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Meta-Analysis
. 2021 Oct;25(10):5579-5593.
doi: 10.1007/s00784-021-04065-6. Epub 2021 Aug 16.

Survival of dental implants and occurrence of osteoradionecrosis in irradiated head and neck cancer patients: a systematic review and meta-analysis

Daniel Jan Toneatti  1 , Ronny Roger Graf  1 , John-Patrik Burkhard  1 , Benoît Schaller  2
Affiliations
Meta-Analysis

Survival of dental implants and occurrence of osteoradionecrosis in irradiated head and neck cancer patients: a systematic review and meta-analysis

Daniel Jan Toneatti et al. Clin Oral Investig. 2021 Oct.

Abstract

Objectives: This systematic review assesses dental implant survival, calculates the incidence rate of osteoradionecrosis, and evaluates risk factors in irradiated head and neck cancer patients.

Materials and methods: Various databases (e.g., Medline/Embase using Ovid) and gray literature platforms were searched using a combination of keywords and subject headings. When appropriate, meta-analysis was carried out using a random effects model. Otherwise, pooled analysis was applied.

Results: A total of 425 of the 660 included patients received radiotherapy. In total, 2602 dental implants were placed, and 1637 were placed in irradiated patients. Implant survival after an average follow-up of 37.7 months was 97% (5% confidence interval, CI 95.2%, 95% CI 98.3%) in nonirradiated patients and 91.9% (5% CI 87.7%, 95% CI: 95.3%) after an average follow-up of 39.8 months in irradiated patients. Osteoradionecrosis occurred in 11 cases, leading to an incidence of 3% (5% CI 1.6%, 95% CI 4.9%). The main factors impacting implant survival were radiation and grafting status, while factors influencing osteoradionecrosis could not be determined using meta-analysis.

Conclusion: Our data show that implant survival in irradiated patients is lower than in nonirradiated patients, and osteoradionecrosis is-while rare-a serious complication that any OMF surgeon should be prepared for. The key to success could be a standardized patient selection and therapy to improve the standard of care, reduce risks and shorten treatment time.

Clinical relevance: Our analysis provides further evidence that implant placement is a feasible treatment option in irradiated head and neck cancer patients with diminished oral function and good long-term cancer prognosis.

Keywords: Bone grafting; Dental implants; Hyperbaric oxygenation; Mandibular reconstruction; Osteoradionecrosis; Radiotherapy.

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Conflict of interest statement

The authors declare no conflict of interest.

Figures

Fig. 1
Fig. 1
Adapted PRISMA flow-diagram. A single asterisk (*) indicates application of a filter proposed by the CADTH
See this image and copyright information in PMC

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