How to improve the survival rate of implants after radiotherapy for head and neck cancer?

Abstract

Implants have been widely used in restorative treatment for patients who have undergone head and neck cancer surgery. With the development of combination treatment of head and neck cancer, radiotherapy has been a common means of therapy. However, it could induce various changes in hard and soft tissues and reduce the success and survival rate of the implants. Some research, using either animal models or clinical studies, have shown that certain strategies could be used for improving the survival rate of implants. In this review, we discussed the changes in both hard and soft tissues, which may reduce the survival rate of the implants, and the proposed methods for improving the survival rate of patients after radiotherapy. Graphical Abstract

Survival of dental implants in patients with oral cancer treated by surgery and radiotherapy: a retrospective study

“…Our results indicate that implant survival is strongly influenced by radiotherapy, confirming previous findings [ 16 ] demonstrating that radiotherapy is an important factor in implant failure. Ihde et al [ 17 ] report that implant failure is a more significant risk (up to 12 times greater) in irradiated bone rather than in non-irradiated bone.…”

Dental implants in patients affected by systemic diseases

“…106 Radiotherapy, which is performed in 60-80% of the patients affected by head and neck cancer, 107 reduces cellular and vascular growth and therefore may significantly impair osseointegration of dental implants and increase the risk of complications (for example, osteoradionecrosis). 108,109 Both animal and human studies have shown an increased risk of implant failure (up to 12 times) in irradiated patients. 110 In a recent systematic review, Chambrone et al 111 reported a mean implant survival rate ranging from 46.3 to 98% and an increased implant failure risk (RR 2.74) in irradiated patients, in particular in the maxilla (RR 5.96).…”

“…Radiotherapy seems to have both early and late effects; the early effects affect mainly salivary glands, skin and oral mucosa, while the late effects involve bone changes and may lead to demineralisation, fibrosis, increased susceptibility to infection and avascular necrosis. 109 Several studies reported that hyperbaric oxygen therapy (HBOT) could significantly increase implant success and reduce unpleasant complications like osteoradionecrosis. 107,[112][113][114] However, two recent systematic reviews found that there is no evidence that HBOT can reduce implant failure and that better designed studies are needed to clarify the real benefit of HBOT on the survival rates of implants in irradiated jaws.…”

Biomimetics of Bone Implants: The Regenerative Road

“…There is conflicting retrospective literature, which debates the use of hyperbaric oxygen (HBO) in treating host bone, specifically during craniofacial reconstruction after head and neck cancer. Some studies show improved vascularity and increased basic fibroblast growth factor of grafted recipient bone, 16 and other studies exhibit no significant difference in graft take with HBO. 17 Macroscopically, there is reliance on mechanical design of threaded implants to give the implant mechanical integration.…”