Irradiated patient implant treatment

Dental Implants Irradiated patient implant treatment Background.—The 5-year survival rate for cancer of the head and neck remains at about 50% to 60%, making this a major health concern. With early detection and correct treatment, cure rates and quality of life may be improved. Radiotherapy is often an essential part of the therapeutic plan and has been associated with reduced anatomic structure and physiologic functioning. Dental rehabilitation after head and neck cancer treatment, especially if radiotherapy has been used, can be highly challenging. Radiotherapy damages the remodeling system and produces vascular injury, which has the potential to compromise bone healing and reduce the viability of dental implants. Dental rehabilitation efforts to restore function, speech, comfort, and quality of life can be complex. Implant-supported prostheses offer many benefits over conventional tissue-born prostheses, with improved retention, mastication, and patient acceptance. To achieve a successful outcome will require the consideration of many variables. A literature review was undertaken to provide recommendations and guidelines for dental implant therapy in patients with a history of radiation to the head and neck region and to compare implant survival between irradiated and non-irradiated patients. Methods.—Thirty-one articles were chosen for review, although overall, the quality and level of evidence was low. A total of 1814 patients received 8177 implants, with 1989 in control groups and inserted in a non-irradiated jaw. Mean follow-up was 56 months, with a range of 3 to 120 months. For the meta-analyses, three studies were used for 1990-2006 and four for 2007-2013. Two studies were used for a meta-analysis of implant survival based on bone origin. Results.—Analysis of the studies showed no significant difference in implant survival between the irradiated and non-irradiated jaws. Meta-analysis of the literature covering 1990 and 2006 revealed a significant difference in implant survival between the irradiated and non-irradiated jaws, but more current reviews indicated implants successfully integrated into bone and remained functionally stable long-

term in irradiated jaws. Mean implant survival rate for all studies was 83%, with a range from 33.96% to 100%. Bone origin analysis found a significantly higher implant survival in irradiated native bone compared to irradiated grafted bone. However, since only two studies had followup of at least 5 years, any conclusions drawn from this analysis should be viewed with caution. Discussion.—The implant survival data for irradiated and non-irradiated native bone were comparable. This indicates that patients who have undergone radiation in the head and neck region can be successfully managed with dental implants. Grafted bone for these patients may have a compromised survival, however.

Clinical Significance.—Recent changes in treatment for patients who have undergone irradiation to the head and neck may have improved the outcomes of implant therapy. Threedimensional planning, guided implant surgery, improved implant surface features, and alterations in treatment concepts may have fundamentally changed implant survival statistics. Dental implants appear to be a favorable treatment alternative, but a multidisciplinary approach is critical for optimal outcome and may significantly improve patient survival.

Schiegnitz E, Al-Nawas B, K€ammerer PW, et al: Oral rehabilitation with dental implants in irradiated patients: A meta-analysis on implant survival. Clin Oral Invest 18:687-698, 2014 Reprints available from E Schiegnitz, Dept of Oral and Maxillofacial Surgery, Plastic Surgery, Univ Medical Ctr of the Johannes Gutenberg-Univ Mainz, Augustusplat 2, 55131 Mainz, Germany; e-mail: [email protected]

Short implants Background.—Short implants are used to restore posterior regions of edentulous jaws as a predictable alternative to the complex surgical procedures usually required

for sites with reduced alveolar bone height. Other benefits associated with these implants are the avoidance of vital anatomical structures such as the inferior alveolar nerve

Volume 60



Issue 1



2015

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