Pacheco Maria Cândida Dourado, Prado Alexandre Henrique Dos Reis, da Costa Danilo Viegas, de Arantes Lara Cancella, Portela Caio Fernando Teixeira, Campos Tarcísio Passos Ribeiro, de Oliveira Arno Heeren
Department of Nuclear Engineering, Federal University of Minas Gerais, School of Engineering, Belo Horizonte, Minas Gerais, Brazil.
Restorative Dentistry, Federal University of Minas Gerais, School of Dentistry, Belo Horizonte, Minas Gerais, Brazil.
PLoS One. 2025 Sep 3;20(9):e0324388. doi: 10.1371/journal.pone.0324388. eCollection 2025.
There is an increasing demand for oral rehabilitation in patients undergoing irradiation for head and neck cancer treatment. Although radiotherapy appears to adversely affect implanted oral rehabilitation, the evidence provided by previous systematic reviews in the field remains controversial. Thus, this umbrella review aimed to evaluate the survival of dental implants installed before and/or after radiotherapy in patients with head and neck cancer compared to those not irradiated.
A comprehensive search of electronic databases was performed in the PubMed, Cochrane Library, Embase, Web of Science, and Google Scholar databases, including manual searches, from inception to February, 2024, with no language or date restrictions. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020 guidelines were followed. Survival percentage of dental implants was the primary outcome. A Measurement Tool to Assess systematic Reviews (AMSTAR) 2 was used as a critical appraisal tool for the included studies. The protocol for this review has been registered with PROSPERO (CRD42023406059).
Of the 1,811 articles screened, 11 articles that evaluated 73,674 implants were included. Quantitative analyses showed 2,674 failures out of 14,471 implants installed in irradiated bone and 1,825 failures out of 34,092 implants in non-irradiated bone. The survival rate was 81.52% for irradiated implants and 94.64% for non-irradiated implants. A significant difference in survival in favor of implants in non-irradiated bone is supported by 11 meta-analyses. The included systematic reviews showed critically low methodological quality.
Although the included studies had low methodological quality, the findings indicate a higher failure rate of implants in irradiated patients. Further well-designed clinical studies are warranted.
对头颈部癌症进行放射治疗的患者对口腔修复的需求日益增加。尽管放射治疗似乎会对植入的口腔修复产生不利影响，但该领域先前的系统评价所提供的证据仍存在争议。因此，本综合评价旨在评估头颈部癌症患者在放疗前和/或放疗后植入牙种植体的存活率，并与未接受放疗的患者进行比较。
在PubMed、Cochrane图书馆、Embase、Web of Science和谷歌学术数据库中对电子数据库进行全面检索，包括手工检索，检索时间从建库至2024年2月，无语言或日期限制。遵循系统评价和Meta分析的首选报告项目（PRISMA）2020指南。牙种植体的存活率是主要结果。使用系统评价评估测量工具（AMSTAR）2作为纳入研究的关键评估工具。本评价方案已在PROSPERO（CRD42023406059）注册。
在筛选的1811篇文章中，纳入了11篇评估73674颗种植体的文章。定量分析显示，在照射骨中植入的14471颗种植体中有2674颗失败，在未照射骨中植入的34092颗种植体中有1825颗失败。照射后种植体存活率为81.52%，未照射种植体存活率为94.64%。11项Meta分析支持未照射骨中种植体的存活率存在显著差异。纳入的系统评价显示方法学质量极低。
尽管纳入的研究方法学质量较低，但研究结果表明接受放疗患者的种植体失败率较高。有必要进行进一步设计良好的临床研究。
