptation du châssis métallique, il est impérative ainsi d'éliminer toutes compressions ainsi tout traumatisme occlusal ou des tissus de soutien (par l'un des éléments métalliques du châssis). Particularité de la réhabilitation par prothèse obturatrice maxillaire : [30] Il existe différents types de configurations qui peuvent se présenter en fonction du siège et de l'étendue de la perte de substance maxillaire (PDSM), nous choisissons pour aborder les particularités thérapeutiques prothétiques selon la classification de Bentahar [35]. Concernant l'utilisation de HBO, Il n'y a pas de consensus strict sur la l'utilisation de la thérapie HBO d'appoint mais de nombreuses études ont souligné les avantages du traitement HBO pour la cicatrisation des plaies dans les tissus mous et durs irradiés. ...
Article
Full-text available
The prevalence of head and neck cancers continues to increase throughout the world, the modality of their management mainly includes surgery, radiotherapy (RTH), and chemotherapy and antiresorptive treatment.The complications of radiotherapy imperatively require concerted management and rigorous monitoring. Indeed, collaboration with the multidisciplinary team is essential and guarantees therapeutic success.The management of patients during and after these anticancer treatments by the specialist in maxillofacial prosthesis essentially comprises the treatment of early and late complications of radiotherapy, oral care and finally prosthetic rehabilitation depending on the case.The objective of this work is to describe the protocols and recommendations for the management of patients during and after radiotherapy and to highlight the role of the specialist in maxillofacial prosthodontics in this management.
... Many factors are important for implant survivors such as age, gender, applied radiation dose, type of radiotherapy applied, the time between radiotherapy and implant surgery, the quality and topography of the bone in the region where the implant is placed, and the surgical procedure applied. Implants are placed as primary or secondary [18][19][20][21]. Placing the implants in the same session as ablative and reconstructive surgery is called primary placement. ...
... Thus, the use of dental implants can significantly improve the functional outcome of the prosthesis [1,2,6,7]. Nevertheless, many risk factors may influence the use of dental implants in patients who have undergone radiotherapy, such as patient age, sex, implant site, total radiation dose, time between end of radiotherapy and implant osteotomy, and type of radiation therapy [6,[12][13][14][15]. Furthermore, the use of endosseous implants may necessitate a bone grafting procedure, which can be further complicated with the induction of radiotherapy [16][17][18]. ...
Article
Full-text available
Introduction The prosthetic rehabilitation of mandibular defects owing to tumor resection is challenging, especially when the patient has undergone subsequent radiotherapy. Presentation of case A 46-year old male presented with a marginal mandibular resection. Following surgery, the patient received adjunctive radiation therapy with a total dose of 70 grays. On clinical examination, the patient presented with severely resorbed edentulous jaws, with an anterior marginal mandibular resection and an obliterated vestibular sulcus. The panoramic radiograph showed a hypocellularity of the maxillary and mandibular bones. A multidisciplinary team was formed, and a treatment plan was formulated which involved the construction of a vestibuloplast stent, and the application of 20 hyperbaric oxygen sessions before implant treatment and 10 more sessions after implant insertion. A total of 16 basal cortical screw implants were inserted to support the fixed prostheses, and a vestibuloplasty was performed to improve esthetics. No complications were observed, and at the 2-year follow-up, the patient presented with excellent peri-implant soft tissue health; increased bone -implant contact; and stable, well-functioning prostheses. Discussion The construction of a stable, retentive, well-supported removable prosthesis may be complicated in cases of comprehensive mandibular resection. Basal implants can eliminate the need for bone grafting, and reduce the treatment period required for providing a fixed prosthesis. Conclusion To our knowledge this is the first evidence reporting the use of fixed basal implant-supported prostheses in irradiated bone, in conjunction with hyperbaric oxygen therapy. A treatment modality that significantly improves the peri-implant tissue health, and ensures an excellent implant-bone contact.
... IMRT, a technique that allows high doses of radiation to be applied to the target volume, while sparing adjacent tissues and thus limiting the damage to vital surrounding organs, represents the current gold standard in the treatment of head and neck cancer patients.26 While one recent study did not observe an influence of using either 3-D conformal radiotherapy or IMRT on crestal bone loss and implant survival,27 another investigation with a median follow-up of 7.4 years could show a preceding radiation using IMRT to result in superior outcome regarding implant survival.28 ...
Article
Full-text available
Background While some medical associations provide guidelines for the implant‐prosthetic rehabilitation of head and neck cancer patients, the circulation and implementation in the everyday routine of practicing dentists remain unknown. Purpose To analyze patterns of care for the prosthetic rehabilitation of head and neck cancer patients after radiotherapy in German speaking countries. Materials and methods An online survey consisting of 34 questions separated into three sections, (a) general inquiries, (b) treatment concepts, and (c) patient cases, was forwarded to university hospital departments for Prosthetic Dentistry and Oral and Maxillofacial Surgery, and members of different medical associations. Statistical differences between groups were analyzed using chi‐squared test (P < .05). Results From May to October 2019, 118 participants completed the survey. The majority practiced in university hospitals, had more than 5 years of work experience, and reported to be involved in <10 post radiation prosthetic rehabilitation cases per year. Rehabilitation protocols involving dental implants were implemented by oral/oral‐ and maxillofacial surgeons and prosthetic dentists, while general dentists favored implant‐free solutions. Xerostomia was recognized as a common problem for a successful prosthetic rehabilitation. The subsequent treatment choice with either fixed dental prostheses or removable dentures was divided among participants. Conclusions As treatment planning differed with regard to the participants' field of expertise and work environment, and most practitioners only handle a low number of cases, patients might benefit from centralization in larger institutes with a multidisciplinary structure. A high agreement between the practitioners' treatment concepts and the current state of research was observed. While the choice between a mucosa‐ or tooth‐supported, and an implant‐supported restoration depends on numerous individual factors, guidelines derived from longitudinal studies would enhance evidence‐based treatment in this field.
Article
Background Microvascular free flap reconstruction of a defect, as a single-stage procedure, does not always achieve the desired functional and esthetic result. Revisions may be necessary to achieve ideal contour, symmetry, and suspension of soft tissues, or to support dental rehabilitation. Purpose The study purpose was to estimate the incidence and identify factors associated with elective free flap revisions. Study design, setting, sample: A retrospective cohort study of subjects who underwent free flap reconstruction was conducted to characterize the rate of elective free flap revision surgery. The study included subjects >18 years old, who underwent head and neck microvascular free flap surgery for any etiology, and both primary and secondary reconstructions, between 2014-2021. Subjects were excluded if they had incomplete records. Predictor variable The predictor variable was composed of a set of variables, grouped into the following categories: subject demographic data, medical history, disease etiology, anatomical site, and postoperative complications. Main outcome variable The outcome variable was time to elective revision surgery measured as months from the date of the initial operation to date of elective revision surgery. Elective revision surgery was defined as a procedure to enhance esthetics or function, which directly modifies the original surgical site, not including procedures to correct a complication, treat the original disease process, or emergencies. Covariates Not applicable. Analysis Kaplan-Meier method was used to analyze the data, with p-value <0.05. Risk factors for elective revisions were analyzed with Cox Hazard ratio. Results The sample was composed of 377 subjects that underwent free flap surgery, with a mean age of 55.9 +/- 15.9. Of these 67% were male, and 33% female, and sixty-two had an elective revision surgery (16.4%), with median follow-up period of 17 months (IQR 9-28). In the Cox regression model, only type of free flap was associated with an elective revision (p<0.05), where radial forearm had the lowest association with elective revision, and fasciocutaneous, latissimus dorsi, and scapula flaps had the highest. Conclusion and Relevance Achieving basic wound coverage with free flaps can be a challenge, however, surgeons should prepare patients for the potential need for functional and esthetic revisions after free flap surgery to improve patient quality of life.
Article
Background Various medical conditions and the drugs used to treat them have been shown to impede or complicate dental implant surgery. It is crucial to carefully monitor the medical status and potential post-operative complications of patients with systemic diseases, particularly elderly patients, to minimize the risk of health complications that may arise. Aim The purpose of this study was to review the existing evidence on the viability of dental implants in patients with systemic diseases and to provide practical recommendations to achieve the best possible results in the corresponding patient population. Methods The information for our study was compiled using data from PubMed, Scopus, Web of Science and Google Scholar databases and searched separately for each systemic disease included in our work until October 2023. An additional manual search was also performed to increase the search sensitivity. Only English-language publications were included and assessed according to titles, abstracts and full texts. Results In total, 6784 studies were found. After checking for duplicates and full-text availability, screening for the inclusion criteria and manually searching reference lists, 570 articles remained to be considered in this study. Conclusion In treating patients with systemic conditions, the cost–benefit analysis should consider the patient's quality of life and expected lifespan. The success of dental implants depends heavily on ensuring appropriate maintenance therapy, ideal oral hygiene standards, no smoking and avoiding other risk factors. Indications and contraindications for dental implants in cases of systemic diseases are yet to be more understood; broader and hardcore research needs to be done for a guideline foundation.
Article
Head and neck cancer (HNC) patients benefit from craniofacial reconstruction, but no clear guidance exists for rehabilitation timing. This meta-analysis aims to clarify the impact of oncologic treatment order on implant survival. An algorithm to guide placement sequence is also proposed in this paper. PubMed, Embase, and Web of Science were searched for studies on HNC patients with ablative and fibula-free flap (FFF) reconstruction surgeries and radiotherapy (RTX). Primary outcomes included treatment sequence, implant survival rates, and RTX dose. Of 661 studies, 20 studies (617 implants, 199 patients) were included. Pooled survival rates for implants receiving >60 Gy RTX were significantly lower than implants receiving < 60 Gy (82.8% versus 90.1%, P =0.035). Placement >1 year after RTX completion improved implant survival rates (96.8% versus 82.5%, P =0.001). Implants receiving pre-placement RTX had increased survival with RTX postablation versus before (91.2% versus 74.8%, P <0.001). One hundred seventy-seven implants were placed only in FFF with higher survival than implants placed in FFF or native bone (90.4% versus 83.5%, P =0.035). Radiotherapy is detrimental to implant survival rates when administered too soon, in high doses, and before tumor resection. A novel evidence-based clinical decision-making algorithm was presented for utilization when determining the optimal treatment order for HNC patients. The overall survival of dental prostheses is acceptable, reaffirming their role as a key component in rehabilitating HNC patients. Considerations must be made regarding RTX dosage, timing, and implant location to optimize survival rates and patient outcomes for improved functionality, aesthetics, and comfort.
Article
Objectives We assessed the radiation dosages ( D mean ) on implant regions to identify the threshold for implant loss in patients with an intraoral malignancy treated with dental implants to support a mandibular denture during ablative surgery before volumetric‐modulated arc therapy (VMAT). Materials and Methods Data was collected prospectively from 28 patients treated surgically for an intraoral malignancy, followed by postoperative radiotherapy (VMAT) and analyzed retrospectively. Patients received 2 implants in the native mandible during ablative surgery. Implant‐specific D mean values were retrieved from the patients' files. Radiographic bone loss was measured 1 year after implant placement and during the last follow‐up appointment. Implant survival was analyzed with the Kaplan–Meier method. Univariate logistic regression and Cox‐regression analyses were performed to investigate the effect of increasing implant‐specific radiation dosages on implant loss. Results Five out of 56 placed implants were lost during follow‐up (median 36.0 months, IQR 39.0). Radiographically, peri‐implant bone loss occurred in implants with a D mean > 40 Gy. Implant loss occurred only in implants with a D mean > 50 Gy. Conclusion An implant‐specific D mean higher than 50 Gy is related to more peri‐implant bone loss and, eventually, implant loss.
Chapter
Functional rehabilitation of the orofacial complex aims to restore the structure and function of the mouth and face. This involves a multidisciplinary approach, including assessment of the defect and functional goals, dental rehabilitation with prosthodontics, surgical procedures for implant placement, and rehabilitation with prosthetics. Patients with significant maxillary defects may benefit from the use of zygomatic implants, pterygoid implants, and implants in osteocutaneous vascularized free flaps. However, dental rehabilitation in irradiated patients poses specific challenges, and careful planning and execution are necessary for success. Collaboration between the surgeon, prosthodontist, and anaplastologist is crucial to developing an appropriate rehabilitation plan and achieving optimal outcomes. This chapter provides an overview of the various aspects of functional rehabilitation of the orofacial complex, including dental rehabilitation, implant placement, and prosthetic reconstruction of the nasal, orbital, and auricular regions. In conclusion, functional rehabilitation of the orofacial complex is a complex process that requires a multidisciplinary approach. The assessment of the defect and functional goals is critical in developing an appropriate rehabilitation plan, and close collaboration between healthcare professionals is essential for success. Dental rehabilitation, surgical implant placement, and prosthetic reconstruction are all important considerations in achieving optimal outcomes for patients with maxillofacial defects.
Article
Full-text available
Increased human life expectancy broadens the alternatives for missing teeth and played a role in the widespread use of dental implants and related augmentation procedures for the aging population. Though, many of these patients may have one or more diseases. These systemic conditions may directly lead to surgical complications, compromise implant/bone healing, or influence long‐term peri‐implant health and its response to biologic nuisances. Offering patients credible expectations regarding intra‐ and postoperative complications and therapeutic prognosis is an ethical and legal obligation. Clear identification of potential types of adverse effects, complications, or errors is important for decision‐making processes as they may be related to different local, systemic, and technical aspects. Therefore, the present review structures the underlying biological mechanisms, clinical evidence, and clinical recommendations for the most common systemic risk factors for implant‐related complications.
Chapter
The primary aim of treatment of head and neck cancer patients with curative intent is to eliminate malignant disease. The secondary aim of treatment of head and neck cancer patients is to restore appearance and function as nearly as possible to pretreatment conditions. This is where the restorative dentistry contribution is so important. In the classic surgical approach to head and neck cancer, the 3Rs apply. These are resection, reconstruction, and rehabilitation. Dentists tend to equate restoration of function in patients who are missing teeth with the ability to chew. The main function of the multidisciplinary meetings is to collate evidence in relation to diagnosis, to decide on appropriate treatment. While psychological well‐being of patients is not the foremost consideration in dentistry, it is an important consideration, particularly in patients treated for head and neck cancer. The preservation of teeth where possible is highly desirable.
Article
The review presents the impact of modern dental treatment of patients with squamous cell carcinoma of the oral mucosa on the prognosis of dental health after the end of the main antitumor treatment. The literature for the last 5 years was analyzed from the databases PubMed MedLine, The Cochrane Library, EMBASE, Global Health and CyberLeninka platforms, eLibrary.ru. The literature sources taken for the review are indexed in the databases Scopus, Web of Science, RSCI. The authors conducted a search for modern methods and algorithms of dental treatment for this category of patients. Indications, possible risks and frequent complications of the main types of antitumor treatment and its long-term impact on dental health in general have been identified.
Article
Background Radiation-associated soft tissue injury is a potentially devastating complication for head and neck cancer patients. The damage can range from minor sequelae such as xerostomia, which requires frequent daily maintenance, to destructive degenerative processes such as osteoradionecrosis, which can contribute to flap failure and delay or reverse oral rehabilitation. Despite the need for effective radioprotectants, the literature remains sparse, primarily focused on interventions beyond the surgeon's control, such as maintenance of good oral hygiene or modulation of radiation dose. Methods This narrative review aggregates and explores noninvasive, systemic treatment modalities for prevention or amelioration of radiation-associated soft tissue injury. Results We highlighted nine modalities with the most clinical potential, which include amifostine, melatonin, palifermin, hyperbaric oxygen therapy, photobiomodulation, pentoxifylline–tocopherol–clodronate, pravastatin, transforming growth factor-β modulators, and deferoxamine, and reviewed the benefits and limitations of each modality. Unfortunately, none of these modalities are supported by strong evidence for prophylaxis against radiation-associated soft tissue injury. Conclusion While we cannot endorse any of these nine modalities for immediate clinical use, they may prove fruitful areas for further investigation.
Article
Full-text available
Objectives This systematic review assesses dental implant survival, calculates the incidence rate of osteoradionecrosis, and evaluates risk factors in irradiated head and neck cancer patients. Materials and methods Various databases (e.g., Medline/Embase using Ovid) and gray literature platforms were searched using a combination of keywords and subject headings. When appropriate, meta-analysis was carried out using a random effects model. Otherwise, pooled analysis was applied. Results A total of 425 of the 660 included patients received radiotherapy. In total, 2602 dental implants were placed, and 1637 were placed in irradiated patients. Implant survival after an average follow-up of 37.7 months was 97% (5% confidence interval, CI 95.2%, 95% CI 98.3%) in nonirradiated patients and 91.9% (5% CI 87.7%, 95% CI: 95.3%) after an average follow-up of 39.8 months in irradiated patients. Osteoradionecrosis occurred in 11 cases, leading to an incidence of 3% (5% CI 1.6%, 95% CI 4.9%). The main factors impacting implant survival were radiation and grafting status, while factors influencing osteoradionecrosis could not be determined using meta-analysis. Conclusion Our data show that implant survival in irradiated patients is lower than in nonirradiated patients, and osteoradionecrosis is—while rare—a serious complication that any OMF surgeon should be prepared for. The key to success could be a standardized patient selection and therapy to improve the standard of care, reduce risks and shorten treatment time. Clinical relevance Our analysis provides further evidence that implant placement is a feasible treatment option in irradiated head and neck cancer patients with diminished oral function and good long-term cancer prognosis.
Article
Prosthetic dental rehabilitation of patients with tumors in the head and neck region is an important milestone in the overall therapeutic concept, enabling functional rehabilitation and social reintegration. Treatment-related changes in anatomic relationships due to resection and reconstruction or xerostomia caused by radiotherapy often prevent conventional prosthetic restoration. For this reason, dental implants are often required to improve retention. In order to ensure the correct anatomic relations after extensive reconstructions, it is advisable to archive the patient’s bite registration before the start of oncologic treatment. Preoperative virtual planning of bony resections and reconstruction with the imported prosthetic alignment nowadays enables bone grafts to be optimally adapted to the defect with ideal functional and prosthetic positioning in the sense of “backward planning”. In irradiated as well as radiotherapy-naive patients, the implant healing time is 10–12 weeks in the maxilla and 6–8 weeks in the mandible. Modified vestibuloplasty with an implant-retained splint creates the best-possible stable, hygienic periimplant soft tissue conditions. Prosthetic rehabilitation with a custom-made bar or fixed dental prosthesis enables primary splinting and stable retention in the reconstructed jawbone. Prerequisites for the long-term success of dental implants are optimal soft tissue management, a strict recall system, and conservative establishment of the indication in irradiated patients with persistent nicotine abuse.
Chapter
Tumor region automated segmentation from the digitized hematoxylin and eosin stained histology image is a fundamental step for efficient tumor quantification and biomarker interrogation. In this study, we presented an automated deep learning-based tumor segmentation model for automated tumor extent delineation in whole slide tissue images of p16-positive oropharyngeal squamous cell carcinomas (n = 248). The employed ResNet model was trained using images with coarse annotations (i.e., polygon-style bounding box annotations). The model was trained using n = 194 images and validated using n = 49 images. Another cohort of five whole slide images was used as independent test purpose. The experimental result demonstrated that satisfactory segmentation results could be achieved, an accuracy of about 90% in both of the validation and test cohorts, even when using non-exhaustive tumor annotations for training the model. Such an accurate and efficient tumor detection model could be used for early detection of disease and the prediction of aggressiveness in oropharyngeal squamous cell carcinomas, which could improve the patients’ survival to manage their therapeutic strategies appropriately.
Chapter
Dental implants have become an integral part of orofacial rehabilitation. In addition to their use for tooth replacement, they have become important in maxillofacial prosthetic rehabilitation. Head and neck cancers often require ablative surgery that includes the maxilla and mandible. The use of dental implants to support prostheses replacing portions of the jaws and facial skeleton has given individuals with this disease functionality, aesthetics, and emotional support that have never before been possible. Digital technology has further provided opportunities in the planning and execution of maxillofacial rehabilitation using dental implants. This allows the use of advanced surgical and prosthetic techniques with an improved result for the patients.
Chapter
The specialty of oral maxillofacial surgery relies heavily on restoration of the oral cavity with dental implants. The foundation to longevity and health of dental implants is a good bone foundation of the alveolus. If the ridge is deficient, reconstruction of the alveolus can take place with substitution of bone, which can come from allogeneic, xenogeneic, or autologous sources. Different methods of grafting the jaws are available. Some are more invasive than others with indications dependent on the degree of bone loss or surgeon preference. Short, narrow, tilted, or special (zygomatic) implants may also be utilized if the patient refuses to undergo invasive reconstructive procedures or has contraindications to grafting Implant dentistry has many applications as it relates to maxillofacial reconstruction. Coordination with the restorative dentist to formulate a treatment plan is paramount. There are many options for prosthetic rehabilitation all with their own nuances. In this chapter, we review implant basics, bone grafting options, surgical techniques, complications, and types of surgical and prosthetic components.
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In the patient with systemic disease, risk stratification must be undertaken for each patient assessing the risks of the surgery and ability of the patient to maintain the planned implant supported prosthesis. Any systemic disease that results in delayed wound healing can affect implant healing and lead to implant failure. Current evidence supports high implant survival rates in most patients with systemic diseases when co-risk factors which include smoking, periodontitis, and poor oral hygiene are removed. Evidence does support a higher implant failure and incidence of peri-implantitis in patients having received radiation therapy for head and neck cancer, high doses of anti-resorptive therapy for osteoporosis, multiple myeloma or metastatic cancer to the skeleton and poorly controlled diabetics. Heavy alcohol consumption also appears to lead to a higher implant failure rate. A thorough medical history, knowledge of the patients’ medications and schedule, optimization of the patient for the surgery, consulting with the patient’s medical providers, and assuring the patient understands when there are increased risks and the absolute need of excellent oral hygiene can lead to implant healing and similar high survival rates that are seen in healthy patients.
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Dental implantlar, titanyum veya zirkonyum malzeme kullanılarak, eksik dişlerin fonksiyon ve estetiğini tekrar sağlamak amacıyla çene kemiğine yerleştirilen yapay diş kökleridir. Bu bölümde, ağız, diş, çene cerrahisinde en önemli disiplinlerden biri olan implantolojiye dair olgu seçimi, cerrahi prensipler, risk faktörleri, tedavi seçenekleri ve komplikasyonları kapsayan özet bilgiler sunulmuştur.
Article
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Background: Oral cancer patients can benefit from dental implant placement. Traditionally implants are placed after completing oncologic treatment (secondary implant placement). Implant placement during ablative surgery (primary placement) in oral cancer patients seems beneficial in terms of early start of oral rehabilitation and limiting additional surgical interventions. Guidelines on the ideal timing of implant placement in oral cancer patients are missing. Objective: To perform a scoping literature review on studies examining the timing of dental implant placement in oral cancer patients and propose a clinical practice recommendations guideline. Methods: A literature search for studies dealing with primary and/or secondary implant placement in Medline was conducted (last search December 27th , 2019). The primary outcome was 5-year implant survival. Results: 16 out of 808 studies were considered eligible. Both primary and secondary implant placement showed acceptable overall implant survival ratios with a higher pooled 5-year implant survival rate for primary implant placement 92.8% (95% CI: 87.1%-98.5%) than secondary placed implants (86.4%, 95% CI: 77.0%-95.8%). Primary implant placement is accompanied by earlier prosthetic rehabilitation after tumor surgery. Conclusion: Patients with oral cancer greatly benefit from, preferably primary placed, dental implants in their prosthetic rehabilitation. The combination of tumor surgery with implant placement in native mandibular bone should be provided as standard care.
Article
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The aim of this retrospective study was to evaluate the survival of dental implants placed after ablative surgery, in patients affected by oral cancer treated with or without radiotherapy. We collected data for 34 subjects (22 females, 12 males; mean age: 51 +/- 19) with malignant oral tumors who had been treated with ablative surgery and received dental implant rehabilitation between 2007 and 2012. Postoperative radiation therapy (less than 50 Gy) was delivered before implant placement in 12 patients. A total of 144 titanium implants were placed, at a minimum interval of 12 months, in irradiated and non-irradiated residual bone. Implant loss was dependent on the position and location of the implants (P = 0.05-0.1). Moreover, implant survival was dependent on whether the patient had received radiotherapy. This result was highly statistically significant (P < 0.01). Whether the implant was loaded is another highly significant (P < 0.01) factor determining survival. We observed significantly better outcomes when the implant was not loaded until at least 6 months after placement. Although the retrospective design of this study could be affected by selection and information biases, we conclude that a delayed loading protocol will give the best chance of implant osseointegration, stability and, ultimately, effective dental rehabilitation.
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The purpose of this study was to evaluate the long-term survival rate and potential influencing factors of dental implants and implant-retained prostheses in oral cancer patients who had undergone surgical tumor resection. In the present study, 157 patients (95 females and 62 males with a mean age of 53.7 years) with 830 implants were included. All patients were diagnosed with a malignant tumor in the oral cavity and had undergone ablative surgery. In 55 patients (292 implants), the surgical procedure was followed by an additional radiochemotherapy (RCT) before implant placement. Nicotine users who received RCT were excluded from this study. Patients were clinically examined every 6 or 12 months according to a standard procedure. Of the 830 examined implants, 450 were placed in the maxilla and 380 in the mandible. A total of 65 implants were lost, 36 in the maxilla and 29 in the mandible; of these, 42 implants (65 %) were documented as lost due to the patient's death. The mean observation period was 121 months. The cumulative survival rate was 94.9 % at 3 years and 92.5 % at 7 years. With an observation period up to 20 years, the cumulative survival rate remained constant after 11 years with 90.8 %. Age, gender, and localization (maxilla/mandible) of implants did not show any influence on the survival of the implants. However, radiochemotherapy was determined as a significant factor influencing the survival rate. The results of this study demonstrate that the survival rate of implants was significantly lower in oral cancer patients who had been treated by ablative surgery and additional radiochemotherapy than in patients without RCT. Since there is no significant difference in the mortality rate of patients with additional RCT compared to patients who underwent sole ablative surgery, the higher loss ratio is due to a late failure of osseointegration. Dental implants in oral cancer patients who had been treated by ablative surgery show a high and steady cumulative survival rate after 11 years. Implant survival of patients with additional RCT is significantly lower. Non-smoking-irradiated patients seem to have a better implant survival.
Article
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The aim of this comprehensive literature review is to provide recommendations and guidelines for dental implant therapy in patients with a history of radiation in the head and neck region. For the first time, a meta-analysis comparing the implant survival in irradiated and non-irradiated patients was performed. An extensive electronic search in the electronic databases of the National Library of Medicine was conducted for articles published between January 1990 and January 2013 to identify literature presenting survival data on the topic of dental implants in patients receiving radiotherapy for head and neck cancer. Review and meta-analysis were performed according to Preferred Reporting Items for Systematic Review and Meta-Analyses statement. For meta-analysis, only studies with a mean follow-up of at least 5 years were included. After screening 529 abstracts from the electronic database, we included 31 studies in qualitative and 8 in quantitative synthesis. The mean implant survival rate of all examined studies was 83 % (range, 34-100 %). Meta-analysis of the current literature (2007-2013) revealed no statistically significant difference in implant survival between non-irradiated native bone and irradiated native bone (odds ratio [OR], 1.44; confidence interval [CI], 0.67-3.1). In contrast, meta-analysis of the literature of the years 1990-2006 showed a significant difference in implant survival between non-irradiated and irradiated patients ([OR], 2.12; [CI], 1.69-2.65) with a higher implant survival in the non-irradiated bone. Meta-analysis of the implant survival regarding bone origin indicated a statistically significant higher implant survival in the irradiated native bone compared to the irradiated grafted bone ([OR], 1.82; [CI], 1.14-2.90). Within the limits of this meta-analytic approach to the literature, this study describes for the first time a comparable implant survival in non-irradiated and irradiated native bone in the current literature. Grafted bone combined with radiotherapy was identified as a negative prognostic factor on implant survival. The evolution of implant hardware and improvement of treatment strategies during the last years have affirmed dental implant-supported concepts as a valuable treatment option for patients with a history of radiation in the head and neck region.
Article
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The aim of this study was to assess the survival rate of titanium implants placed in irradiated jaws. MEDLINE, EMBASE, and CENTRAL were searched for studies assessing implants that had been placed in nongrafted sites of irradiated patients. Random effects meta-analyses assessed implant loss in irradiated versus nonirradiated patients and in irradiated patients treated with hyperbaric oxygen (HBO) therapy. Of 1,051 potentially eligible publications, 15 were included. A total of 10,150 implants were assessed in the included studies, and of these, 1,689 (14.3%) had been placed in irradiated jaws. The mean survival rate in the studies ranged from 46.3% to 98.0%. The pooled estimates indicated a significant increase in the risk of implant failure in irradiated patients (risk ratio: 2.74; 95% confidence interval: 1.86, 4.05; p < .00001) and in maxillary sites (risk ratio: 5.96; 95% confidence interval: 2.71, 13.12; p < .00001). Conversely, HBO therapy did not reduce the risk of implant failure (risk ratio: 1.28; 95% confidence interval: 0.19, 8.82; p = .80). Radiotherapy was linked to higher implant failure in the maxilla, and HBO therapy did not improve implant survival. Most included publications reported data on machined implants, and only 3 studies on HBO therapy were included. Overall, implant therapy appears to be a viable treatment option for reestablishing adequate occlusion and masticatory conditions in irradiated patients.
Article
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The aim of this study is to analyze implant survival in patients who received radiotherapy treatment for oral malignancies and in patients who had suffered mandibular osteoradionecrosis. We reviewed retrospectively 225 implants placed in 30 patients who had received radiotherapy as part of the oncologic treatment. Radiation doses ranged between 50 and 70 Gy. 39 implants were placed after a combined treatment of radiotherapy and chemotherapy. Data referred to tumour type and reconstruction, presence of osteoradionecrosis, region of implant installation and type of prostheses were recorded. Survival rates were calculated with cumulative Kaplan-Meier survival curves and compared between different groups with a log-rank test. 152 osseointegrated implants were placed in patients who presented previous reconstruction procedure. Five patients developed osteorradionecrosis as a complication of the radiotherapy treatment. Once osteoradionecrosis had healed in these patients, 41 implants were installed. The overall 5 year survival rate in irradiated patients was 92.6%. Irradiated patients had a marginally significantly higher implant loss than non-irradiated patients. (p = 0.063). The 5 year survival rate in the osteoradionecrosis group was of 48.3% and in the non-osteoradionecrosis group 92.3%, with a statistically significant difference between both groups. (p = 0.002). Osseointegrated implants enhance oral rehabilitation in most irradiated patients, even being an acceptable option for patients who had suffered osteoradionecrosis. Totally implant supported prostheses are recommended after irradiation providing functional, stable and aesthetically satisfactory rehabilitation.
Article
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In this multicenter study, submerged implants were prospectively followed to evaluate their long-term prognosis in irradiated patients. In a total of 77 patients treated for oral or neck cancer, 188 implants were consecutively placed. After a healing period, the successfully integrated implants were restored with 69 removable and 38 fixed restorations. The implants cumulative survival and success rates were evaluated over a period of at least 36 months. In addition, cumulative success rates were calculated for implant subgroups divided per implant site (mandible or maxilla), radiation dosage, and the time interval between the last irradiation and implant placement. During the healing period, 20 implants did not successfully integrate, whereas 168 implants were classified as success (including both survival and success rates). The analysis of implant subgroups showed slightly more favorable cumulative success rate for mandibular implants (98.4%) compared with maxillary implants (57.1%) and clearly better success rate for a radiation dosage minor of 50-Gy doses. A time greater than 12 months as interval between last irradiation and implant placement seems not to promote better clinical results.
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This prospective clinical study evaluated the 5-year survival and success rates of 66 titanium implants placed in bone that had been previously augmented with autografts and nonresorbable barrier membranes. During the observation period, three patients with five implants dropped out of the study. None of the remaining 61 implants were lost during the follow-up period (implant survival rate of 100%). One implant exhibited a periimplant infection, whereas 60 implants were considered clinically successful at the 5-year examination, resulting in a 5-year success rate of 98.3%. It can be concluded that the clinical results of implants in regenerated bone are comparable to those of implants in nonregenerated bone.
Article
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Oral malignancy is often treated with a combination of surgery and radiation therapy (RT). The aim of this systematic review was to examine the effects of pre- and postimplantation RT on dental implant failure. The literature published from 1990 through 2006 was reviewed for studies assessing pre- and postimplantation RT. Potential studies were identified by searches of PubMed, SCIRUS, and the Cochrane Central Register of Controlled Trials (CENTRAL). The incidence of implant failure has been linked to the following variables: post- versus preimplantation RT, site of implant placement, RT dose, delay from RT to implant placement, and timing of implant failure after placement. Similar failure rates were found for implants placed post-RT compared to those placed pre-RT (3.2% and 5.4%). In preimplantation RT, the implant failure rate was lower for the mandible (4.4%) in comparison to the maxilla (17.5%; OR = 4.63; 95% CI: 2.25 to 9.49). Other results did not reach statistical significance. No failures were observed in association with an RT dose lower than 45 Gy. All implant failures observed occurred within 36 months after RT, and most occurred between 1 and 12 months after placement. Notwithstanding the low number of implants evaluated, this review showed similar failure rate for implants placed post-RT and those placed pre-RT (3.2% and 5.4%, respectively).
Article
Purpose: Radiotherapy and compromised vital bone and/or surrounding soft tissue can be a challenge to the successful osseointegration of dental implants. We evaluated the long-term results of dental implants in patients with oral cancer. Materials and Methods: To address the research purpose, we designed and implemented a retrospective cohort study that included patients with oral cancer who had received dental implants from 2003 to 2011. The data were collected from a clinical oncology database. The predictor variables included a set of heterogeneous variables grouped into logical sets of demographics, surgical treatment, dental rehabilitation, radiotherapy type, and tumor entity. The primary outcome variable was implant survival; the secondary outcome variable was peri-implantitis. The descriptive statistics, survival time analysis, Kaplan-Meier implant survival curves, and Cox hazard proportional modeling were computed. Results: The study sample included 59 patients with oral cancer (20 women [33.9%], 39 men [66.1%]; mean age at tumor diagnosis, 55years), who had had 272 implants placed during the study period. The mean follow-up period was 30.9months (range 3 to 82). Of the 272 implants, 269 (98.9%) and 264 (97.1%) had survived for 2 and 5years, respectively. During the observation period, 10 implants were lost (3.7%). Of the implant failures, 82% occurred in transplanted bone (4 fibula flaps, 4 iliac crests, and 2 native mandibles). We observed peri-implantitis caused by insufficiently attached gingiva and bone loss in 182 of the implants (67%). The factors associated with implant failure were peri-implantitis, insufficient soft and hard tissue, muscle dysfunction, and xerostomia. Conclusions: Implant-based rehabilitation in oncology patients can achieve a high long-term success rate, although risk factors such as impaired muscle function and a high frequency of peri-implantitis can affect healing. © 2015 American Association of Oral and Maxillofacial Surgeons.
Article
The aim of this study was to evaluate the effect of hyperbaric oxygen therapy (HBOT) on microvascular tissue and cell proliferation in the oral mucosa. Twenty patients, aged 51–78 years, were allocated randomly to a treatment or a control group. All had a history of radiotherapy (50–70 Gy) to the orofacial region 2–6 years previously. Tissue samples were taken from the irradiated buccal oral mucosa before HBOT and at 6 months after treatment. In the control group, tissue samples were taken on two occasions, 6 months apart. The samples were subjected to immunohistochemistry staining: double staining with CD31 and D2-40 for microvessels, or Ki-67 for the analysis of cell proliferation. Blood vessel density and area were significantly increased after HBOT (P = 0.002–0.041). D2-40-positive lymphatic vessels were significantly increased in number and area in the sub-epithelial area (P = 0.002 and P = 0.019, respectively). No significant differences were observed in the control group. There were no significant differences in Ki-67-expressing epithelial cells between the two groups. It is concluded that the density and area of blood and lymphatic vessels in the irradiated mucosa are increased by HBOT 6 months after therapy. Epithelial cell proliferation is not affected by HBOT.
Article
Background/Methods. The purpose of the present meta-analysis was to test the null hypothesis of no difference in dental implant failure rates, postoperative infection, and marginal bone loss for patients being rehabilitated by dental implants and being previously irradiated in the head and neck region versus non-irradiated patients, against the alternative hypothesis of a difference.Results/Conclusion. The study suggests that irradiation negatively affects the survival of implants, as well as the difference in implant location (maxilla vs. mandible), but there is no statistically significant difference in survival when implants are inserted before or after 12 months after radiotherapy. The study failed to support the effectiveness of hyperbaric oxygen therapy in irradiated patients. It was observed a tendency to lower survival rates of implants inserted in the patients submitted to higher irradiation doses. The results should be interpreted with caution due to the presence of uncontrolled confounding factors in the included studies. Head Neck, 2014
Article
Background/Methods. The purpose of the present meta-analysis was to test the null hypothesis of no difference in dental implant failure rates, postoperative infection, and marginal bone loss for patients being rehabilitated by dental implants and being previously irradiated in the head and neck region versus non-irradiated patients, against the alternative hypothesis of a difference. Results/Conclusion. The study suggests that irradiation negatively affects the survival of implants, as well as the difference in implant location (maxilla vs. mandible), but there is no statistically significant difference in survival when implants are inserted before or after 12 months after radiotherapy. The study failed to support the effectiveness of hyperbaric oxygen therapy in irradiated patients. It was observed a tendency to lower survival rates of implants inserted in the patients submitted to higher irradiation doses. The results should be interpreted with caution due to the presence of uncontrolled confounding factors in the included studies.
Article
An increasing number of reports indicate successful use of dental implants (DI) during oral rehabilitation for head and neck cancer patients undergoing tumor surgery and radiation therapy. Implant-supported dentures are a viable option when patients cannot use conventional dentures due to adverse effects of radiation therapy, including oral dryness or fragile mucosa, in addition to compromised anatomy; however, negative effects of radiation, including osteoradionecrosis, are well documented in the literature, and early loss of implants in irradiated bone has been reported. There is currently no consensus concerning DI safety or clinical guidelines for their use in irradiated head and neck cancer patients. It is important for health care professionals to be aware of the multidimensional risk factors for these patients when planning oral rehabilitation with DIs, and to provide optimal treatment options and maximize the overall treatment outcome. This paper reviews and updates the impact of radiotherapy on DI survival and discusses clinical considerations for DI therapy in irradiated head and neck cancer patients.
Article
To study the long-term survival of dental implants placed in native or grafted bone in irradiated bone in subjects who had received radiation for head and neck cancer. A retrospective chart review was conducted for all patients who received dental implants following radiation treatment for head and neck cancer between May 1, 1987 and July 1, 2008. Only patients irradiated with a radiation dose of 50 Gy or greater and those who received dental implants in the irradiated field after head and neck radiation were included in the study. The associations between implant survival and patient/implant characteristics were estimated by fitting univariate marginal Cox proportional hazards models. A total of 48 patients who had prior head and neck radiation had 271 dental implants placed during May 1987-July 2008. There was no statistically significant difference between implant failure in native and grafted bone (P=0.76). Survival of implants in grafted bone was 82.3% and 98.1% in maxilla and mandible, respectively, after 3 years. Survival of implants in native bone in maxilla and mandible was 79.8% and 100%, respectively, after 3 years. For implants placed in the native bone, there was a higher likelihood of failure in the maxilla compared to the mandible and there was also a tendency for implants placed in the posterior region to fail compared to those placed in the anterior region. There was no significant difference in survival when implants were placed in native or grafted bone in irradiated head and neck cancer patients. For implants placed in native bone, survival was significantly influenced by the location of the implant (maxilla or mandible, anterior or posterior).
Article
Patients who undergo surgical management of oral cancer may greatly benefit from an implant-supported prosthesis. This study reports on the clinical experience of dental implant placement in patients following resection of oral cancer over a 15-year period. Controversies including the use of dental implants in irradiated tissues, and hyperbaric oxygen treatment will also be discussed. Thirty-one patients who had dental implants placed as part of their oral rehabilitation between 1992 and 2007 were investigated. Demographic data and factors including implant survival, type of prosthesis provided, radiotherapy and the hyperbaric oxygen therapy were analysed. In this retrospective study, there was a retention rate of 110 implants from a total of 115 implants placed. A high rate of implant retention was found, with 5 implant failures from a total of 115 implants placed. The 5 failed implants occurred in free flap bone that had been irradiated. Dental implants provide an important role in the oral rehabilitation of oral cancer patients. There may be an increased risk of implant failure in free flap bone that has been irradiated.
Article
The aim of this study was to evaluate the success rate of chemically modified and conventional sandblasted acid-etched surface (SLA) titanium implants in irradiated oral squamous cell carcinoma patients. Twenty patients with a mean age of 61.1 years were treated with dental implants after ablative surgery and radio-chemotherapy of oral cancer. All patients were non-smokers. The placement of SLA and modSLA implants was performed bilaterally according to a split-mouth design. All 102 implants (50 SLA, 52 modSLA) placed showed an unloaded healing time of 6 weeks in the mandible and 10 weeks in the maxilla. Mean crestal bone changes using standardized orthopantomographies and clinical parameters like pocket depths, mPII and mBI were evaluated. Of 102 implants, 55 implants (27 SLA implants, 28 modSLA) were located in the maxilla and 47 implants (23 SLA, 24 modSLA) in the mandible. The average observation period was 14.4 months. The amount of bone loss at the implant shoulder of SLA implants was 0.4 mm mesial and 0.4 mm distal. The modSLA implants displayed a bone loss of mesial 0.3 mm and distal 0.3 mm. Two SLA implants were lost resulting in a success rate of 96%. The success rate of modSLA implants was 100%. Regarding the data found in this investigation, we can conclude that implants with chemically modified and conventional SLA titanium surface show high success rates in irradiated patients. SLA implants with or without a chemically modified surface regardless of the location can be restored with a high predictability of success at least in the short time range observed.
Article
The overall impression regarding the success of dental implants (DI) in patients having undergone oral cancer therapy remains unclear. The aim of the present review study was to assess the implant survival rate after oral cancer therapy. Databases were explored from 1986 up to and including September 2010 using the following keywords in various combinations: "cancer", "chemotherapy", "dental implant", "oral", "osseointegration", "radiotherapy", "surgery" and "treatment". The eligibility criteria were: (1) original research articles; (2) clinical studies; (3) reference list of pertinent original and review studies; (4) intervention: patients having undergone radio- and chemotherapy following oral cancer surgery; and (5) articles published only in English. Twenty-one clinical studies were included. Results from 16 studies reported that DI can osseointegrate and remain functionally stable in patients having undergone radiotherapy following oral cancer surgery; whereas three studies showed irradiation to have negative effects on the survival of DI. Two studies reported that DI can osseointegrate and remain functionally stable in patients having undergone chemotherapy. It is concluded that DI can osseointegrate and remain functionally stable in patients having undergone oral cancer treatment.
Article
The aim of this paper is to provide a systematic review of articles concerning primary osseointegrated dental implants in the head and neck oncology setting. We searched MEDLINE (1950 to March 2009) and Embase (1980 to March 2009) using the terms head and neck, oral, maxillofacial, craniofacial, jaws, mandible, maxilla, zygoma, dental implants, osseointegrated implants, implants, tumour, cancer, oncology, immediate, simultaneous, and primary. Two authors independently reviewed the abstracts, and all those written in the English language that referred to the placement of primary dental implants in patients with cancer of the head neck were included. Articles that referred to craniofacial or extraoral implants were excluded. Of 892 abstracts 83 were eligible for further consideration; the full articles were evaluated, and 41 that complied fully with the inclusion criteria are presented as a tabulated summary. There are three case reports, 13 reviews, and 25 clinical studies. Eight of the clinical studies refer solely to the insertion of dental implants at the time of primary oncological resection, and only two were of a prospective design. We have concisely summarised publications concerning primary dental implants, and our findings will help to inform head and neck cancer teams, particularly oncological surgeons, restorative dentists, and maxillofacial prosthodontists of the evidence base surrounding this approach to oral rehabilitation.
Article
The aim of this study was to analyze the long-term survival of implants and implant-retained prostheses in patients after ablative surgery of oral cancer with or without adjunctive radiation therapy. Between 1997 and 2008, 66 patients who had undergone ablative tumor surgery in the oral cavity were treated with dental implants (n = 262). Thirty-four patients received radiation therapy in daily fractions of 2 Gy administered on 18 to 30 days. Implants were inserted in the maxilla (49; 18.7%) or mandible (213; 81.3%), in non-irradiated residual (65; 24.8%) or grafted bone (44; 16.8%) and in irradiated residual (15.6%) or grafted bone (39; 14.9%). Seventeen fixed protheses and 53 removable dentures (34 bar attachments, 9 telescopic and 10 ball retained dentures) were inserted. Mean follow-up after implant insertion was 47.99 (±34.31) months (range 12-140 months). The overall 1-, 5-, and 10-year survival rates of all implants were 96.6%, 96.6%, and 86.9%, respectively. Fourteen implants were lost in nine patients (5.3% of all implants); eight implants were primary losses, and five secondary losses because of an operation of tumor recurrence. There was no significantly lower implant survival for implants inserted into irradiated bone (p = .302), bone and/or soft-tissue grafts (p = .436), and maxilla or mandible (p = .563). All prosthetic restorations in patients without tumor recurrence could be maintained during the observation period. Implant survival is not significantly influenced by radiation therapy, grafts (bone and/or soft tissue), or location (maxilla or mandible). However, implants placed in irradiated bone exhibit a higher failure rate during the healing period than those placed in non-irradiated bone. No superstructure was particularly favorable. Osseointegrated implants can be used successfully in patients with prior history of ablative surgery with and without additional radiation therapy.
Article
The theories of the effects of radiation therapy on craniofacial and dental implants have been challenged by new models. Animal and clinical studies differ on the importance of dose effect and implant location regarding implant survival. Our purpose was to explore the risks of irradiation regarding dose levels, timing of radiation, implant location, and material. A systematic search of the literature was performed to identify studies reporting animal and human data on the success of implants in irradiated versus nonirradiated bone. Eleven animal studies exploring histomorphometric, biomechanical, and histologic features of implants in irradiated bone were summarized. Sixteen human clinical studies evaluating craniofacial (n = 8) and dental (n = 8) implants in irradiated bone were summarized. No meta-analyses of dental implants in irradiated bone were found. Efficacy studies comparing different implant types in irradiated bone were not found. Studies from both animal subjects and human patients indicate that irradiated bone has a greater risk of implant failure than nonirradiated bone. This increase in risk may be up to 12 times greater; however, studies making these comparisons are of poor to moderate quality, so the magnitude of this difference should be accepted with caution.
Article
Endosseous implants have been placed at the Mayo Clinic Department of Dental Specialties for over 12 years. On the basis of the clinical success of the osseointegration program, the use of implants has been expanded to include placement into tissue beds that have been exposed to therapeutic radiation. This article details preliminary data regarding implant survival in the previously radiated tissue beds. Presurgical evaluation and surgical technique are described and postprosthetic reconstruction complications are also related. Consideration is given to the relatively small number of patients in this review. It is suggested that the results should be shared among multiple institutions to create a meaningful data bank.
Article
A survey was undertaken to analyze implants placed in irradiated tissues. It was found that nine centers had placed 118 implants in 24 patients in Japan. Of 118 implants, 39 were in the maxilla, 71 were in the mandible, and 8 were in the orbital region. Seven patients underwent adjunctive hyperbaric oxygen treatment. The treatment decreased implant loss only in the maxilla. (The success rate without hyperbaric oxygen treatment was 62.5%, and that with hyperbaric oxygen treatment was 80.0% for the maxilla.) Implants 7 and 10 mm in length were at a greater risk of being lost than longer implants in the maxilla.
Article
The success rates of osseointegrated implants used to restore patients who were irradiated for head and neck tumors are influenced by radiation-induced changes in the hard and soft tissues. This article examined, by review of the literature, current perspectives on the restoration of irradiated patients using osseointegrated implants. In published reports that investigated both intraoral and extraoral applications, irradiation decreased implant success rates and the amount of reduction was dependent on the location within the craniofacial skeleton. The limited number of implants and patients in these studies precludes definitive conclusions regarding the efficacy of placing implants into irradiated tissues. The implants placed into the irradiated anterior mandible have demonstrated an acceptable implant success rate of 94% to 100% with a minimal risk of osteoradionecrosis. The efficacy of implants in the posterior mandible has not been examined. Implant success rates ranged from 69% to 95% in the irradiated maxilla for intraoral applications. Extraoral applications demonstrated excellent implant success rates in the temporal bone (91% to 100%). The rates in the anterior nasal floor have varied from 50% to 100%. The implant success rates in the frontal bone decreased as the length of the studies increased (96% to 33%). The long-term efficacy of implants in the irradiated frontal bone is poor.
Article
The aim of this study was to evaluate the risks and complications of rehabilitation with dental implants after tumour surgery and radiotherapy. After a disease-free survival of 18 months, 29 patients who had undergone oral cancer treatment were rehabilitated with dental implants. The complication rate of implants in irradiated, non-irradiated and grafted bone was analyzed at least 3 years after implant placement. In the healing period, 28.6% of the implants in irradiated bone and 8.4% in non-irradiated bone showed soft tissue complications. Of the implants, 26.7% in the irradiated and 14.7% in the non-irradiated mandibular bone were lost in the first 36 months after placement. Thirty-one point two percent of implants inserted in non-irradiated bone grafts were affected and did not osseointegrate. Of 109 inserted implants, 70 were suitable for prosthetic rehabilitation. There are high complication rates after implant placement in oral cancer patients. Irradiation adversely affects soft tissue healing. Osseointegration is frequently disturbed, especially when implants were placed in non-vascularized bone grafts.
Article
The current investigation was undertaken to study whether osseointegration of implants in irradiated tissues is subject to a higher failure rate than in nonirradiated tissues. It further aimed to study whether hyperbaric oxygen treatment (HBO) can be used to reduce implant failure. Seventy-eight cancer patients who were rehabilitated using osseointegrated implants between 1981 and 1997 were investigated. Three groups of patients were compared: irradiated (A), nonirradiated (B), and irradiated and HBO-treated (C). In addition, 10 irradiated patients who had lost most of their implants received new ones after HBO treatment. These were compared as a case-control group. Implant failures were highest in group A (53.7%). Implant failure was 13.5% in group B and 8.1% in group C. The difference between group A and the other two groups was statistically significant (P = .001 to .0023, Mantell's test). HBO significantly improved implant survival in the case-control group from 34 of 43 implants lost to 5 of 42 lost (P = .0078). Implant insertion in irradiated bone is associated with a higher failure rate. Adjuvant HBO treatment can reduce the failures.
Article
In the period between 1990 and 1996, 279 endosteal dental Bone-Lock implants were placed in 79 patients. Of them 63 have been treated with ablative tumor and reconstructive surgery in the oral cavity, the rest presented with maxillo-mandibular defects of different origin. The circumstances of implant loss were noted down for descriptive analysis concerning age, sex, topography, implant dimensions, loading, time in place and type of superstructure. Failure analysis was done concerning the implants and the patients. Five causes for implant loss could be detected: lacking primary osseointegration, acute inflammation, bone loss, biomechanical overloading and tumor recurrence. No predictive factors for implant loss and no age influence on implant loss could be detected, no specific local implant site and no specific superstructure had an identifiable higher risk. Survival rate of all placed implants in oral tumor and defect patients was 83.5% after 6 years observation. Male tumor patients were found to have a higher risk to lose implants than females. Free iliac bone grafts impaired osseointegration of implants. The mandible offered a better prognosis for the implants than the maxilla. Shorter and thinner implants had a higher risk of being lost. A quarter of all patients (26.3%) had to face implant loss. Clustering of implant loss in several patients was caused by free iliac bone grafting and by prosthetic faults. Chemotherapy had no negative influence on implant survival. Most implants were lost early (76%) before fabrication of the prosthesis. After restoration there was a nearly 100% probability of function. It is concluded that implant treatment can be equally effective for tumor and defect patients as it is known for healthy subjects.
Article
In this prospective study, we determined the effects of the time interval between irradiation and implant therapy, implant location, bone-resection surgery, and irradiation dose on implant survival. We analyzed the survival of 446 implants inserted after radiotherapy over a period of up to 14 years in 130 consecutive patients treated for oral cancer. The 10-year overall Kaplan-Meier implant survival percentage is 78%. The difference in survival percentages of implants inserted < 1 year and >/= 1 year after irradiation (76% and 81%, respectively) is not significant. We concluded that implant survival is significantly influenced by the location (maxilla or mandible, 59% and 85%, respectively; p = 0.001), by the incidence of bone-resection surgery in the jaw where the implant was installed (p = 0.04), and by the irradiation dose at the implant site (< 50 Gray or >/= 50 Gray, p = 0.05).
Article
Surgical treatment of malignancies in the oral cavity (tongue, floor of the mouth, alveolus, buccal sulcus, oropharynx) often results in an unfavourable anatomic situation for prosthodontic rehabilitation. The outcome is a severe disturbance of oral functioning despite the improved surgical techniques for reconstruction that are currently available. Radiotherapy, which often is applied postsurgically, worsens oral functioning in many cases. Main problems that may hamper proper prosthodontic rehabilitation of these patients include a severe reduction of the neutral zone, an impaired function of the tongue, and a very poor load-bearing capacity of the remaining soft tissues and mandibular bone. Many of these problems can, at least in part, be diminished by the use of endosseous oral implants. These implants can contribute to the stabilisation of the prostheses and intercept the main part of the occlusal loading. Surgical interventions after radiotherapy are preferably avoided because of compromised healing, which may lead to development of radionecrosis of soft tissues and bone as well as to increased implant loss. If surgical treatment after radiotherapy is indicated, measures to prevent implant loss and development of radionecrosis have to be considered e.g. antibiotic prophylaxis and/or pre-treatment with hyperbaric oxygen (HBO). To avoid this problem, implant insertion during ablative surgery has to be taken into consideration if postoperative radiotherapy is scheduled or possibly will be applied. This approach is in need of a thorough pre-surgical examination and multidisciplinary consultation for a well-established treatment planning. The primary curative intent of the oncological treatment and the prognosis for later prosthodontic rehabilitation have to be taken into account too.
Article
This study retrospectively evaluated implant survival of 631 osseointegrated implants installed in irradiated cancer patients over a 25-year period. The files of 107 patients followed since 1979 were evaluated. Factors influencing implant survival as oncologic treatment, radiotherapy protocols, patient and implant related elements were analyzed. Compared with a control group of non-irradiated patients, implant failures were higher after previous radiotherapy. High implant failures were seen after high dose radiotherapy and a long time after irradiation. All craniofacial regions were affected, but the highest implant failures were seen in frontal bone, zygoma, mandible, and nasal maxilla. Lowest implant failures were seen in oral maxilla. The use of long fixtures, fixed retention, and adjuvant hyperbaric oxygen therapy decreased implant failures. Noncontributing factors to implant survival were gender, age, smoking habits, tumor type and size, surgical oncologic treatment, and osseointegration (OI) surgery experience. Survival after cancer therapy is so high, and outcome from OI therapy so favorable that OI in the irradiated patient can be recommended. However, the OI clinician should be aware of the risks and pitfalls of treating such patients.
Article
The aim of this study was to analyze long-term implant survival in the mandible after radiotherapy and radical surgery in oral cancer patients. Between 1990 and 2003, 71 patients (15 females, 56 males; average age 57.8 years, range 16-84.1 years) were treated with dental implants after radiochemotherapy and ablative surgery of oral cancer. Radiation therapy was delivered in daily fractions of 2 Gy given on 25 days (total dose of 50 Gy). Oral defects were reconstructed microsurgically with jejunal, iliac crest or radial forearm grafts. Thereafter 316 dental implants were placed in the non-irradiated residual bone (84; 27%), irradiated residual bone (154; 49%) or grafted bone (78; 25%) at various intervals (mean interval 1.41 (+/- 1.01) years, range 0.34-6.35 years). The mean follow-up time after implant insertion was 5.42 (+/- 3.21) years (range 0.3-13.61 years). The overall 2-, 3-, 5-, and 8-year survival rates of all implants were 95%, 94%, 91% and 75%. Forty-four implants were lost in 21 patients during the observation period. Irradiation of the mandibular bone showed significantly (P = 0.0028) lower implant survival compared with non-irradiated mandibular bone. The 8-year survival rate in the non-irradiated residual bone (two loss), irradiated residual bone (29 loss) or grafted bone (13 loss) were 95%, 72% and 54%, respectively. Time of implantation after irradiation showed no statistically significant influence. Implant brand, length or diameter or the incidence of resective surgery on the mandible and gender of patients had no statistically significant influence on implant survival. Radiation therapy with 50 Gy was significantly related to shorter implant survival in mandibular bone. Survival was lowest in grafted bone. Time of implant placement had no statistically significant influence on survival under the conditions of this study. Although implant survival is lower in irradiated mandibles, implants significantly facilitate prosthodontic treatment and enhance outcome of oral rehabilitation in cancer patients.
Article
The purpose of this retrospective study was to evaluate the survival of dental implants placed during ablative surgery in the interforaminal region of the original edentulous mandible in patients with squamous cell carcinoma of the oral cavity in relation to postoperative radiotherapy. Forty-eight patients treated in 1996-2003 with surgery alone or in combination with postoperative radiotherapy were analysed. In all patients, 2 to 4 Brånemark Mk II/III 2-phase implants were placed during tumour resection. A total of 139 implants were placed of which 61 (21 patients) received postoperative radiotherapy: 60-68 Gy as a boost dose on the primary tumour site and 10-68 Gy on the symphyseal area. No difference was found in percentage of functional dentures on implants between the radiated and non-radiated groups. The success rate of osseointegration was 97% in the postoperative irradiated group and 100% in the non-irradiated group. The prosthetic success rate (75%) was lower because in 12 of the 48 patients (34 implants) a functional denture could not be fitted due to tumour recurrence or metastasis (7 patients, 22 implants) or for psychological reasons (4 patients, 12 implants), independent of whether radiotherapy was administered. Postoperative radiotherapy does not affect the osseointegration of dental implants placed during tumour ablation and the ultimate number of functional dentures. Primary implant placement in edentulous mandibles may have advantages over secondary implant placement in patients with oral squamous cell carcinoma.
Article
Osteoradionecrosis (ORN) is a severe and devastating late complication of radiotherapy in patients with head and neck cancer. Management of ORN remains controversial and the current approach has been focused on debridement, systemic antibiotics, and eventually hyperbaric oxygen therapy for small and limited ORN. However, this conservative approach is ineffective in controlling extensive bone and soft-tissue necrosis. Microvascular composite flaps have been used in a variety of head and neck ablative surgeries but its use for the management of ORN has not been fully explored. From 1999 to 2002, 5 patients with refractory ORN of the mandible underwent radical resection and reconstruction with immediate microvascular-free fibular composite flap. All patients had been treated initially with conservative procedures and hyperbaric oxygen therapy. All patients had initially successful vascularized reconstruction by clinical examination with minimal postoperative morbidity. One patient had complete flap loss at 20 days due to orocutaneous fistula and infection. Radical resection followed by microvascular composite flap reconstruction is a reliable procedure in the management of patients with extensive ORN of the mandible.