Dental Implant Survival in Irradiated Oral Cancer Patients: A Systematic Review of the Literature
Nasser Nooh, BDS, MS, DSc
Purpose: Oral cancer therapy with surgery and radiation is associated with comorbidities; this affects rehabilitation with osseointegrated dental implants. The aim of this systematic review was to evaluate the effect of radiation therapy on osseointegrated dental implant survival in oral cancer patients. Materials and Methods: A review of the literature published between 1990 and June 2012 was conducted. Pertinent studies evaluating the effect of radiation therapy on osseointegration of implants were identified through searches of PubMed, SCIRUS, and Google Scholar. Overall implant survival rates were compared with respect to timing of radiation (prior to or after implantation), site of implant placement (maxilla, mandible, vascularized free flaps, nonvascular bone grafts), radiation dose, time interval between radiation therapy and implant placement, and the effect of hyperbaric oxygen therapy. Results: Thirty-eight articles were eligible for inclusion in the review. Overall implant survival rates with radiation therapy done pre- and postimplantation were 88.9% and 92.2%, respectively. In preimplantation radiation therapy, the implant survival rate was significantly higher for the mandible (93.3%) than for the maxilla (78.9%) or for grafted bone (87.5%). Similarly, the implant survival rate was higher when implants were placed in free flaps (89.3%) than in nonvascularized bone grafts (81.7%). While a radiation dose above 55 Gy significantly decreased implant survival, no significant relationship between increased implant survival and the remaining variables were found. Conclusion: There, was no significant difference in dental implant survival rates between preimplantation and postimplantation radiation therapy. The anatomical site of implant placement in preimplantation radiation therapy was the most pertinent variable affecting implant survival, with a better survival rate in the mandible compared to the maxilla and grafted bone.