Implant survival rate after oral cancer therapy: A review

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DOI: 10.1016/j.oraloncology.2010.10.004 · Source: PubMed
Abstract
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.

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Review
Implant survival rate after oral cancer therapy: A review
Fawad Javed
a,
, Khalid Al-Hezaimi
a,b
, Abdulaziz Al-Rasheed
a,b
, Khalid Almas
c
, George E. Romanos
d
a
Eng. A.B. Growth Factors and Bone Regeneration Research Chair, King Saud University, Riyadh, Saudi Arabia
b
Department of Periodontics & Community Dentistry, College of Dentistry, King Saud University, Riyadh, Saudi Arabia
c
Division of Periodontology, School of Dental Medicine, University of Connecticut, Farmington, CT, USA
d
Eastman Institute for Oral Health, Division of Periodontology, University of Rochester, Rochester, NY, USA
article info
Article history:
Received 24 September 2010
Received in revised form 9 October 2010
Accepted 11 October 2010
Available online 4 November 2010
Keywords:
Cancer
Chemotherapy
Dental implant
Oral
Osseointegration
Radiotherapy
Surgery
Treatment
summary
The overall impression regarding the success of dental implants (DI) in patients having undergone oral can-
cer 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) interven-
tion: 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 under-
gone chemotherapy. It is concluded that DI can osseointegrate and remain functionally stable in patients
having undergone oral cancer treatment.
Crown Copyright Ó 2010 Published by Elsevier Ltd. All rights reserved.
Introduction
Several studies
1–5
have reported high osseointegration rates of
dental implants (DI) in patients undergoing therapy for systemic
disorders (such as diabetes mellitus, Pagets’ disease and breast
cancer); however, the overall impression regarding the success of
DI in patients having undergone oral cancer therapy remains
unclear.
Surgical excision of oral malignancies is often followed by either
radiotherapy or chemotherapy or both. According to Granstrom
et al.
6
irradiated sites are more susceptible to tissue necrosis and
consequent loss of implants compared to non-irradiated sites. A re-
duced salivary flow rate irradiated patients may cause complica-
tions such as dental caries (in patients with remaining natural
teeth), periodontal disease and oral fungal infections.
7–10
Cao and
Weischer
9
investigated the prognosis of 131 DI in 27 patients hav-
ing undergone radiotherapy for the management of oral carcinoma.
After approximately 2 years of follow-up, the results showed a sig-
nificantly lower implant survival rate (ISR) in irradiated- compared
to non-irradiated patients.
9
In another study,
11
one patient lost
three of the nine DI inserted following protracted chemotherapy.
In the Schoen study,
12
prognosis of implant-retained prosthesis
was shown to be superior in non-irradiated patients compared to
patients having undergone radiotherapy following oral cancer sur-
gery. Thus, the appropriateness of using DI in irradiated patients
may be questioned. On the contrary, some studies
13–17
have
reported that DI installed in patients having undergone oral cancer
therapy, can osseointegrate and remain functionally stable over
long durations. In a study by Cuesta-Gil et al.
14
the 9-year follow-
up results showed a high ISR (92.9%) of DI in irradiated patients.
Similar results were reported by Taira et al.
17
Since controversy persists over the osseointegration and func-
tional stability of DI in patients having undergone oral cancer
treatment; the aim of the present study was to assess the ISR after
oral cancer therapy.
Materials and methods
Focused question
The addressed focused question was: ‘‘Can DI osseointegrate
and remain functionally stable in patients having undergone oral
cancer treatment?”
Eligibility criteria
The eligibility criteria were: (1) original research articles; (2)
clinical studies; (3) reference list of pertinent original and review
1368-8375/$ - see front matter Crown Copyright Ó 2010 Published by Elsevier Ltd. All rights reserved.
doi:10.1016/j.oraloncology.2010.10.004
Corresponding author. Tel.: +966 54 1251 074.
E-mail address: fawjav@gmail.com (F. Javed).
Oral Oncology 46 (2010) 854–859
Contents lists available at ScienceDirect
Oral Oncology
journal homepage: www.elsevier.com/locate/oraloncology
Author's personal copy
studies; (4) intervention: patients having undergone radio- and
chemotherapy following oral cancer surgery; and (5) articles pub-
lished only in English.
Historic reviews, letters to the editor and unpublished articles
were excluded.
Search strategy
The authors searched the MEDLINE/PubMed databases of the
National Library of Medicine, Bethesda, Maryland, for appropriate
articles addressing the focused question. Titles and abstracts of
articles that satisfied the eligibility criteria were screened by the
authors and checked for agreement. Databases were explored from
1986 up to and including September 2010 using the following key-
words in various combinations: ‘‘cancer”, ‘‘chemotherapy”, ‘‘dental
implant”, ‘‘oral”, ‘‘osseointegration”, ‘‘radiotherapy”, ‘‘surgery” and
‘‘treatment”.
Hand-searching was also performed. The initial search yielded
31 studies. Ten studies, which did not satisfy the eligibility criteria,
were excluded (see Further readings). In total, 21 studies
9,12–31
were included and processed for data extraction (Table 1).
Results
Characteristics of included studies
All studies
9,12–31
were performed in humans and were either
carried out at universities or healthcare centers. The numbers of
participants ranged between one subject to 130 individuals. The
participants were aged between 13 and 81 years. In 19 stud-
ies,
9,12–29
the patients had undergone radiotherapy prior to im-
plant installation whereas in two studies
30,31
the patients had
undergone chemotherapy before DI treatment. The radiation dos-
ages ranged between 20 and 116 grays (Gy). The intermission be-
tween the cessation of radio- or chemotherapy (following surgery)
and the installation of DI ranged between at least 2 months and
14 years. The number of DI installed in the study participants ran-
ged from 2 to 446. The follow-up duration ranged between
6 months and 10 years following the installation of DI.
Sixteen studies
12–17,19,21–29
reported that DI can osseointegrate
and remain functionally stable in patients having undergone radio-
therapy. The osseointegration success rates reported by these stud-
ies
12–17,19,21–29
ranged between 68% and 100%.
9,12–15,17–27
Three
studies
9,18,20
cautioned that irradiation has negative effects on
the survival of DI. Two studies
30,31
reported that chemotherapy
does not have detrimental effects on the osseointegration and
functional stability of DI. The osseointegration success rates re-
ported by these studies
30,31
were 99.1% and 97.6%, respectively.
In 20 studies
9,12–17,19–31
implants were inserted in the mandi-
ble; however, in one study,
18
DI were inserted in the maxilla
(n = 108) and mandible (n = 338). Adjunct hyperbaric oxygen
(HBO) therapy preceding DI installation was performed in four
studies.
15,17,22,23
Discussion
Over the past years, the use of DI in oral cancer patients having
undergone surgery and adjunct cancer therapy (radiotherapy and/
or chemotherapy) has increased.
14–24
It may be hypothesized that jaw location may also contribute to
the success and failure of implant treatment. From the literature
reviewed, it seems that the survival and functionally stability of
DI is higher in the mandible as compared to the maxilla; however,
it should be noted that in all the included studies,
9,12–31
DI were
inserted exclusively in the mandible; with the exception of the
studies by Visch et al.
18
and Niimi et al.
23
where DI were installed
in the mandible and maxilla. Results by Visch et al.
18
showed the
ISR to be slightly higher in the posterior- as compared to the ante-
rior maxilla; however the difference was not statistically signifi-
cant. In the Niimi study,
23
the number of DI inserted in the
maxilla were too low to depict any definite conclusions; yet, it
may be speculated that poor bone quality of the maxilla (which
was not assessed in this study
23
) could be associated with the poor
ISR. Due to a scarcity of indexed literature on this regard, we found
it exigent to discuss the role of jaw location on the survival of DI in
patients having undergone oral cancer therapy.
Osteoradionecrosis is usually observed several years following
radiotherapy and is associated with local trauma within the hypo-
vascular–hypocellular hypoxic tissues (which occurs as a result of
radiation-induced endarteritris).
32,33
Thus, the interval between
the end of oral cancer therapy and installation of DI may contribute
to the success or failure of osseointegration. Various studies
9,12,15–22
have investigated the required time interval between radiotherapy
and implant installation that may influence osseointegration; how-
ever the results remain debatable. Marx and Johnson
32
reported
that the risk of oral complications (particularly osteoradionecrosis)
and the probability of implant failure is higher in cases where DI are
inserted between one and 6 months following radiotherapy. Similar
results were reported by another study
9
where DI, installed
6 months following irradiation demonstrated significantly lower
ISR. However, the Visch study
18
reported no significant differences
in the survival of DI inserted less than 12 months (76%) or at least
one year (81%) after radiotherapy. In the Werkmeister study
20
osseointegration was reported to be negatively influenced in DI in-
stalled 2 years following end of radiation therapy; however, the ISR
in non-irradiated bone was also reported to be low (approximately
68%).
20
It is known alcohol consumption, smoking, poor oral hy-
giene and systemic conditions (such as poorly-controlled diabetes)
are significant risk-factors of periodontal inflammation.
2,5,10
It may
therefore be argued that such factors may contribute in altering the
ISR in patients having undergone oral cancer therapy. Although
smokers were excluded in the Werkmeister study,
20
however, it re-
mained unclear whether or not the study population was screened
for other risk-factors as mentioned above. This may be an explana-
tion for the lower osseointegration rate among non-irradiated pa-
tients in this study.
20
It is intricate to reach a definitive conclusion regarding the
influence of interval on the survival of DI in patients having under-
gone chemotherapy. Likewise, we did not observe any consistency
in the follow-up durations after installation of DI in these patients.
For example, in the studies by Taira et al.
17
and Keller et al.
26
, the
follow-ups were performed a decade after Di installation. These
follow-up durations seem to be reliable with respect to the stabil-
ity and function of DI following oral cancer therapy. On the other
hand, Oechslin et al.
21
and August et al.
22
reported 100% ISR follow-
ing oral cancer treatment; however it should be noted that in these
studies
21,22
the follow-up examinations were performed after rela-
tively shorter durations (6- and 16.4 months, respectively). Should
the same ISR be expected in these studies
21,22
after longer dura-
tions (for example after 10 years) is debatable. Further prospective
studies with long-term follow-up are needed to elucidate the ef-
fects of radiotherapy on the survival and stability of DI. From the
two studies
30,31
where the patients had undergone chemotherapy,
it seems that DI can successfully osseointegrate and remain func-
tionally stable when inserted at least 6 months after therapy. Also,
in these studies, the follow-up examinations were performed after
at least 5 years of DI installation. Therefore it may be suggested
that DI may remain functionally stable after chemotherapy. Since
only a limited number of studies
30,31
have investigated the impact
of chemotherapy on stability and function of DI in oral cancer pa-
tients, further studies are warranted in this regard.
F. Javed et al. / Oral Oncology 46 (2010) 854–859
855
Author's personal copy
Table 1
Author/s, aim, subjects, mean radiation dosage, interval, implants inserted, follow-up osseointegration success rate and conclusions of included studies.
Author/s
et al. Year
Aim Subject/s
(mean
age/range
in years)
Mean
radiation
dosage in Gy
a
(range)
Interval
b
Dental
implants
inserted
(n)
Follow-up Osseointegration
success rate
Conclusion
Korfage et al.
13
To assess the outcome of
DI
e
therapy in irradiated
oral cancer patients
50 (61.5/
41–81)
>40 (12–70) 195 5 years 89.4% Dental implants can
osseointegrate and remain
functionally stable in oral
cancer patients having
undergone surgery and
radiotherapy
Cuesta-Gil et al.
14
To assess the outcome of
DI
e
therapy in oncologic
patients
111 (52/
13–79)
NA
c
(50–60) At least
12 months
(in 34 cases)
706 9 years 92.9% Dental implants can
osseointegrate and remain
functionally stable in patients
having undergone surgery and
radiotherapy for oncologic
disorders
Schoen et al.
12
To assess the outcome of
DI
e
therapy in irradiated
and non-irradiated oral
cancer patients
50 (61.5/
41–81)
60.1 (30–70) NA
c
4 implants
per patient
At least
18 months
97% DI
e
retained prosthesis can
osseointegrate and remain
functionally stable in patients
having undergone therapy for
OSCC
d
. This effect is more
enhanced in non-irradiated
compared to irradiated patients
Schoen et al.
15
To assess the effect of
oral cancer therapy on
the osseointegration of
dental implants
26 (60.1/
47–77)
61.4 (46–116) At least
1 year
103 3 years 93.9% Dental implants can
osseointegrate and remain
functionally stable in patients
having undergone therapy for
OSCC
d
Schepers et al.
16
To evaluate the survival
of dental implants in
patients with OSCC
d
48 (64.8/
54–75)
NA
c
(60–68) 9 months 139 9 months 97% Dental implants can
osseointegrate and remain
functionally stable in patients
having undergone radiotherapy
for the treatment of OSCC
d
Taira et al.
17
To evaluate the outcome
of an implant-supported
after radiotherapy and
hemiglossectomy in a
patient with carcinoma
of tongue
1 (52-
year-old
male)
40 13 years 4 10 years NA
d
The implants remained
aesthetically and functionally
successful for up to at least
10 years
Cao and
Weischer
9
To investigate the
prognosis of DI
e
supported prosthesis in
irradiated and non-
irradiated patients
27 (NA
c
/
45–79)
NA
c
(36–76) 6 months 131 At least
2 years
88% DI
e
supported prosthesis have
significantly lower survival
rates in irradiated patients
compared to non-irradiated
patients
Visch et al.
18
To assess the success of
dental implant therapy
in patients having
undergone oral cancer
surgery and
radiotherapy
130 (62/
34–87)
NA
c
(0 to
>than 72)
At least
6 months
446 14 years 78% Implant survival is significantly
influenced by location, extent of
surgery and by the irradiation
dose at the implant site
Weischer and
Mohr
19
To assess the 10-year
experience in oral
implant rehabilitation of
irradiated and non-
irradiated cancer
patients
40 (55/
43–75)
50 (36–72) 13 months 175 10 years 91% Irradiated patients should be
restored with exclusively
implant-supported prostheses,
without any mucosal contact
Werkmeister
et al.
20
To evaluate the risks and
complications of
rehabilitation with
dental implants after
tumor surgery and
radiotherapy
29 (55/
35–79)
54 (42–64) At least
24 months
109 3 years 68.8% (in non-
irradiated bone)
Osseointegration is disturbed
after implant placement in oral
cancer patients. Irradiation
adversely affects soft tissue
healing
Oechslin et al.
21
To assess the prognosis
of a DI
e
supported
prosthesis in a patient
having undergone oral
cancer therapy
162-year-
old male
72 15 months 2 6 months 100% Dental implants can
osseointegrate and the
supported prosthesis can
remain functionally stable in
patients having undergone oral
cancer therapy
August et al.
22
To assess the prognosis
of a DI
e
supported
prosthesis in a patient
having undergone oral
cancer therapy
18(64/
46–81)
65.4 (54–75) 44.5 months 18 16.4 months 100% Dental implants can
osseointegrate and the
supported prosthesis can
remain functionally stable in
patients having undergone oral
cancer therapy
856 F. Javed et al. / Oral Oncology 46 (2010) 854–859
Author's personal copy
Radiation dosage has been reported to influence osseointegra-
tion
6
; however, there seems no consensus regarding the radiation
dosages to which oral cancer patients should be exposed in order
to achieve high ISR. Studies
34,35
have reported that radiation dos-
ages exceeding 40–50 Gy may impair bone healing that may in
turn jeopardize implant osseointegration. From the literature re-
viewed, we observed that DI showed up to 100% osseointegration
when exposed to radiation dosages up to 65 Gy (Fig. 1). It may
be presumed that radiation dosages between 50 and 65 Gy do
not negatively influence osseointegration; however irradiated pa-
tients should always be consented for the complications that
may arise following implant surgery.
Some studies
27,36,37
have recommended that HBO therapy
should precede implant surgery particularly following radiation
doses of more than 50 Gy. HBO therapy has been reported to pro-
voke capillary angiogenesis and bone formation by causing an in-
creased oxygen tension in the irradiated ischemic bone
27
;
however, the role of adjunct HBO therapy prior to implant treat-
ment remains debatable. In the study by Cao and Weischer
9
adjunct
HBO therapy was not performed and the results showed a poorer ISR
Table 1 (continued)
Author/s
et al. Year
Aim Subject/s
(mean
age/range
in years)
Mean
radiation
dosage in Gy
a
(range)
Interval
b
Dental
implants
inserted
(n)
Follow-up Osseointegration
success rate
Conclusion
Niimi et al.
23
To assess the prognosis
of DI
e
placed in
irradiated tissues from
the data of centers in
Japan and the United
States
22
patients
from each
center
(NA
c
/NA
c
)
NA
c
(<25–>66) NA
c
228 Up to
2 years
88.9% (Japan
center) 86%
(United States
center)
Dental implants can
osseointegrate and remain
functionally stable in patients
having undergone therapy for
oral malignancy
McGhee et al.
24
To establish the validity
of using osseointegrated
implants for dental
restoration in patients
with head and neck
cancer
6 (NA
c
/
NA
c
)
At least 50
(NA
c
)
At least
2 months
26 12 months 92% Dental implants can
osseointegrate and remain
functionally stable in patients
having undergone oral cancer
therapy
Marker et al.
25
To investigate whether
or not dental implants
can osseointegrate in
patients having
undergone oral cancer
therapy
12 (71/
42–81)
50 (40–66) Approx.
2 years
38 Up to
3.9 years
100% Dental implants can
osseointegrate and remain
functionally stable in patients
having undergone oral cancer
therapy
Keller et al.
26
To investigate the
prognosis of dental
implant treatment in
patients having
undergone oral cancer
surgery and
radiotherapy
19 (57/
24–84)
60 (50–66) Approx.
4 years
98 10 years 99% Dental implants can
osseointegrate and the
supported prosthesis can
remain functionally stable in
patients having undergone
radiotherapy
Taylor and
Worthington
27
To assess the prognosis
of DI
e
supported
prosthesis in patients
having undergone oral
cancer therapy
61-year-
old male
60 7 years 6 7 years 100% Dental implants can
osseointegrate and can remain
functionally stable in patients
having undergone radiotherapy
59-year-
old female
65 2 years 4 6 months 100%
49-year-
old female
59.5 6 months 5 Approx.
3.6 years
100%
59-year-
old female
64.8 2.6 years 6 Approx.
3 years
100%
Vassos
28
To assess the prognosis
of DI
e
supported
prosthesis in patients
having undergone oral
cancer therapy
56-year-
old male
20 6 years 5 2 years 100% Dental implants can
osseointegrate and can remain
functionally stable in patients
having undergone radiotherapy
Misch et al.
29
To assess the prognosis
of DI
e
supported
prosthesis in a patient
having undergone oral
cancer therapy
56-year-
old male
60 NA
c
7NA
c
100% Dental implants can
osseointegrate and remain
functionally stable in patients
having undergone radiotherapy
Kovács
30
To investigate the effect
of chemotherapy on the
survival and success of
dental implants in oral
cancer patients
30 (55/
NA
c
)
10.5 months 106 10 years 99.1% Chemotherapy did not have
detrimental effects on the
survival and success of dental
implants in oral cancer patients
Kovács
31
To investigate the fate of
osseointegrated
implants in patients
following oral cancer
surgery and
chemotherapy
45 (53.5 in
males/
range: NA
c
49.1 in
females/
range:
NA
c
)
At least
6 months
162 6 years 97.6% Dental implants can
osseointegrate and remain
functionally stable in patients
having undergone surgery and
chemotherapy
a
Gray (Unit: Joules/kilogram).
b
Interval between conclusion of radiotherapy and dental implant installation.
c
Not available.
d
Oral squamous cell carcinoma.
e
DI: dental implant.
F. Javed et al. / Oral Oncology 46 (2010) 854–859
857
Author's personal copy
in irradiated compared to non-irradiated patients. Should this
poorer ISR be attributed to the absence of HBO therapy in this study
9
remains dubious as other studies
21,23–26
have reported successful
osseointegration and function of DI in the absence of adjunct HBO
therapy. The Visch study
18
showed an inadequate ISR of DI (59%) in-
serted in irradiated maxilla which was previously treated with HBO.
In the study by Niimi et al.
23
169 mandibular implants and 59 max-
illary implants were evaluated. For the mandible, the ISR was rela-
tively high even when HBO had not been used. Results from this
study
23
suggested that DI can be placed in the irradiated mandibles
in the absence of adjunct HBO therapy.
Conclusion
DI can osseointegrate and remain functionally stable in patients
having undergone oral cancer therapy; however, such patients
should be informed and consented in advance regarding complica-
tions associated with implant treatment following irradiation.
Conflicts of interest statement
None declared.
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    • "De therapie wordt als veelbelovend beschouwd, maar de kennis over de invloed van hyperbare zuurstoftherapie op wondgenezing is (nog) onvolledig en men kan er nog geen erg betrouwbare conclusies aan verbinden (Ihde et al. 2009). Er worden ook goede resultaten op het terrein van osseo-integratie gerapporteerd zonder hyperbare zuurstoftherapie (Javed et al. 2010). Volgens The European Committee for Hyperbaric Medicine is het gebruik van hyperbare zuurstoftherapie in geval van osteoradionecrose 'sterk aanbevolen', het gebruik ervan bij chirurgie of implantatie in bestraalde weefsels is 'aanbevolen~ Het veelvuldig klinisch gebruik van hyperbare zuurstoftherapie blijft echter opmerkelijk, gezien de tegenstrijdige meningen rond de werkzaamheid en toegevoegde waarde ervan. "
    [Show abstract] [Hide abstract] ABSTRACT: Patiënten die bestraald werden in het hoofd-halsgebied, hebben vaak baat bij dentale implantaten. Implantaten die geplaatst worden in bestraalde kaken lopen echter een groter risico dat ze verloren gaan dan in niet-bestraalde kaken. Bot dat bestraald wordt, ondergaat veranderingen die in de kaken van invloed kunnen zijn op de osseo-integratie van implantaten. Naast deze veranderingen, kunnen andere factoren leiden tot meer implantaatverlies in bestraalde kaken. Enkele factoren die hierbij een rol zouden kunnen spelen zijn de bestralingsdosis en -zone, de tijd tussen bestraling en implantatie, de locatie waar de implantaten worden geplaatst en hyperbare zuurstoftherapie. In de literatuur bestaat echter over al deze factoren nog veel discussie, evenals over het succespercentage van implantaten in bestraalde kaken. Voor de algemeen practicus is het voornamelijk van belang deze patiënten op de hoogte te brengen van de bestraling als compromitterende factor en de mogelijke risico’s die eraan verbonden zijn. Aanbevolen wordt de patiënt te verwijzen naar een gespecialiseerd medisch centrum, zoals de afdeling Mond- kaak- en aangezichtschirurgie van een ziekenhuis. Daar beschikt men over de nodige ervaring en kan men de mogelijkheid tot implantaatplaatsing en de risico’s die eraan verbonden kunnen zijn, het best beoordelen.
    Full-text · Chapter · Dec 2015 · BMC Oral Health
    • "Dans un secteur irradié, sans ostéoradionécrose, la pose d'implant est réalisable [43,44]. Le succès de la thérapeutique implantaire est lié à la dose reç ue par le site implanté, au délai de mise en charge après la radiothérapie et la localisation osseuse du site implanté (meilleur résultat pour la mandibule que le maxillaire [45]), mais le taux d'échec implantaire est deux à trois fois plus important pour un os irradié que pour un os non irradié [43,46] . Le taux de conservation à 5 ans des implants chez des patients irradiés est de 92,6 % [43]. "
    [Show abstract] [Hide abstract] ABSTRACT: In France, in 2005, there were approximately 16,000 new cases of head and neck cancer. These cancers have an unfavourable prognosis: the survival rates at 3 and 10 years are 50% and 10% respectively. The consumption of alcohol and tobacco is the most important risk factor; in some countries HPV infection was identified as a risk factor of head and neck tumours. Furthermore, a poor oral hygiene seems to raise this risk. We found many decay and periodontium problems in patients with an upper aerodigestive tract cancer. An evaluation of dental state is necessary before any cancer treatment. Treatments by radiotherapy engender noxious effects: hypocellular, hypovascularization, hypoxie of the irradiated tissues, which lead to immediate and chronically oral complications such as mucositis, fibrosis, xerostomia, decay, or osteoradionecrosis. An oral follow-up of these patients can prevent these complications, or reduce the severity of oral complications, and promote a good oral state.
    Full-text · Article · Apr 2015
    • "This is advantageous because initial implant healing (osseointegration) takes place before irradiation and there is a reduced risk of late complications , such as the development of osteoradionecrosis202122 . However, there is a risk of inappropriate implant positioning, which makes subsequent prosthodontic treatment more complex [13,18,19]. There is also a risk that early tumor recurrence will negate the benefits of the implant therapy [25]. "
    [Show abstract] [Hide abstract] ABSTRACT: 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.
    Full-text · Article · Jan 2015
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