• Dr. Siri
  • 9 July, 2023

Radiation Therapy and Dental Implant Osseointegration – An Update

The irradiated hypocellular, hypovascular, and hypoxic tissues are the main cause of dental implants osseointegration failure. A meta-analysis found almost three-fold increased failure risk for implants placed in the irradiated bone and an almost six-fold risk for implants placed in irradiated bone in the maxilla compared to irradiated bone in the mandible.

Factors responsible for clinical success of implants in oral cancer patients:

  • Irradiation source
  • Dose and fractionation
  • Use of chemotherapy
  • Risk for tumor recurrence
  • Anatomic region in which the implants are to be inserted
  • Timing from radiotherapy to implant surgery
  • Preoperative planning
  • Retention systems used
  • Loading factors

Studies in which radiation doses exceeded 70 Gy (20-25) reported lower survival rates of dental implants in comparison to studies in which radiation doses were ≤70Gy.

Timeline from radiotherapy to implant surgery

 Many investigators have recommended a waiting period of 12 months to 2 years after radiotherapy before starting the implant rehabilitation. Factors that can affect the choice of rehabilitation period are risk of tumor recurrence, risk of osteoradionecrosis, implant survival and patient acceptance. From a practical point of view, early rehabilitation is recommended. This is in accordance with patient expectations. The improvement of life quality for the patient is so high that early implant rehabilitation is justified.

Time between first and second stage implant surgery

Implant integration in irradiated bone takes place at a reduced speed. Wagner et al found a significantly higher implant failure when the time from first to second stage surgery was shorter than 4 months. Loading of the mucosa by a removable denture can also extend the healing time.

Risk for osteoradionecrosis in relation to implant surgery

Minimum surgical trauma to the mandible is known to cause osteoradionecrosis in the time period close to radiotherapy. Such trauma could comprise a tooth extraction or surgery for an osseointegrated implant. To minimize the risk for osteoradionecrosis, HBO is strongly advised. The use of HBO is still controversial. Some studies found it useful while others considered it as an additional burden of treatment.

Effect of Irradiation on Osseointegrated Dental Implants

There is a general concern among oncologists to irradiate with metal implants close to a tumor in the field of irradiation. There is limited information in the scientific literature as to the best way to handle these patients.

Final Note

Dental implant therapy requiers careful consideration of patient's general health. In patients who have undergone surgical therapy for head and neck cancer, dental implants might serve as a great option for rehabilitation. However, proper assessment of treatment history is mandatory to avoid potential complications of radiotherapy on success of dental implant therapy.

Article by Dr. Siri P.B.

Categories:
Implantology Oral & Maxillofacial Radiology
Tags :
radiotherapy implants dental care
Comments :
There are no comments yet.
Authentication required

You must log in to post a comment.

Log in

Upcoming webinars:

  • 28 February,2024
Power of beautiful Smile- Exploring the world of smile design Q & A Session

For all those wanting to know the intricacies of creating / recreating a dazzling smile , this Q&A session is for you .

  • 3 March,2024
Early Childhood Caries”-Responsibility of Dentists- Diagosis and promt treatment

Early Childhood Caries (ECC) is most common chronic disease of childhood (more common than obesity and asthma).

  • 5 March,2024
Root Resorption-a diagnostic conundrum

Diagnosing Root Resorption is an intricate topic considering its perplexed entity

  • 13 March,2024
Metamorphosis of Palatal Expansion - Reminiscing the Past and Embracing the Present

This webinar will brief about the evolution of the concept of palatal expansion and emphasize on the current concepts of expansion

  • 14 March,2024
Aligner Alchemy: Demystifying the Magic Behind Straight Smiles

To demystify aligner treatments with professional guidance by making orthodontic concepts simplified

  • 16 March,2024
Implant Occlusion

It specifically deals with the occlusion to be given for implant prosthesis, that would increase the longevity & survival of prosthesis as well as implant

  • 7 April,2024
Dental Dams Demystified: Expert Troubleshooting Tips for Success

Unlock the Secrets of Seamless Dentistry: Join our exclusive webinar on 'Rubber Dam Troubleshooting Tips.