Mancha de la Plata Maria, Gías Luis Naval, Díez Pedro Martos, Muñoz-Guerra Mario, González-García Raul, Lee Gui-Youn Cho, Castrejón-Castrejón Sergio, Rodríguez-Campo Francisco J
Department of Oral and Maxillofacial Surgery, University Hospital Montepríncipe, Grupo Madrid, Madrid, Spain.
J Oral Maxillofac Surg. 2012 May;70(5):1052-63. doi: 10.1016/j.joms.2011.03.032. Epub 2011 Jul 22.
The aim of this study is to analyze implant survival in patients who received radiotherapy treatment for oral malignancies and in patients who had suffered mandibular osteoradionecrosis.
We reviewed retrospectively 225 implants placed in 30 patients who had received radiotherapy as part of the oncologic treatment. Radiation doses ranged between 50 and 70 Gy. 39 implants were placed after a combined treatment of radiotherapy and chemotherapy. Data referred to tumour type and reconstruction, presence of osteoradionecrosis, region of implant installation and type of prostheses were recorded. Survival rates were calculated with cumulative Kaplan-Meier survival curves and compared between different groups with a log-rank test.
152 osseointegrated implants were placed in patients who presented previous reconstruction procedure. Five patients developed osteorradionecrosis as a complication of the radiotherapy treatment. Once osteoradionecrosis had healed in these patients, 41 implants were installed. The overall 5 year survival rate in irradiated patients was 92.6%. Irradiated patients had a marginally significantly higher implant loss than non-irradiated patients. (p = 0.063). The 5 year survival rate in the osteoradionecrosis group was of 48.3% and in the non-osteoradionecrosis group 92.3%, with a statistically significant difference between both groups. (p = 0.002).
Osseointegrated implants enhance oral rehabilitation in most irradiated patients, even being an acceptable option for patients who had suffered osteoradionecrosis. Totally implant supported prostheses are recommended after irradiation providing functional, stable and aesthetically satisfactory rehabilitation.
本研究旨在分析接受口腔恶性肿瘤放射治疗的患者以及患有下颌骨放射性骨坏死的患者的种植体存活率。
我们回顾性分析了30例接受放射治疗作为肿瘤治疗一部分的患者植入的225枚种植体。放射剂量在50至70 Gy之间。39枚种植体是在放疗和化疗联合治疗后植入的。记录了肿瘤类型和重建情况、放射性骨坏死的存在、种植体植入区域和假体类型等数据。用累积Kaplan-Meier生存曲线计算存活率，并通过对数秩检验在不同组之间进行比较。
152枚骨整合种植体植入了先前进行过重建手术的患者。5例患者发生放射性骨坏死，作为放射治疗的并发症。这些患者的放射性骨坏死愈合后，植入了41枚种植体。接受放疗患者的总体5年存活率为92.6%。接受放疗的患者种植体丢失率略高于未接受放疗的患者。（p = 0.063）。放射性骨坏死组的5年存活率为48.3%，非放射性骨坏死组为92.3%，两组之间存在统计学显著差异。（p = 0.002）。
骨整合种植体可改善大多数接受放疗患者的口腔功能，即使对于患有放射性骨坏死的患者也是一个可接受的选择。建议放疗后使用完全种植支持的假体，以提供功能、稳定且美观满意的修复。
