Teeth Extractions in Subjects Undergoing Radiotherapy for Head and Neck Cancers: A Systematic Review on the Clinical Protocols for Preventing Osteoradionecrosis (ORN). Extractions after Radiotherapy (Part 2) (original) (raw)
Related papers
s u m m a r y Objectives: Osteoradionecrosis of the jaws (ORNJ) is painful for patients and relatively difficult to treat clinically. The high risk of ORNJ for post radiotherapy R/T dental extraction is known; however, many patients still have to have teeth extracted after head and neck R/T. The objective of the present study is to review post R/T dental extraction and determine the ORNJ risk. Materials and methods: We preformed a retrospective cohort study of 1759 patients with head and neck cancer s/p R/T from a random sample of 1,000,000 insurants in the National Health Insurance Research Database during 2000–2013 in Taiwan. Statistical methods included two-proportion Z-test. Results: We evaluated two cohorts: 522 patients with post R/T dental extraction and 1237 patients without post R/T extraction. Overall moderate-to-severe ORNJ after R/T was 2.22% (39/1759), and a total of 39 ORNJ cases were noted during an average of 3.02 years (range: 0.62–8.89 years, ±2.07). ORNJ prevalence in the overall post R/T extraction-exposed cohort (5.17%, 27/522) was significantly greater than that in the unexposed cohort (0.97%, 12/1237). In a group of patients with 65 post R/T dental extractions (n = 373), the ORNJ risk was 2.4% (ORNJ case n = 9); in a group of patients with >5 dental extractions (n = 149), the ORNJ risk was 12.1% (ORNJ case n = 18) (Z-score = 4.5062; p-value < 0.0001). In the extraction-exposed cohort, the ORNJ risk is higher if the index day to first extraction day was 60.5 year (n = 103) compared with the group with the index day to first extraction day >0.5 year (n = 419) (Z-score = À2.1506; p-value = 0.0315). Conclusion: A tooth extraction time less than half a year after R/T or during the head and neck R/T period, and extraction tooth number 65 would significant lower the ORNJ prevalence.
Oral Surgery Oral Medicine Oral Pathology Oral Radiology and Endodontology, 2008
Objective. This study evaluates the frequency of osteoradionecrosis associated with dental extractions. Study design. A total of 405 patients submitted to radiotherapy and had dental extractions were evaluated. The patients were divided into 3 groups. Results. In group 1, 316 patients were submitted to 1.647 dental extractions (mean 5.2 teeth per patient) and in another 47 patients the number of teeth removed was not clearly reported. Group 2 comprised 5 patients who had 33 teeth extracted (mean 6.6 each). In group 3, 55 patients had 290 teeth removed (mean 5.3 each) and in another 2 patients the number of dental extractions could not be established. In general, only 3 cases of osteoradionecrosis related to dental extractions were observed: 2 related to exodontias performed before and 1 after radiotherapy. Conclusions. The low prevalence of osteoradionecrosis found in this work suggests the possibility of performing exodontias after radiotherapy by experienced dentists in the management of head and neck cancer. (Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2008;105:e1-e6) Supported by Sao Paulo Research Foundation-FAPESP.
Oral Diseases, 2007
Management of irradiated patients with cancer in the head and neck region represents a challenge for multidisciplinary teams. Radiotherapy promotes cellular and vascular decrease that results in a low response rate in the healing. Consequently, surgical procedures in irradiated tissues present high rates of complication. Osteoradionecrosis (ORN) is the most severe sequelae caused by radiotherapy. It is associated with previous extractions especially those carried out post-irradiation. The management of this side effect is difficult and can result in bone or soft tissue loss, affecting the quality of life.The literature regarding dental extractions performed before and after head and neck radiotherapy was evaluated, focusing on indications, criteria, surgical techniques and adjunctive therapies such as antibiotics and hyperbaric oxygen.Osteoradionecrosis can be minimized by oral evaluation and care prior to irradiation and healing time which allows tissue repair until the commencement of radiotherapy. In dental extractions realized after irradiation, minimal trauma, alveolectomy, primary alveolar closure and adjunctive therapies are recommended.Patients must be evaluated before radiation therapy and at that time all unrestorable teeth and/or teeth with periodontal problems must be extracted to reduce the post-radiotherapy exodontias that contribute to ORN. Once dental extractions become unavoidable after irradiation, additional care is needed.
Dental extractions and radiotherapy in head and neck oncology: review of the literature
Oral diseases, 2008
Management of irradiated patients with cancer in the head and neck region represents a challenge for multidisciplinary teams. Radiotherapy promotes cellular and vascular decrease that results in a low response rate in the healing. Consequently, surgical procedures in irradiated tissues present high rates of complication. Osteoradionecrosis (ORN) is the most severe sequelae caused by radiotherapy. It is associated with previous extractions especially those carried out post-irradiation. The management of this side effect is difficult and can result in bone or soft tissue loss, affecting the quality of life. The literature regarding dental extractions performed before and after head and neck radiotherapy was evaluated, focusing on indications, criteria, surgical techniques and adjunctive therapies such as antibiotics and hyperbaric oxygen. Osteoradionecrosis can be minimized by oral evaluation and care prior to irradiation and healing time which allows tissue repair until the commencem...
Brazilian Dental Science
A osteorradionecrose (ORN) é uma das complicações bucais mais graves pós-tratamento de câncer de cabeça e pescoço, sendo a extração dentária, por meio de sua estimulação traumática, apontada como um importante fator predisponente. As indicações e métodos preventivos para a realização destes procedimentos em pacientes irradiados são questionados, se tornando fundamental o conhecimento de protocolos adequados. O presente artigo relata um caso de exodontias múltiplas em um paciente oncológico em fase terminal, cujas medidas preventivas foram realizadas, não ocorrendo desenvolvimento de complicações. Por meio de revisão de literatura, explana as possíveis indicações deste procedimento, o risco de desenvolvimento de osteorradionecrose e as possibilidades de prevenção para esta sequela. Além disso, aborda uma alternativa de reabilitação oral viável após este tipo de cirurgia, por meio de overdenture sobre dentes em mandíbula.
Journal of Investigative and Clinical Dentistry, 2017
Aim: The aims of the present retrospective study were to evaluate the outcomes of dental extractions in nasopharyngeal carcinoma patients who had undergone dental clearance pre-and post-radiotherapy (RT) with intensity-modulated RT, and to report on the incidence and timing of osteoradionecrosis (ORN) in these patients. Methods: A total of 231 patients were seen pre-, mid-, and postradiation therapy. Information on patient demographics, smoking history, staging, treatment modalities, dental extraction indications, and number and site of dental extractions was gathered. Wilcoxon two-sample tests and Fisher's exact test were used to test the association between groups for patient variables. Results: The mean number of teeth removed was 4.1 teeth per patient. A total of 334 (35.2%) teeth were removed for periodontal reasons, 322 (34.03%) were removed prophylactically, and the remaining teeth were removed because of deep caries, retained roots, partial impaction, endodontic lesions, and prosthodontic reasons. Patients had an average of 19.6 teeth remaining after dental clearance, and only 97 (42%) required prosthetic intervention. The statistical analysis showed that there was no correlation between dental extractions pre-or post-RT and the development of ORN. Conclusions: No specific parameter was directly associated with dental extractions, although smoking and increased number of teeth removed preradiation seemed to be prevalent in patients who developed ORN.
Predictors of osteoradionecrosis following irradiated tooth extraction
2021
Background Tooth extraction post radiotherapy is one of the most important risk factors of osteoradionecrosis of the jawbones. The objective of this study was to determine the predictors of osteoradionecrosis (ORN) which were associated with a dental extraction post radiotherapy. Methods A retrospective analysis of medical records and dental panoramic tomogram (DPT) of patients with a history of head and neck radiotherapy who underwent dental extraction between August 2005 to October 2019 was conducted. Results Seventy-three patients fulfilled the inclusion criteria. 16 (21.9%) had ORN post dental extraction and 389 teeth were extracted. 33 sockets (8.5%) developed ORN. Univariate analyses showed significant associations with ORN for the following factors: tooth type, tooth pathology, surgical procedure, primary closure, target volume, total dose, timing of extraction post radiotherapy, bony changes at extraction site and visibility of lower and upper cortical line of mandibular can...
Osteoradionecrosis of the Jaws after Radiotherapy Treatment in Head and Neck Area
2015
Although it can be stated that the incidence of osteoradionecrosis of the jaws (ORNJ) in the last reported period decreases, the therapy of this diagnosis has a considerably more complicated continuance as with bisphosphonates osteonecrosis (BON). Oral findings are extensive, not only alveolar bones of jaws are affected by radiation, but also oral mucosa and salivary glands, resulting to a significant mucositis and xerostomia. Research in dental and oral surgery often involves materials and procedures which are capable of improving clinical outcomes in terms of percentages of success. The goal of this research was to find a treatment approach which could reduce bleeding, promote effective bone regeneration and rapid soft-tissue healing by employing resources which are easy to use at a modest cost. Patients in our study were divided into three categories: patients with newly diagnosed cancer waiting for treatment, patients after radiotherapy without signs of osteonecrosis and patient...
Radiation Oncology, 2013
Purpose: Retrospective evaluation of the dental status of patients with oral cancer before radiotherapy, the extent of dental rehabilitation procedures, demographic and radiotherapy data as potential risk factors for development of infected osteoradionecrosis of the lower jaw. Methods: A total of 90 patients who had undergone radiotherapy for oral cancer were included into this retrospective evaluation. None of them had distant metastases. After tumour surgery the patients were referred to an oral and maxillofacial surgeon for dental examination and the necessary dental rehabilitation procedures inclusive potential tooth extraction combined with primary soft tissue closure. Adjuvant radiotherapy was started after complete healing of the gingiva (> 7 days after potential extraction). The majority of patients (n = 74) was treated with conventionally fractionated radiotherapy with total doses ranging from 50-70Gy whereas further 16 patients received hyperfractionated radiotherapy up to 72Gy. The records of the clinical data were reviewed. Furthermore, questionnaires were mailed to the patients' general practitioners and dentists in order to get more data concerning tumour status and osteoradionecrosis during follow-up. Results: The patients' dental status before radiotherapy was generally poor. On average 10 teeth were present, six of them were regarded to remain conservable. Extensive dental rehabilitation procedures included a mean of 3.7 tooth extractions. Chronic periodontitis with severe attachment loss was found in 40%, dental biofilm in 56%. An infected osteoradionecrosis (IORN) grade II according to (Schwartz et al., Am J Clin Oncol 25:168-171, 2002) was diagnosed in 11 of the 90 patients (12%), mostly within the first 4 years after radiotherapy. We could not find significant prognostic factors for the occurrence of IORN, but a trendwise correlation with impaired dental status, rehabilitation procedures, fraction size and tumour outcome. Conclusion: The occurrence of IORN is an important long-term side effect of radiotherapy for oral cancers. From this data we only can conclude that a poor dental status, conventional fractionation and local tumour progression may enhance the risk of IORN which is in concordance with the literature.