Long-term implant failure in patients treated for oral cancer by external radiotherapy: a retrospective monocentric study (original) (raw)
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Nigerian Journal of Surgery, 2016
In patients undergoing head and neck surgery for various pathologic conditions, implants are one of the best restorative options and are increasingly widely used. [1] The healing process of a wounded, diseased or an injured bone is a normal phenomenon. It begins with fibrin clot formation that alters the normal flow of blood and feeds and supports the osteoprogenitor cells. [2] Successful implant insertion occurs in human bone due to optimum osseointegration at the junction or interface of bone and implants. [3] Most common form of malignancy occurring in humans is the head and neck cancer with over 0.5 million new cases occurring every year. The treatment modality for malignant lesions involves most commonly surgical intervention in combination with radiotherapy. Since, surgical therapy for cancer patients' results in loss of considerable amount of tissue, oral rehabilitation by artificial prosthesis, implants, etc., is a necessary procedure to redress both functional and esthetic disabilities. Artificial prosthesis has certain side-effects such as having the capability of producing xerostomia, mucositis, and altering the healing process in irradiated tissues. Dental implants avoid these side-effects to a much extent but successfully placing implants in patients treated for oral cancer is itself a difficult task because some have had radiation exposure in the tissues. [4] Patients exposed to radiotherapy for treatment of cancer have reduced healing capacity due to progressive fibrosis of vasculature. Radiation
A Review of the Success Rate of Dental Implants in Patients Undergoing Radiotherapy and Chemotherapy
ACTA SCIENTIFIC OTOLARYNGOLOGY (ASOL), 2022
Introduction: According to the World Health Organization, the incidence of head and neck cancers, both primary and secondary (metastatic), is increasing. Currently, the main treatments for this complication are radiotherapy and chemotherapy. On the other hand, the success of implant treatment in these patients due to the cellular changes is a very significant point that should be considered. Objective: The aim of this study was to review the success rate of dental implants in patients undergoing radiotherapy and chemotherapy. Materials and Methods: This study was a narrative review. In this study, research published in PubMed, Google Scholar, and Scapus databases has been reviewed by a review method and with a keyword search strategy. Results: 4320 articles were found from the mentioned databases that after deleting unrelated research (3101 cases) and duplicate research (1050 cases), 105 articles remained for final review. Then, those that were presented in the scientific conference and were in the form of abstracts or did not have a correct statistical population were excluded from the study (90 cases). Finally, 15 articles in this study were reviewed. Conclusion: The survival rate of dental implants may be negatively affected by radiotherapy; however, implants can remain osteointegrated and remain functionally stable and, therefore, can be a good treatment option for rehabilitation and improving the quality of life of cancer patients. The use of bone grafts and higher doses of radiation in the jaw area can be negative prognostic factors.
The Influence of Radiation Therapy on Dental Implantation in Head and Neck Cancer Patients
Journal of Analytical Oncology
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 prim...
Osseointegrated Implant Rehabilitation of Irradiated Oral Cancer Patients
Journal of Oral and Maxillofacial Surgery, 2012
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. Materials and Methods: 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. Results: 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 ϭ 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 ϭ 0.002). Conclusion: Osseointegrated implants enhance oral rehabilitation in most irradiated patients, even being an acceptable option for patients who had suffered osteoradionecrosis. Totally implantsupported prostheses are recommended after irradiation providing functional, stable and aesthetically satisfactory rehabilitation.
Factors Affecting the Placement of Implant in Irradiated Bone: A Literature Review
https://www.ijhsr.org/IJHSR\_Vol.7\_Issue.8\_Aug2017/IJHSR\_Abstract.060.html, 2017
The success rates of osseointegrated implants used to restore patients who were irradiated for head and neck tumors are greatly influenced by radiation-induced changes in the hard and soft tissues. There are 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. Patients cannot use conventional dentures due to the adverse effects of radiation therapy, which include dryness of the mouth or fragile mucosa, in addition to compromised anatomy. Implant-supported dentures are a feasible option for such patients. However, the adverse effects of radiation including osteoradionecrosis, are well documented in the literature, and early loss of implants in irradiated bone has also been reported.
Two-stage implant placement technique for the management of irradiated jaws: An animal study
Journal of Prosthetic Dentistry, 2017
The incidence of oral cancer has significantly increase in the last decade, with over 45 000 individuals being diagnosed annually in the United States alone. 1,2 Treatment still depends on surgical resection and adjunctive radiotherapy and chemotherapy. 3 Radiotherapy is usually administered postoperatively to reduce the risk of recurrence, 4 whereas for certain types of oral cancer, it could be the only treatment option. 5,6 Irradiation of the maxilla and mandible is known to damage osteoblasts and osteoclasts, hindering the mineralization process and reducing its healing and remodeling capacity. 6-8 Several studies have reported the (3-to 12-fold) increased risk of failure of dental implants inserted in irradiated patients. 8,11,12 However, retrospective studies have reported that dental implants inserted during ablative surgery or exposed to radiation doses have an equal chance of becoming osseointegrated, 6,11-13 albeit with a lower overall survival rate. 9-13 Therefore, the general consensus suggests that implant placement should be performed either before irradiation or at least 6 months after the last dose. 8-10 Unfortunately, such a delay has a negative impact on the physical and psychological health of already traumatized patients. Similar findings have been reported in animal studies, as inferior bone quality was observed around implants inserted in irradiated bone (roughly one-third) and that the notable incidence of fibrous integration was 7-fold
Rehabilitation with dental implants of oral cancer patients
Journal of Cranio-Maxillofacial Surgery, 1999
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.
Oral rehabilitation with dental implants in irradiated patients: a meta-analysis on implant survival
Clinical Oral Investigations, 2014
Objectives 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. Material and methods 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. Results 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)(2008)(2009)(2010)(2011)(2012)(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.
Clinical implant dentistry and related research, 2013
BackgroundTypically, dental implants are placed in irradiated bone after a delay that exceeds 6 months, but it is not known whether longer delays are beneficial.Typically, dental implants are placed in irradiated bone after a delay that exceeds 6 months, but it is not known whether longer delays are beneficial.PurposeThe purpose of the study is to review the literature comparing the failure rate of dental implants placed in irradiated bone between 6 and 12 months and after 12 months from the cessation of radiotherapy.The purpose of the study is to review the literature comparing the failure rate of dental implants placed in irradiated bone between 6 and 12 months and after 12 months from the cessation of radiotherapy.Materials and MethodsFour electronic databases were searched for articles published until February 2013 without language restriction: Lilacs, Medline, Scopus, and the Cochrane Central Register of Controlled Trials. Two reviewers independently assessed the eligibility criteria and extracted data. Fixed effect meta-analysis was performed.Four electronic databases were searched for articles published until February 2013 without language restriction: Lilacs, Medline, Scopus, and the Cochrane Central Register of Controlled Trials. Two reviewers independently assessed the eligibility criteria and extracted data. Fixed effect meta-analysis was performed.ResultsOverall, 3,749 observational studies were identified. After the screening of titles and abstracts, 236 publications were selected, and 10 were included in the final analysis. The pooled relative risk (RR) of failure was RRpooled = 1.34 (95% confidence interval [CI]: 1.01–1.79), higher in individuals who had dental implants installed between 6 and 12 months after receiving radiotherapy. I2 indicated nearly 21% heterogeneity (p = .25). Egger's test indicated no evidence of publication bias (p = .62); however, the removal of one study significantly affected the overall RR (RRpooled = 1.08, 95% CI: 0.77–1.52).Overall, 3,749 observational studies were identified. After the screening of titles and abstracts, 236 publications were selected, and 10 were included in the final analysis. The pooled relative risk (RR) of failure was RRpooled = 1.34 (95% confidence interval [CI]: 1.01–1.79), higher in individuals who had dental implants installed between 6 and 12 months after receiving radiotherapy. I2 indicated nearly 21% heterogeneity (p = .25). Egger's test indicated no evidence of publication bias (p = .62); however, the removal of one study significantly affected the overall RR (RRpooled = 1.08, 95% CI: 0.77–1.52).ConclusionsPlacing implants in bone within a period shorter than 12 months after radiotherapy may result in a higher risk of failure; however, additional evidence from clinical trials is needed to verify this risk.Placing implants in bone within a period shorter than 12 months after radiotherapy may result in a higher risk of failure; however, additional evidence from clinical trials is needed to verify this risk.