Retrospective long‐term clinical evaluation of implant‐prosthetic rehabilitations after head and neck cancer therapy

Abstract

Objective To assess clinical and patient‐reported outcomes of implant‐prosthetic rehabilitations in patients with a history of head–neck cancer (HNC), treated with tumor resection without (TR) or with adjuvant radiotherapy (TR/RT). A healthy cohort rehabilitated with the same reconstructive protocols served as control group (C). Materials and Methods A total of 28 women and 29 men were considered in the present retrospective study. Participants received 322 implants, finally supporting 79 prosthetic reconstructions. Primary outcome was the assessment of implant and prosthetic survival rates. Furthermore peri‐implant soft tissue parameters (attached peri‐implant mucosa, AM; modified bleeding and plaque indices, mBI/mPI; probing depth, PD) and prosthetic technical complications were documented. Patient‐reported outcome measures (PROMs) by means of visual analog scales (VAS) and the Oral Health Impact Profile German 14 form (OHIP G14) were collected. For statistical purposes Chi‐square and Mann–Whitney‐U‐Test were adapted. Results After a mean follow‐up of 81.2 ± 50.3 months, implant survival rate was 98.1% (HNC‐TR), 98.2% (HNC‐TR/RT) and 100.0% (C), respectively (four implants failed in the HNC groups). HNC‐TR/RT showed significant higher mPI and mBI compared to C. Within HNC‐TR/RT, vestibuloplasty significantly reduced mBI and PD values. No failures occurred at the prosthetic level. Overall, higher VAS scores were reported for bar‐ compared with Locator‐retained prostheses. Furthermore, increased OHIP G14 values resulted for HNC‐TR/RT. Conclusions High survival rates on implant and prosthetic level were observed. The use of soft tissue grafts resulted in stabilization of the peri‐implant mucosa in irradiated patients. In terms of retention and chewing ability, participants preferred bars over Locator attachments.

Dental implants in patients with head and neck cancer—A systematic review and meta‐analysis of the influence of radiotherapy on implant survival

“…Furthermore, Ettl et al (2020) concluded that radiation with a dose of over 60 Gray negatively influenced implant success ( p = .025). Contrary to that, other studies found only a minor influence of radiotherapy on the outcome of dental implantation (Alberga et al, 2020; Dholam et al, 2013; Laverty et al, 2019; Moore et al, 2019; Patel et al, 2020; Woods et al, 2019) or even resulted in comparable survival rates for implants placed in the two above‐mentioned groups (Ch'ng et al, 2016; Gander et al, 2014; Pieralli et al, 2021). All irradiated patients included into the studies by Doll et al (2015) and Hessling et al (2015) were treated with radiochemotherapy.…”

“…The importance of the oral rehabilitation of patients treated for head and neck cancer is beyond question, especially in view of the improvement of health‐related quality of life (AWMF, 2015; Petrovic et al, 2019; Pieralli et al, 2021; Woods et al, 2019). Implant therapy plays an important role in the reconstruction of esthetical and functional defects and in the restoring of the masticatory function, particularly through better retention of the prosthetic superstructure (Buurman et al, 2013).…”

“…All irradiated patients included into the studies by Doll et al (2015) and Hessling et al (2015) were treated with radiochemotherapy. This might be a reason for the higher failure rates in irradiated bone, as the combination of radio‐ and chemotherapy may increase the adverse effects of irradiation (Pieralli et al, 2021). Laverty et al (2019) observed slightly, but not significantly, lower implant survival for patients treated with chemoradiation.…”

“…Although Gander et al (2014) reported six implant failures in only two patients treated with conventional radiotherapy compared with six implant failures in 19 patients treated with IMRT, there was no significant difference found between IMRT and conventional radiotherapy due to the small number of patients receiving conventional radiotherapy. In this review, many studies reported the use of dose distributing techniques such as IMRT and volume‐modulated arch therapy (VMAT (Teoh et al, 2011)) as radiation modality for at least some or even all patients (Alberga et al, 2020; Ch'ng et al, 2016; Curi et al, 2018; Ernst et al, 2016; Gander et al, 2014; Neckel et al, 2020; Papi et al, 2019; Pieralli et al, 2021; Sandoval et al, 2020). In fact, the literature found on this subject strongly recommends the use of IMRT as it shows good rates of locoregional control and has positive effects on the quality of life (Anand et al, 2008; Graff et al, 2007; Nutting et al, 2011; Peponi et al, 2011; Setton et al, 2012).…”

Clinical long-term and patient-reported outcomes of dental implants in oral cancer patients

“…A meta-analysis by Chambrone et al showed a higher risk for implant failure in radiated patients compared to non-irradiated patients [ 18 ]. However, a recent study showed similar survival rates in both, patients who received radiation therapy and those who did not receive radiation therapy during their oncological treatment [ 19 ]. It should be mentioned that this study had very strict eligibility criteria and therefore other variables influencing long-term implant survival were excluded.…”