Department of Oral & Maxillofacial Surgery, Yonsei University College of Dentistry, 50-1 Yonsei-ro, Seodaemun-gu, Seoul 03722, Republic of Korea.
Department of Oral & Maxillofacial Surgery, Yonsei University College of Dentistry, 50-1 Yonsei-ro, Seodaemun-gu, Seoul 03722, Republic of Korea.
Oral Oncol. 2024 Sep;156:106945. doi: 10.1016/j.oraloncology.2024.106945. Epub 2024 Jul 13.
This study aimed to compare the risk of osteoradionecrosis and implant survival in oral cancer patients undergoing immediate dental implants during jaw reconstruction, termed "Jaw in a Day" (JIAD), with those receiving no implants or delayed implants (non-JIAD).
PATIENTS & METHODS: Clinicopathologic data were collected from prospectively enrolled JIAD patients (n = 10, 29 implants) and retrospectively from non-JIAD patients (n = 117, 86 implants). Survival analyses were performed to assess implant survival and osteoradionecrosis-free survival.
Osteoradionecrosis occurred in 0 % of JIAD cases compared to 19.3 % in non-JIAD cases without implants and 71.4 % in non-JIAD cases with delayed implants (p = 0.008). Osteoradionecrosis-free survival was significantly better in the JIAD group than the non-JIAD group (p = 0.0059). Implants in the JIAD group all survived regardless of radiation therapy (29/29, 100 %) and 95.1 % (58/61) of implants survived in delayed implants in non-irradiated fibula without radiotherapy. Meanwhile, only 11 of 25 implants placed in irradiated fibula flaps survived, even when the implants were placed after a median time interval of 624 days after radiotherapy, and none of them were earlier than 360 days. The survival analysis revealed a significant difference (p < 0.0001).
JIAD appears to offer superior outcomes in terms of implant survival and osteoradionecrosis prevention compared to delayed implant placement. Placing implants in irradiated fibula, even after years, significantly poses high risk of implant failure and osteoradionecrosis. JIAD represents a promising approach for optimal rehabilitation, particularly in oral cancer patients requiring postoperative radiotherapy. Proper positioning and orientation of implants and flaps are crucial for implant survival.
本研究旨在比较颌骨重建过程中即刻牙种植（JIAD）与未种植或延迟种植（非 JIAD）的口腔癌患者发生放射性骨坏死（ORN）和种植体存活率的风险。
从前瞻性纳入的 JIAD 患者（n=10，29 个种植体）中收集临床病理数据，并从非 JIAD 患者（n=117，86 个种植体）中回顾性收集数据。进行生存分析以评估种植体存活率和 ORN 无失败存活率。
JIAD 组 ORN 发生率为 0%，而非 JIAD 组无种植体者为 19.3%，延迟种植体者为 71.4%（p=0.008）。JIAD 组 ORN 无失败存活率明显优于非 JIAD 组（p=0.0059）。无论是否接受放疗，JIAD 组的所有种植体均存活（29/29，100%），在未放疗腓骨延迟种植体中，95.1%（58/61）的种植体存活。同时，即使在放疗后中位 624 天的时间间隔后将种植体放置在照射腓骨瓣中，也仅有 25 个种植体中的 11 个存活，且无一早于 360 天。生存分析显示存在显著差异（p<0.0001）。
与延迟种植相比，JIAD 似乎在种植体存活率和预防 ORN 方面具有更好的效果。即使在数年后，将种植体放置在照射的腓骨中，也会显著增加种植体失败和 ORN 的风险。JIAD 是一种很有前途的方法，可用于优化康复，特别是在需要术后放疗的口腔癌患者中。适当的种植体和皮瓣定位和定向对于种植体的存活至关重要。
