Abstract
Objectives
The aim of this comprehensive literature review is to provide recommendations and guidelines for dental implant therapy in patients with a history of radiation in the head and neck region. For the first time, a meta-analysis comparing the implant survival in irradiated and non-irradiated patients was performed.
Material and methods
An extensive electronic search in the electronic databases of the National Library of Medicine was conducted for articles published between January 1990 and January 2013 to identify literature presenting survival data on the topic of dental implants in patients receiving radiotherapy for head and neck cancer. Review and meta-analysis were performed according to Preferred Reporting Items for Systematic Review and Meta-Analyses statement. For meta-analysis, only studies with a mean follow-up of at least 5 years were included.
Results
After screening 529 abstracts from the electronic database, we included 31 studies in qualitative and 8 in quantitative synthesis. The mean implant survival rate of all examined studies was 83 % (range, 34–100 %). Meta-analysis of the current literature (2007–2013) revealed no statistically significant difference in implant survival between non-irradiated native bone and irradiated native bone (odds ratio [OR], 1.44; confidence interval [CI], 0.67–3.1). In contrast, meta-analysis of the literature of the years 1990–2006 showed a significant difference in implant survival between non-irradiated and irradiated patients ([OR], 2.12; [CI], 1.69–2.65) with a higher implant survival in the non-irradiated bone. Meta-analysis of the implant survival regarding bone origin indicated a statistically significant higher implant survival in the irradiated native bone compared to the irradiated grafted bone ([OR], 1.82; [CI], 1.14–2.90).
Conclusions
Within the limits of this meta-analytic approach to the literature, this study describes for the first time a comparable implant survival in non-irradiated and irradiated native bone in the current literature. Grafted bone combined with radiotherapy was identified as a negative prognostic factor on implant survival.
Clinical relevance
The evolution of implant hardware and improvement of treatment strategies during the last years have affirmed dental implant-supported concepts as a valuable treatment option for patients with a history of radiation in the head and neck region.
Similar content being viewed by others
References
Parkin DM, Bray F, Ferlay J, Pisani P (2005) Global cancer statistics, 2002. CA Cancer J Clin 55(2):74–108
Silverman S Jr (2001) Demographics and occurrence of oral and pharyngeal cancers. The outcomes, the trends, the challenge. J Am Dent Assoc 132:7S–11S
Schiegnitz E, Kammerer PW, Koch FP, Kruger M, Berres M, Al-Nawas B (2012) GDF 15 as an anti-apoptotic, diagnostic and prognostic marker in oral squamous cell carcinoma. Oral Oncol 48(7):608–614. doi:10.1016/j.oraloncology.2012.01.020
Tanaka TI, Chan HL, Tindle DI, Maceachern M, Oh TJ (2013) Updated clinical considerations for dental implant therapy in irradiated head and neck cancer patients. J Prosthodont. doi:10.1111/jopr.12028
Ihde S, Kopp S, Gundlach K, Konstantinovic VS (2009) Effects of radiation therapy on craniofacial and dental implants: a review of the literature. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 107(1):56–65. doi:10.1016/j.tripleo.2008.06.014
Marx RE, Johnson RP (1987) Studies in the radiobiology of osteoradionecrosis and their clinical significance. Oral Surg Oral Med Oral Pathol 64(4):379–390
Hobo S, Garcia LT (1989) Osseointegration and occlusal rehabilitation. Quintessence, Tokyo
Liberati A, Altman DG, Tetzlaff J, Mulrow C, Gotzsche PC, Ioannidis JP, Clarke M, Devereaux PJ, Kleijnen J, Moher D (2009) The PRISMA statement for reporting systematic reviews and meta-analyses of studies that evaluate health care interventions: explanation and elaboration. J Clin Epidemiol 62(10):e1–e34. doi:10.1016/j.jclinepi.2009.06.006
Miller SA, Forrest JL (2001) Enhancing your practice through evidence-based decision making: PICO, learning how to ask good questions. Journal of Evidence-Based Dental Practice 1:136–141
Fleiss JL, Chilton NW (1983) The measurement of interexaminer agreement on periodontal disease. J Periodontal Res 18(6):601–606
Buddula A, Assad DA, Salinas TJ, Garces YI, Volz JE, Weaver AL (2012) Survival of dental implants in irradiated head and neck cancer patients: a retrospective analysis. Clin Implant Dent Relat Res 14(5):716–722. doi:10.1111/j.1708-8208.2010.00307.x
Sammartino G, Marenzi G, Cioffi I, Tete S, Mortellaro C (2011) Implant therapy in irradiated patients. J Craniofac Surg 22(2):443–445. doi:10.1097/SCS.0b013e318207b59b
Jisander S, Grenthe B, Alberius P (1997) Dental implant survival in the irradiated jaw: a preliminary report. Int J Oral Maxillofac Implants 12(5):643–648
Buddula A, Assad DA, Salinas TJ, Garces YI (2011) Survival of dental implants in native and grafted bone in irradiated head and neck cancer patients: a retrospective analysis. Indian J Dent Res 22(5):644–648
Salinas TJ, Desa VP, Katsnelson A, Miloro M (2010) Clinical evaluation of implants in radiated fibula flaps. J Oral Maxillofac Surg 68(3):524–529. doi:10.1016/j.joms.2009.09.104
Korfage A, Schoen PJ, Raghoebar GM, Roodenburg JL, Vissink A, Reintsema H (2010) Benefits of dental implants installed during ablative tumour surgery in oral cancer patients: a prospective 5-year clinical trial. Clin Oral Implants Res 21(9):971–979. doi:10.1111/j.1600-0501.2010.01930.x
Klein MO, Grotz KA, Walter C, Wegener J, Wagner W, Al-Nawas B (2009) Functional rehabilitation of mandibular continuity defects using autologous bone and dental implants—prognostic value of bone origin, radiation therapy and implant dimensions. Eur Surg Res 43(3):269–275. doi:10.1159/000229027
Schoen PJ, Raghoebar GM, Bouma J, Reintsema H, Burlage FR, Roodenburg JL, Vissink A (2008) Prosthodontic rehabilitation of oral function in head-neck cancer patients with dental implants placed simultaneously during ablative tumour surgery: an assessment of treatment outcomes and quality of life. Int J Oral Maxillofac Surg 37(1):8–16. doi:10.1016/j.ijom.2007.07.015
Yerit KC, Posch M, Seemann M, Hainich S, Dortbudak O, Turhani D, Ozyuvaci H, Watzinger F, Ewers R (2006) Implant survival in mandibles of irradiated oral cancer patients. Clin Oral Implants Res 17(3):337–344. doi:10.1111/j.1600-0501.2005.01160.x
Watzinger F, Ewers R, Henninger A, Sudasch G, Babka A, Woelfl G (1996) Endosteal implants in the irradiated lower jaw. J Craniomaxillofac Surg 24(4):237–244
Linsen SS, Martini M, Stark H (2012) Long-term results of endosteal implants following radical oral cancer surgery with and without adjuvant radiation therapy. Clin Implant Dent Relat Res 14(2):250–258. doi:10.1111/j.1708-8208.2009.00248.x
Bodard AG, Bemer J, Gourmet R, Lucas R, Coroller J, Salino S, Breton P (2011) Dental implants and free fibula flap: 23 patients. Rev Stomatol Chir Maxillofac 112(2):e1–e4. doi:10.1016/j.stomax.2011.01.008
Fenlon MR, Lyons A, Farrell S, Bavisha K, Banerjee A, Palmer RM (2012) Factors affecting survival and usefulness of implants placed in vascularized free composite grafts used in post-head and neck cancer reconstruction. Clin Implant Dent Relat Res 14(2):266–272. doi:10.1111/j.1708-8208.2009.00250.x
Chiapasco M, Colletti G, Romeo E, Zaniboni M, Brusati R (2008) Long-term results of mandibular reconstruction with autogenous bone grafts and oral implants after tumor resection. Clin Oral Implants Res 19(10):1074–1080. doi:10.1111/j.1600-0501.2008.01542.x
Mancha de la Plata M, Gias LN, Diez PM, Munoz-Guerra M, Gonzalez-Garcia R, Lee GY, Castrejon-Castrejon S, Rodriguez-Campo FJ (2012) Osseointegrated implant rehabilitation of irradiated oral cancer patients. J Oral Maxillofac Surg 70(5):1052–1063. doi:10.1016/j.joms.2011.03.032
Anderson L, Meraw S, Al-Hezaimi K, Wang HL (2013) The influence of radiation therapy on dental implantology. Implant Dent 22(1):31–38. doi:10.1097/ID.0b013e31827e84ee
Pace-Balzan A, Rogers SN (2012) Dental rehabilitation after surgery for oral cancer. Curr Opin Otolaryngol Head Neck Surg 20(2):109–113. doi:10.1097/MOO.0b013e32834f5fef
Grötz KA, Schmidt BLJ (2013) Onko II: supportive TU-Betreuung. Handbuch MKG Update 1:17–20
Javed F, Al-Hezaimi K, Al-Rasheed A, Almas K, Romanos GE (2010) Implant survival rate after oral cancer therapy: a review. Oral Oncol 46(12):854–859. doi:10.1016/j.oraloncology.2010.10.004
Friedland PL, Bozic B, Dewar J, Kuan R, Meyer C, Phillips M (2011) Impact of multidisciplinary team management in head and neck cancer patients. Br J Cancer 104(8):1246–1248. doi:10.1038/bjc.2011.92
Cawood JI, Stoelinga PJ (2006) International academy for oral and facial rehabilitation–consensus report. Int J Oral Maxillofac Surg 35(3):195–198. doi:10.1016/j.ijom.2005.09.008
Dholam KP, Gurav SV (2012) Dental implants in irradiated jaws: a literature review. J Cancer Res Ther 8(Suppl 1):S85–S93. doi:10.4103/0973-1482.92220
Kovacs AF (2000) Clinical analysis of implant losses in oral tumor and defect patients. Clin Oral Implants Res 11(5):494–504
Asikainen P, Klemetti E, Kotilainen R, Vuillemin T, Sutter F, Voipio HM, Kullaa A (1998) Osseointegration of dental implants in bone irradiated with 40, 50 or 60 gy doses, An experimental study with beagle dogs. Clin Oral Implants Res 9(1):20–25
Granstrom G (2005) Osseointegration in irradiated cancer patients: an analysis with respect to implant failures. J Oral Maxillofac Surg 63(5):579–585. doi:10.1016/j.joms.2005.01.008
Grotz KA, Wahlmann UW, Krummenauer F, Wegener J, Al-Nawas B, Kuffner HD, Wagner W (1999) [Prognosis and prognostic factors of endosseous implants in the irradiated jaw]. Mund Kiefer Gesichtschir 3(Suppl 1):S117–S124
Schepers RH, Slagter AP, Kaanders JH, van den Hoogen FJ, Merkx MA (2006) Effect of postoperative radiotherapy on the functional result of implants placed during ablative surgery for oral cancer. Int J Oral Maxillofac Surg 35(9):803–808. doi:10.1016/j.ijom.2006.03.007
Eckert SE, Desjardins RP, Keller EE, Tolman DE (1996) Endosseous implants in an irradiated tissue bed. J Prosthet Dent 76(1):45–49
Kämmerer PW, Lehmann KM, Karbach J, Wegener J, Al-Nawas B, Wagner W (2011) Prevalence of peri-implant diseases associated with a rough-surface dental implant system 9 years after insertion. Int J Oral Imp Clin Res 3(3):135–139
Froschl T, Kerscher A (1997) The optimal vestibuloplasty in preprosthetic surgery of the mandible. J Craniomaxillofac Surg 25(2):85–90
Kao SY, Lui MT, Fong J, Wu DC, Wu CH, Tu HF, Hung KF, Yeung TC (2005) A method using vestibulo-sulcoplasty combining a split-thickness skin graft and a palatal keratinized mucosa graft for peri-implant tissue secondary to oral cancer surgery. J Oral Implantol 31(4):186–191. doi:10.1563/1548-1336(2005)31[186:AMUVCA]2.0.CO;2
Heberer S, Nelson K (2009) Clinical evaluation of a modified method of vestibuloplasty using an implant-retained splint. J Oral Maxillofac Surg 67(3):624–629. doi:10.1016/j.joms.2008.09.029
Marx RE, Johnson RP, Kline SN (1985) Prevention of osteoradionecrosis: a randomized prospective clinical trial of hyperbaric oxygen versus penicillin. J Am Dent Assoc 111(1):49–54
Coulthard P, Patel S, Grusovin GM, Worthington HV, Esposito M (2008) Hyperbaric oxygen therapy for irradiated patients who require dental implants: a Cochrane review of randomised clinical trials. Eur J Oral Implantol 1(2):105–110
Moergel M, Karbach J, Kunkel M, Wagner W (2013) Oral squamous cell carcinoma in the vicinity of dental implants. Clin Oral Investig. doi:10.1007/s00784-013-0968-5
Shaw R, Sutton D, Brown J, Cawood J (2004) Further malignancy in field change adjacent to osseointegrated implants. Int J Oral Maxillofac Surg 33(4):353–355. doi:10.1016/j.ijom.2003.09.017
Schache A, Thavaraj S, Kalavrezos N (2008) Osseointegrated implants: a potential route of entry for squamous cell carcinoma of the mandible. Br J Oral Maxillofac Surg 46(5):397–399. doi:10.1016/j.bjoms.2007.09.009
De Ceulaer J, Magremanne M, van Veen A, Scheerlinck J (2010) Squamous cell carcinoma recurrence around dental implants. J Oral Maxillofac Surg 68(10):2507–2512. doi:10.1016/j.joms.2010.01.023
Heberer S, Kilic S, Hossamo J, Raguse JD, Nelson K (2011) Rehabilitation of irradiated patients with modified and conventional sandblasted acid-etched implants: preliminary results of a split-mouth study. Clin Oral Implants Res 22(5):546–551
Cuesta-Gil M, Ochandiano Caicoya S, Riba-García F, Duarte Ruiz B, Navarro Cuéllar C, Navarro Vila C (2009) Oral rehabilitation with osseointegrated implants in oncologic patients. J Oral Maxillofac Surg 67(11):2485–2496
Nelson K, Heberer S, Glatzer C (2007) Survival analysis and clinical evaluation of implant-retained prostheses in oral cancer resection patients over a mean follow-up period of 10 years. J Prosthet Dent 98(5):405–410
Schoen PJ, Raghoebar GM, Bouma J, Reintsema H, Vissink A, Sterk W, Roodenburg JL (2007) Rehabilitation of oral function in head and neck cancer patients after radiotherapy with implant-retained dentures: effects of hyperbaric oxygen therapy. Oral Oncol 43(4):379–388
Cao Y, Weischer T (2003) Comparison of maxillary implant-supported prosthesis in irradiated and non-irradiated patients. J Huazhong Univ Sci Technolog Med Sci 23(2):209–212
Visch LL, van Waas MA, Schmitz PI, Levendag PC (2002) A clinical evaluation of implants in irradiated oral cancer patients. J Dent Res 81(12):856–859
Betz T, Purps S, Pistner H, Bill J, Reuther J (1999) Oral rehabilitation of tumor patients with enosseous dental implants – success rate taking into account the peri-implant hard and soft tissues. Mund Kiefer GesichtsChir 3(Suppl 1): S99–S105
Weischer T, Mohr C (1999) Ten-year experience in oral implant rehabilitation of cancer patients: treatment concept and proposed criteria for success. Int J Oral Maxillofac Implants 14(4):521–528
Schliephake H, Neukam FW, Schmelzeisen R, Wichmann M (1999) Long-term results of endosteal implants used for restoration of oral function after oncologic surgery. Int J Oral Maxillofac Surg 28(4):260–265
Werkmeister R, Szulczewski D, Walteros-Benz P, Joos U (1999) Rehabilitation with dental implants of oral cancer patients. J Craniomaxillofac Surg 27(1):38–41
Niimi A, Ueda M, Keller EE, Worthington P (1998) Experience with osseointegrated implants placed in irradiated tissues in Japan and the United States. Int J Oral Maxillofac Implants 13(3):407–411
Keller EE, Tolman DE, Zuck SL, Eckert SE (1997) Mandibular endosseous implants and autogenous bone grafting in irradiated tissue: a 10-year retrospective study. Int J Oral Maxillofac Implants 12(6):800–813
Esser E, Wagner W (1997) Dental implants following radical oral cancer surgery and adjuvant radiotherapy. Int J Oral Maxillofac Implants 12(4):552–557
Author information
Authors and Affiliations
Corresponding author
Additional information
There are no commercial or other associations that might create a duality of interests in connection with the article.
Rights and permissions
About this article
Cite this article
Schiegnitz, E., Al-Nawas, B., Kämmerer, P.W. et al. Oral rehabilitation with dental implants in irradiated patients: a meta-analysis on implant survival. Clin Oral Invest 18, 687–698 (2014). https://doi.org/10.1007/s00784-013-1134-9
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00784-013-1134-9