Survival of dental implants and occurrence of osteoradionecrosis in irradiated head and neck cancer patients
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BORIS DOI
Subtitle
a systematic review and meta-analysis
Abstract
Objectives:
This systematic review assesses dental implant survival, calculates the
incidence rate of osteoradionecrosis, and evaluates risk factors in irradiated
head and neck cancer patients.
Materials and methods:
Various databases (e.g., Medline/Embase using Ovid) and gray literature
platforms were searched using a combination of keywords and subject
headings. When appropriate, meta-analysis was carried out using a random
effects model. Otherwise, pooled analysis was applied.
Results:
A total of 425 of the 660 included patients received radiotherapy. In total,
2602 dental implants were placed, and 1637 were placed in irradiated
patients. Implant survival after an average follow-up of 37.7 months was
97% (5% confidence interval, CI 95.2%, 95% CI 98.3%) in nonirradiated
patients and 91.9% (5% CI 87.7%, 95% CI: 95.3%) after an average follow-up
of 39.8 months in irradiated patients. Osteoradionecrosis occurred in 11
cases, leading to an incidence of 3% (5% CI 1.6%, 95% CI 4.9%). The main
factors impacting implant survival were radiation and grafting status, while
factors influencing osteoradionecrosis could not be determined using meta-analysis.
Conclusion:
Our data show that implant survival in irradiated patients is lower than in
nonirradiated patients, and osteoradionecrosis is—while rare—a serious
complication that any OMF surgeon should be prepared for. The key to
success could be a standardized patient selection and therapy to improve
the standard of care, reduce risks and shorten treatment time.
Clinical relevance:
Our analysis provides further evidence that implant placement is a feasible
treatment option in irradiated head and neck cancer patients with
diminished oral function and good long-term cancer prognosis.
This systematic review assesses dental implant survival, calculates the
incidence rate of osteoradionecrosis, and evaluates risk factors in irradiated
head and neck cancer patients.
Materials and methods:
Various databases (e.g., Medline/Embase using Ovid) and gray literature
platforms were searched using a combination of keywords and subject
headings. When appropriate, meta-analysis was carried out using a random
effects model. Otherwise, pooled analysis was applied.
Results:
A total of 425 of the 660 included patients received radiotherapy. In total,
2602 dental implants were placed, and 1637 were placed in irradiated
patients. Implant survival after an average follow-up of 37.7 months was
97% (5% confidence interval, CI 95.2%, 95% CI 98.3%) in nonirradiated
patients and 91.9% (5% CI 87.7%, 95% CI: 95.3%) after an average follow-up
of 39.8 months in irradiated patients. Osteoradionecrosis occurred in 11
cases, leading to an incidence of 3% (5% CI 1.6%, 95% CI 4.9%). The main
factors impacting implant survival were radiation and grafting status, while
factors influencing osteoradionecrosis could not be determined using meta-analysis.
Conclusion:
Our data show that implant survival in irradiated patients is lower than in
nonirradiated patients, and osteoradionecrosis is—while rare—a serious
complication that any OMF surgeon should be prepared for. The key to
success could be a standardized patient selection and therapy to improve
the standard of care, reduce risks and shorten treatment time.
Clinical relevance:
Our analysis provides further evidence that implant placement is a feasible
treatment option in irradiated head and neck cancer patients with
diminished oral function and good long-term cancer prognosis.
Date of Publication
2021
Year of graduation
2021
Theses Type
dissertation
Subject(s)
Language(s)
en
Author(s)
Toneatti, Daniel Jan |
Faculty/Graduate School
Access(Rights)
open.access
Primary OA Publication
true