Dental implants feasible in patients following radiation for oral cancer
MedWire News: The survival of dental implants in patients with oral cancer receiving radiation therapy is similar to that of nonirradiated patients, a Spanish study shows.
Oral cancer therapy generally involves resection of the tumor followed by radiation therapy. This can lead to anatomic and physiologic changes, such as a smaller area of attached mucosa and decreased regenerative capacity, which present a challenge for the use of dental implants.
In the present study, Maria Mancha de la Plata (University Hospital Montepríncipe, Madrid, Spain) and colleagues retrospectively analyzed the survival of 225 osseointegrated implants in patients with oral cancer who received radiation therapy
The implants were inserted into 30 patients from 2000 to 2007. The median age of patients was 56 years and 66% were men.
All patients received radiotherapy (50-70 Gy) as part of their therapy. Of the implants placed, 44% were in the anterior mandible, 14% in the posterior mandible, 25% in the anterior maxilla, and 16% in the posterior maxilla.
Five patients developed osteoradionecrosis as a complication of radiotherapy. Once the osteoradionecrosis had healed, 41 implants were placed in these five patients.
For comparison, 20 patients (mean age 56 years, 75% men) with oral cancer but not receiving radiation therapy who received 130 implants were used as a control group.
At the end of the follow-up period (6-96 months) 165 implants (73%) were osseointegrated and loaded, 37 (16%) were osseointegrated but not loaded, and 23 (10%) had been lost.
After 5 years the percentage of implants surviving was slightly lower in the radiated group (93%) compared with the nonirradiated group (97%), a difference which was not statistically significant.
However, the 5-year implant survival rates in the osteonecrosis group were 48.3% compared with 92.3% in the group without osteonecrosis, a significant decrease.
Writing in the Journal of Oral and Maxillofacial Surgery, Mancha de la Planta and team conclude that "prosthetic implant rehabilitation in patients with oral cancer treated with radiotherapy offers an optimal survival rate.
"Although implant failure is greater after radiotherapy, osseointegrated implants increase oral rehabilitation in most patients after irradiation and are an acceptable option for patients who develop osteoradionecrosis."
By Iain Bartlett