Ability to Propose Optimal Prosthetic Rehabilitation can be Improved by Discussion between the Dentist and Radiation Oncologist Regarding Upstream Dosimetry

Abstract

Objective Improvement of dental rehabilitation for patients who have undergone radiation therapy requires knowledge of the dose in the maxillary and mandible bones. Materials and Methods Forty-three patients with head and neck cancers underwent evaluation for dental rehabilitation before radiation treatment dosimetry. The delivered dose to the maxilla and mandible was determined. From the dose data in the literature, three levels of risk of implant failure were defined. According to the delivered doses, the authors calculated the percentage of patients who could be fully rehabilitated with an implant, as proposed by the dentist before radiation planning. Results Before dosimetry calculation, all of the completely edentulous arches and 94 partially edentulous (PESs) sextants could be optimally rehabilitated. After dose calculation, among the 14 arches of 7 patients who were completely edentulous, according to the mean and maximal delivered doses, 11 arches (78.6%) and 7 arches (50%) could receive an optimal prosthesis, respectively. For the three patients, who were PESs but with one arch that was completely edentulous, according to the mean and maximal delivered doses, one arch for each dose condition could receive an optimal prosthesis. Among the 94 PESs sextants, according to the mean and maximal delivered doses, 41 (43.6%) and 24 (25.5%) sextants could receive an optimal prosthesis, respectively. Conclusion By determining the sites of implantation before dosimetry, the radiation oncologist could shield specified areas, potentially improving the possibilities for dental rehabilitation. The dialogue between the dentist and the radiation oncologist can improve the possibilities for implants and decrease the risk of unsafe implantation.

Survival of dental implants and occurrence of osteoradionecrosis in irradiated head and neck cancer patients: a systematic review and meta-analysis

“…Criteria for patient selection were defined by Chiapasco et al (2006), who proposed excluding patients with persisting alcohol or tobacco abuse and poor compliance, whereas good tumor prognosis, sufficient oral hygiene, absence of periodontal disease, or patient request were seen as inclusion criteria [74]. Smolka et al (2008) evaluated a treatment concept based on the defect classification by Iizuka et al (2005), in which the number of osteotomies needed to recreate the mandibular contour was the defining factor. In this treatment concept, the mandibular defect size-described by the classification above-dictates the type of prosthodontic rehabilitation.…”

“…In this treatment concept, the mandibular defect size-described by the classification above-dictates the type of prosthodontic rehabilitation. They were able to show a high percentage of successfully completed functional dental reconstructions and had similar results to conventionally planned rehabilitations in terms of implant survival and complication rates [75,76]. Rouers et al (2019) proposed an earlier inclusion of the prosthodontist into the treatment process by selecting implant sites before radiation treatment dosimetry [77].…”

“…They were able to show a high percentage of successfully completed functional dental reconstructions and had similar results to conventionally planned rehabilitations in terms of implant survival and complication rates [75,76]. Rouers et al (2019) proposed an earlier inclusion of the prosthodontist into the treatment process by selecting implant sites before radiation treatment dosimetry [77]. Combining those or similar approaches to standardized workflows could not only potentially impact treatment outcome and the patient's quality of life but also help to generate more comparable data.…”

Cyberknife Radiosurgery for the Treatment of Head and Neck Cancer: A Systematic Review

“…In dentistry, this feature plays a vital role in improving the potential for dental rehabilitation, improving the function and at the same time offering better quality of life. 46 There were several precincts in this study. The outcomes reported in the published studies have heterogenous methodology and parameters of assessment hindering the metaanalysis in all variables.…”

“…In dentistry, this feature plays a vital role in improving the potential for dental rehabilitation, improving the function and at the same time offering better quality of life. 46 …”