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Clinical Oral Investigations

Published in:

01-04-2014 | Review

Oral rehabilitation with dental implants in irradiated patients: a meta-analysis on implant survival

Authors: E. Schiegnitz, B. Al-Nawas, P. W. Kämmerer, K. A. Grötz

Published in: Clinical Oral Investigations | Issue 3/2014

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.

Parkin DM, Bray F, Ferlay J, Pisani P (2005) Global cancer statistics, 2002. CA Cancer J Clin 55(2):74–108PubMedCrossRef

Silverman S Jr (2001) Demographics and occurrence of oral and pharyngeal cancers. The outcomes, the trends, the challenge. J Am Dent Assoc 132:7S–11SPubMedCrossRef

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 PubMedCrossRef

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 PubMedCrossRef

Marx RE, Johnson RP (1987) Studies in the radiobiology of osteoradionecrosis and their clinical significance. Oral Surg Oral Med Oral Pathol 64(4):379–390PubMedCrossRef

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 PubMedCrossRef

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 1:136–141CrossRef

10.

Fleiss JL, Chilton NW (1983) The measurement of interexaminer agreement on periodontal disease. J Periodontal Res 18(6):601–606PubMedCrossRef

11.

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 PubMedCrossRef

12.

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 PubMedCrossRef

13.

Jisander S, Grenthe B, Alberius P (1997) Dental implant survival in the irradiated jaw: a preliminary report. Int J Oral Maxillofac Implants 12(5):643–648PubMed

14.

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

15.

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 PubMedCrossRef

16.

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 PubMed

17.

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 PubMedCrossRef

18.

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 PubMedCrossRef

19.

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 PubMedCrossRef

20.

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):237–244PubMedCrossRef

21.

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 PubMedCrossRef

22.

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 PubMedCrossRef

23.

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 PubMedCrossRef

24.

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 PubMedCrossRef

25.

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 PubMedCrossRef

26.

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 PubMedCrossRef

27.

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 PubMedCrossRef

28.

Grötz KA, Schmidt BLJ (2013) Onko II: supportive TU-Betreuung. Handbuch MKG Update 1:17–20

29.

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 PubMedCrossRef

30.

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 PubMedCentralPubMedCrossRef

31.

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 PubMedCrossRef

32.

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 PubMed

33.

Kovacs AF (2000) Clinical analysis of implant losses in oral tumor and defect patients. Clin Oral Implants Res 11(5):494–504PubMedCrossRef

34.

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):20–25PubMedCrossRef

35.

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 PubMedCrossRef

36.

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–S124PubMedCrossRef

37.

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 PubMedCrossRef

38.

Eckert SE, Desjardins RP, Keller EE, Tolman DE (1996) Endosseous implants in an irradiated tissue bed. J Prosthet Dent 76(1):45–49PubMedCrossRef

39.

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):135–139CrossRef

40.

Froschl T, Kerscher A (1997) The optimal vestibuloplasty in preprosthetic surgery of the mandible. J Craniomaxillofac Surg 25(2):85–90PubMedCrossRef

41.

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 PubMedCrossRef

42.

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 PubMedCrossRef

43.

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):49–54PubMedCrossRef

44.

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):105–110PubMed

45.

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

46.

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 PubMedCrossRef

47.

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 PubMedCrossRef

48.

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 PubMedCrossRef

49.

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

50.

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

51.

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

52.

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

53.

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

54.

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

55.

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

56.

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

57.

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

58.

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

59.

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

60.

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

61.

Esser E, Wagner W (1997) Dental implants following radical oral cancer surgery and adjuvant radiotherapy. Int J Oral Maxillofac Implants 12(4):552–557

Title: Oral rehabilitation with dental implants in irradiated patients: a meta-analysis on implant survival
Authors: E. Schiegnitz
B. Al-Nawas
P. W. Kämmerer
K. A. Grötz
Publication date: 01-04-2014
Publisher: Springer Berlin Heidelberg
Published in: Clinical Oral Investigations / Issue 3/2014
Print ISSN: 1432-6981
Electronic ISSN: 1436-3771
DOI: https://doi.org/10.1007/s00784-013-1134-9

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Oral rehabilitation with dental implants in irradiated patients: a meta-analysis on implant survival

Abstract

Objectives

Material and methods

Results

Conclusions

Clinical relevance

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Abstract

Objectives

Material and methods

Results

Conclusions

Clinical relevance

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