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. 2021 Jul 14;16(1):130.
doi: 10.1186/s13014-021-01851-0.

Predictors of osteoradionecrosis following irradiated tooth extraction

Szu Ching Khoo  1 , Syed Nabil  1 , Azizah Ahmad Fauzi  2 , Siti Salmiah Mohd Yunus  1 , Wei Cheong Ngeow  3 , Roszalina Ramli  4
Affiliations

Predictors of osteoradionecrosis following irradiated tooth extraction

Szu Ching Khoo et al. Radiat Oncol. .

Abstract

Background: Tooth extraction post radiotherapy is one of the most important risk factors of osteoradionecrosis of the jawbones. The objective of this study was to determine the predictors of osteoradionecrosis (ORN) which were associated with a dental extraction post radiotherapy.

Methods: A retrospective analysis of medical records and dental panoramic tomogram (DPT) of patients with a history of head and neck radiotherapy who underwent dental extraction between August 2005 to October 2019 was conducted.

Results: Seventy-three patients fulfilled the inclusion criteria. 16 (21.9%) had ORN post dental extraction and 389 teeth were extracted. 33 sockets (8.5%) developed ORN. Univariate analyses showed significant associations with ORN for the following factors: tooth type, tooth pathology, surgical procedure, primary closure, target volume, total dose, timing of extraction post radiotherapy, bony changes at extraction site and visibility of lower and upper cortical line of mandibular canal. Using multivariate analysis, the odds of developing an ORN from a surgical procedure was 6.50 (CI 1.37-30.91, p = 0.02). Dental extraction of more than 5 years after radiotherapy and invisible upper cortical line of mandibular canal on the DPT have the odds of 0.06 (CI 0.01-0.25, p < 0.001) and 9.47 (CI 1.61-55.88, p = 0.01), respectively.

Conclusion: Extraction more than 5 years after radiotherapy, surgical removal procedure and invisible upper cortical line of mandibular canal on the DPT were the predictors of ORN.

Keywords: Dental extraction; Osteoradionecrosis; Post radiotherapy; Predictors.

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Conflict of interest statement

The authors declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
Bony sclerosis in relation to tooth 47
Fig. 2
Fig. 2
Bony resorption in relation to tooth 44
Fig. 3
Fig. 3
Mixed radiopaque-radiolucent lesion in relation to tooth 36
Fig. 4
Fig. 4
Visible upper cortical line of the left mandibular canal
Fig. 5
Fig. 5
Invisible upper cortical line of the left mandibular canal
See this image and copyright information in PMC

References

    1. Epstein JB, Wong FLW, Stevenson-Moore P. Osteoradionecrosis: clinical experience and a proposal for classification. J Oral Maxillofac Surg. 1987;45:104–110. doi: 10.1016/0278-2391(87)90399-5. - DOI - PubMed
    1. Nabil S, Samman N. Incidence and prevention of osteoradionecrosis after dental extraction in irradiated patients: a systematic review. Int J Oral Maxillofac Surg. 2011;40:229–243. doi: 10.1016/j.ijom.2010.10.005. - DOI - PubMed
    1. Marx RE. Osteoradionecrosis: a new concept of its pathophysiology. J Oral Maxillofac Surg. 1983;41:283–288. doi: 10.1016/0278-2391(83)90294-X. - DOI - PubMed
    1. Thorn JJ, Hansen HS, Specht L, Bastholt L. Osteoradionecrosis of the jaws: clinical characteristics and relation to the field of irradiation. J Oral Maxillofac Surg. 2000;58:1088–1093. doi: 10.1053/joms.2000.9562. - DOI - PubMed
    1. Reuther T, Schuster T, Mende U, Kübler A. Osteoradionecrosis of the jaws as a side effect of radiotherapy of head and neck tumour patients—a report of a thirty year retrospective review. Int J Oral Maxillofac Surg. 2003;32:289–295. doi: 10.1054/ijom.2002.0332. - DOI - PubMed

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