MDS Periodontics, Gainesville, Florida, USA.
Regenerative Medicine and Tissue Engineering Saint Camillus International University of Health and Medical Science, Rome, Italy.
J Biol Regul Homeost Agents. 2021 Mar-Apr;35(2 Suppl. 1):53-65. doi: 10.23812/21-2supp1-5.
Radiotherapy to head and neck has always been considered as a risk factor for rehabilitation with dental implants. Nevertheless, recent data suggest that overall, 5-year implant survival in irradiated patients can be greater than 90%. The purpose of this review was to compare the implant survival rates of irradiated and non-radiated head and neck cancer sites, and discuss the outcomes, through a systematic review approach of prospective and retrospective studies. Electronic searches were performed in the EMBASE, Cochrane, and PubMed/Medline databases up to 2019 Dec, to identify retrospective and prospective clinical studies addressing the subject. This systematic review was conducted according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. The primary variables collected from the studies were the site of tumor, age and sex of the patient, site of implant placement, radiation dosage, frequency and duration of radiotherapy, follow-up duration, implant survival and stability, hard and soft tissue changes after implant placement, any type of biological and mechanical complication, and oral health quality of life (QOL). Fifteen studies including 1097 patients and a total of 4637 implants placed in irradiated and non-irradiated sites, with a follow up duration varying from 6 to 120 months, were selected for the systematic review. The results of the quantitative synthesis suggested statistically significantly better survival rate of implants placed in nonradiated sites, as compared to irradiated sites (p<0.00001). However, the cumulative survival rates over a period of 7-10 years were reported to be comparable. Quality of life (QOL) after implant rehabilitation was not found to be significantly different between the compared groups. Due to the limited number of information, insufficient data was available to draw conclusion on peri-implant complication rate. No relationship was found between age, gender, and implant survival rates. Implant placement in irradiated sites is challenging and often warrants protocol modifications. Although statistically the survival rates at irradiated sites were lower in comparison to non-radiated sites, a strict inclusion criterion in patient selection, timing of implant placement after radiotherapy, radiation dosage and regular oral hygiene maintenance could minimize the chances of implant failure in irradiated patients.
头颈部放射治疗一直被认为是牙科种植体修复的一个危险因素。然而，最近的数据表明，总的来说，接受放射治疗的患者 5 年种植体存活率可以大于 90%。本综述的目的是通过系统评价前瞻性和回顾性研究，比较头颈部癌放疗和非放疗部位的种植体存活率，并讨论其结果。通过电子检索 EMBASE、Cochrane 和 PubMed/Medline 数据库，截至 2019 年 12 月，检索到解决该问题的回顾性和前瞻性临床研究。本系统评价按照系统评价和荟萃分析的首选报告项目（PRISMA）指南进行。从研究中收集的主要变量包括肿瘤部位、患者年龄和性别、种植体放置部位、放射剂量、放射治疗频率和持续时间、随访时间、种植体存活率和稳定性、植入后软硬组织变化、任何类型的生物和机械并发症以及口腔健康生活质量（QOL）。纳入了 15 项研究，共 1097 例患者，共 4637 枚种植体分别放置在放疗和非放疗部位，随访时间从 6 个月到 120 个月不等，对其进行了系统评价。定量综合结果表明，与放疗部位相比，非放疗部位种植体的存活率明显更高（p<0.00001）。然而，在 7-10 年的时间段内，累积存活率报告相当。两组比较发现，种植体修复后的生活质量（QOL）没有显著差异。由于信息有限，不足以得出关于种植体周围并发症发生率的结论。年龄、性别与种植体存活率之间没有关系。在放疗部位放置种植体具有挑战性，通常需要修改方案。尽管统计学上，与非放疗部位相比，放疗部位的存活率较低，但通过严格选择患者，在放疗后选择合适的时机放置种植体，控制放射剂量并定期进行口腔卫生维护，可以最大程度地降低放疗患者种植体失败的几率。
