Postradiation dental extractions: a review of the literature and a report of 72 episodes.

This report outlines our experiences involving 72 episodes of postradiation dental extraction over an 11-year period. Bone exposures of 3 months or longer developed following 16 of the 72 postradiation extraction episodes (22%). The necrosis rate in the mandible was 29% (13 of 45) and in the maxilla was 11% (3 of 27). The risk of bone necrosis increased when the dose to bone exceeded 6,500 rad, and when 75% or more of the body of the mandible was within the radiation treatment volume. Five of the 13 mandibular bone necroses precipitated by postradiation extractions eventually required radical resection of the affected portion of the mandible. The remaining eight mandibular episodes healed with conservative measures. When possible, given the two above conditions, root canal therapy rather than dental extraction should be employed to resolve mandibular dental infection within the radiation field after radiotherapy.