What is the optimal timing for implant placement in oral cancer patients? A scoping literature review

Abstract

Background: Oral cancer patients can benefit from dental implant placement. Traditionally, implants are placed after completing oncologic treatment (secondary implant placement). Implant placement during ablative surgery (primary placement) in oral cancer patients seems beneficial in terms of early start of oral rehabilitation and limiting additional surgical interventions. Guidelines on the ideal timing of implant placement in oral cancer patients are missing. Objective: To perform a scoping literature review on studies examining the timing of dental implant placement in oral cancer patients and propose a clinical practice recommendations guideline. Methods: A literature search for studies dealing with primary and/or secondary implant placement in MEDLINE was conducted (last search December 27, 2019). The primary outcome was 5-year implant survival. Results: Sixteen out of 808 studies were considered eligible. Both primary and secondary implant placement showed acceptable overall implant survival ratios with a higher pooled 5-year implant survival rate for primary implant placement 92.8% (95% CI: 87.1%-98.5%) than secondary placed implants (86.4%, 95% CI: 77.0%-95.8%). Primary implant placement is accompanied by earlier prosthetic rehabilitation after tumor surgery. Conclusion: Patients with oral cancer greatly benefit from, preferably primary placed, dental implants in their prosthetic rehabilitation. The combination of tumor surgery with implant placement in native mandibular bone should be provided as standard care.

Use of dentures, receipt of information, quality of life, and oral function following radiotherapy for head and neck cancer

“…For example, a recent retrospective, case‐control study concluded that placing immediate dental implants at the time of surgery does not increase radiotherapy treatment toxicities 20 . Another recent scoping review concluded that the combination of surgery and placement of dental implant should be considered as standard care for HNC survivors 21 . Other dental clinicians recommend replacement of missing teeth with dentures as this is less expensive, noninvasive, takes less time, and can be delivered safely without involvement of a specialist 22 .…”

Prosthodontic rehabilitation of head and neck cancer patients—Challenges and new developments

“…Advanced tumours can result in large defects, requiring surgical reconstruction (Vaughan, Bainton, & Martin, 1992) As implant placement during primary reconstruction shortens the interval between surgery and dental rehabilitation, the number of orally rehabilitated patients will increase (Alberga et al, 2020;Urken et al, 1989).…”

“…This allows for the preferred prosthodontic rehabilitation of head and neck patients. For example, choices in planning, positioning and amount of endosseous oral implants or oncology zygomatic implants are key factors for retention of the prosthetic construction (Alberga et al, 2020; Hackett, El‐Wazani, & Butterworth, 2020). Literature emphasizes the importance of an immediate implant procedure as it has been shown that placement of mandibular implants in edentulous patients during ablative surgery results in a higher number of patients with functioning mandibular dentures after completion of oncologic therapy (Korfage et al., 2011; Mizbah et al., 2013; Wetzels et al, 2017).…”

European white paper: oropharyngeal dysphagia in head and neck cancer

“…Following RT, dental extractions from the bone which has received high dose radiation should only be undertaken if unavoidable-endodontic treatment and decoronation should be considered first [302]. In the context of oral health and dental rehabilitation, treating periodontal disease and restoring occlusal function are important for mastication of food and bolus preparation, facilitating nutritional intake, and reducing the risk of aspiration of food and/or of oral micro-organisms into the respiratory tract [303][304][305][306].…”