Carl W, Ikner C
Department of Dentistry and Maxillofacial Prosthetics, Roswell Park Cancer Institute, Buffalo, N.Y., USA.
J Prosthet Dent. 1998 Mar;79(3):317-22. doi: 10.1016/s0022-3913(98)70244-6.
Dental extractions in patients who had radiation therapy for cancer in the head and neck region carry with them the risks of delayed healing, prolonged alveolar bone exposure, infection, and osteoradionecrosis. Among the precautions to minimize these risks are antibiotic coverage, limited extractions at any one time, soft tissue closure, and hyperbaric oxygen treatment. Rapid epithelization and minimal bone exposure are essential after extractions in irradiated patients.
This study examined the effects of hard tissue replacement on head and neck cancer patients who were treated with radiation therapy.
In a series of eight patients who had radiation doses from 4000 cGy to 7440 cGy in the head and neck area and who had 44 teeth extracted, hard tissue replacement material mixed with tetracycline powder was placed in the extraction sites.
Of the 44 teeth extracted, 19 mandibular molars and premolars were in the direct field of radiation in seven patients. One patient also had 6 mandibular anterior teeth and 12 maxillary teeth extracted that received minimal radiation exposure. One patient had 6 mandibular anterior teeth extracted that were not in the area of direct exposure. One patient had a mandibular first molar extracted in an area that received minimal radiation exposure. Clinically, complete epithelization occurred in all patients. No infections developed. Radiographically no bone dissolution could be identified in the extraction area(s). The follow-up times ranged from 7 months to 18 months when the patients were seen last.
The hard tissue replacement particles appears to provide a matrix for fibrous connective tissue formation.
对头颈部癌症进行过放射治疗的患者进行拔牙，存在愈合延迟、牙槽骨长期暴露、感染和放射性骨坏死的风险。将这些风险降至最低的预防措施包括使用抗生素、每次进行有限的拔牙操作、软组织闭合以及高压氧治疗。对于接受过放射治疗的患者，拔牙后快速上皮化和最小程度的骨暴露至关重要。
本研究探讨了硬组织替代物对接受放射治疗的头颈部癌症患者的影响。
在一系列8名头颈部接受4000厘戈瑞至7440厘戈瑞放射剂量且拔除了44颗牙齿的患者中，将与四环素粉末混合的硬组织替代材料置于拔牙位点。
在拔除的44颗牙齿中，19颗下颌磨牙和前磨牙位于7名患者的直接放射野内。1名患者还拔除了6颗下颌前牙和12颗上颌牙，这些牙齿接受的放射暴露极少。1名患者拔除了6颗下颌前牙，这些牙齿不在直接暴露区域。1名患者在接受极少放射暴露的区域拔除了1颗下颌第一磨牙。临床上，所有患者均实现了完全上皮化。未发生感染。影像学检查在拔牙区域未发现骨溶解。患者最后一次就诊时的随访时间为7个月至18个月。
硬组织替代颗粒似乎为纤维结缔组织形成提供了基质。
