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What are the clinical considerations for dental implant therapy in irradiated head and neck cancer patients?

This summary is based on the article published in the Journal of Prosthodontics: Updated Clinical Considerations for Dental Implant Therapy in Irradiated Head and Neck Cancer Patients (August 2013)

Context

An increasing number of reports indicate successful use of dental implants (DI) during oral rehabilitation for head and neck cancer patients undergoing tumor surgery and radiation therapy. Implant-supported dentures are a viable option when patients cannot use conventional dentures due to adverse effects of radiation therapy, including oral dryness or fragile mucosa, in addition to compromised anatomy. However, negative effects of radiation, including osteoradionecrosis, are well documented in the literature, and early loss of implants in irradiated bone has been reported.

There is currently no consensus concerning DI safety or clinical guidelines for their use in irradiated head and neck cancer patients. It is important for health care professionals to be aware of the multidimensional risk factors for these patients when planning oral rehabilitation with DIs, and to provide optimal treatment options and maximize the overall treatment outcome.

Purpose

The paper reviews and updates the impact of radiotherapy on DI survival and discusses clinical considerations for DI therapy in irradiated head and neck cancer patients.

Clinical Considerations

  • Reasonable oncologic prognosis should be obtained from the physician.
  • If possible, consultation with the radiation oncologist is encouraged to obtain radiation dose distribution. 
  • A timespan of 12 months between the last radiotherapy and implant insertion seems reasonable from both the oncologic and dental prospective.
  • It is important to maintain optimal periodontal health with appropriate management of any adverse effects of RT.

Key Messages

  • The negative impacts of RT on DI therapy are undeniable.
  • The benefit of using implant-supported dentures over conventional dentures must outweigh the risks.
  • Meticulous treatment planning along with careful preoperative oral examination and good coordination with oncologic specialists cannot be overemphasized.
  • It is also important for the dental profession to keep abreast of the latest available radiotherapy technologies.

 

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