Gorjizad Mansour, Aryannejad Majid, Shahriari Ali, Aslani Khiavi Mahsa, Barkhordari Dashtkhaki Maedeh, Rigi Amirhossein, Mohamadi Zhina, Asgari Pouya, Shirazi Shirindokht, Ziaei SeyedMehdi, Asadi Anar Mahsa
School of Dentistry, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
Student Research Committee, Dental School, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran.
Spec Care Dentist. 2025 Mar-Apr;45(2):e70022. doi: 10.1111/scd.70022.
The use of implants in irradiated patients has been critically questioned due to the presence of Osteoradionecrosis and other side effects of radiation therapy. Hence, our objective is to examine the likelihood of dental implant survival and the incidence of osteoradionecrosis in patients with head and neck cancer who have undergone radiation therapy. This analysis will aid in making informed therapeutic decisions on oral rehabilitation for individuals at high risk, ensuring maximal benefit.
PubMed, Scopus, and Web of Science were queried until April 2024. The digital data were extracted using the Web plot digitizer. We utilized the most recent iteration of STATA (version 18) to perform a meta-analysis of the data. The studies were evaluated for quality using the New Castle-Ottawa Scale. Egger's test was used to evaluate the presence of publication bias caused by modest research effects.
The study analyzed data from 21 research papers on 753 head and neck cancer patients. The majority were male, with a mean age of 60.25 years. 46% underwent radiotherapy, with 2261 dental implants inserted. The mandible was the most used implant site, accounting for 62.4%. The mean time between implant placement and radiotherapy was 5.3 weeks, with a median waiting period of 30.7 months for secondary surgery. After an average follow-up of 42.25 months, 58% of implants failed in the irradiated control group, while 6% failed in the non-irradiated control subgroup. Osteoradionecrosis was seen in 26 patients, resulting in an incident rate of 1.81%. As a result of this problem, an average of 2.5 implants per patient were not successfully retained. Radiotherapy was found to be a significant risk factor for implant survival.
Our research indicates that the survival rate of implants in patients who have undergone radiation therapy is lower compared to those who have not received radiation therapy. Additionally, although rare, osteoradionecrosis is a significant complication that every oral and maxillofacial surgeon should be ready to address. Enhancing the quality of care, mitigating hazards, and reducing treatment duration may hinge upon implementing a systematic approach to patient selection and therapy.
由于放射性骨坏死以及放射治疗的其他副作用的存在，在接受过放射治疗的患者中使用植入物受到了严格质疑。因此，我们的目标是研究接受过放射治疗的头颈癌患者牙种植体存活的可能性以及放射性骨坏死的发生率。该分析将有助于为高危个体的口腔修复做出明智的治疗决策，确保最大获益。
截至2024年4月，对PubMed、Scopus和Web of Science进行了检索。使用Web绘图数字化仪提取数字数据。我们使用最新版本的STATA（版本18）对数据进行荟萃分析。使用纽卡斯尔-渥太华量表评估研究质量。使用Egger检验评估由适度研究效应引起的发表偏倚的存在。
该研究分析了来自21篇关于753名头颈癌患者的研究论文的数据。大多数为男性，平均年龄为60.25岁。46%的患者接受了放射治疗，共植入2261颗牙种植体。下颌骨是最常使用的种植部位，占62.4%。种植体植入与放射治疗之间的平均时间为5.3周，二次手术的中位等待期为30.7个月。平均随访42.25个月后，放射治疗对照组中58%的种植体失败，而未接受放射治疗的对照组亚组中6%的种植体失败。26例患者出现放射性骨坏死，发生率为1.81%。由于这个问题，平均每位患者有2.5颗种植体未成功保留。发现放射治疗是种植体存活的一个重要危险因素。
我们的研究表明，与未接受放射治疗的患者相比，接受过放射治疗的患者种植体的存活率较低。此外，尽管罕见，但放射性骨坏死是每个口腔颌面外科医生都应随时准备应对的重大并发症。提高护理质量、减轻风险和缩短治疗时间可能取决于实施系统的患者选择和治疗方法。
