Implant-Supported Oral Rehabilitation in Head and Neck Cancer Patients: A 20-Year Single-Center Study (2005-2024)

Abstract

Background/Objectives: Oral cancer resection often leads to maxillofacial defects and dentition loss, compromising patients' quality of life. Implant-supported prosthetic rehabilitation offers a reliable solution to restore function, though factors such as bone reconstruction, radiotherapy, and timing of implant placement (immediate vs. delayed) may influence outcomes. This study aimed to evaluate long-term implant survival and rehabilitation timelines in oncologic patients, comparing two cohorts (2005-2014 and 2015-2024) to assess the impact of evolving clinical practices. Methods: A retrospective cohort study was conducted at Hospital General Universitario Gregorio Marañón (Madrid, Spain), including 304 patients who underwent ablative oral cancer surgery and subsequent implant-based rehabilitation between 2005 and 2024. Data on demographics, oncologic treatment, reconstruction, implant timing, and prosthetic rehabilitation were collected. Outcomes were compared using Kaplan-Meier analysis and appropriate statistical tests between the 2005-2014 (n = 122) and 2015-2024 (n = 182) cohorts. Results: A total of 2341 Ticare Implants^® were placed, supporting 281 prostheses. Implant placement during primary surgery increased from 41% to 71% (p < 0.001). The median time from surgery to prosthesis significantly decreased from 24 to 15 months (p < 0.001). Five-year implant survival was 95% in the early cohort versus 97% in the later cohort. Implant survival was comparable between irradiated and non-irradiated patients (~94-96%). Fixed prostheses became more frequent (92% vs. 79%, p = 0.002). Conclusions: Implant-supported rehabilitation in oncologic patients is highly feasible and durable, with improved timelines and functional outcomes associated with early implant placement and modern digital planning strategies.

Keywords: 3D printing; dental implants; free fibula flap; head and neck oncology; implant stability quotient; implant survival; oral cancer; osseointegration; point-of-care manufacturing; prosthetic rehabilitation; radiotherapy.

Figure 1

Example of an implant surgical guide manufactured through an academic point-of-care manufacturing workflow. The guide was designed for mandibular reconstruction using a fibula free flap and fabricated by stereolithography (SLA) technology with Biomed Clear V1 resin. Intraoperative view of the static guided implant surgical guide in position. Final panoramic radiograph (OPG) showing the completed case.

Figure 2

Kaplan–Meier curves showing the implant survival over time in the two cohorts (2005–2014 in red, 2015–2024 in blue). The Y-axis represents the percentage of implants remaining successfully integrated (not lost) as a function of time since implant placement. Both cohorts exhibit high survival, but the 2015–2024 cohort shows a slightly higher survival curve, especially in the early post-implant period. By 60 months (5 years), survival was ~95% in the 2005–2014 group vs. ~97% in the 2015–2024 group (log-rank p = 0.30, n.s.). The initial steeper drop in the red curve reflects a higher rate of early implant failures in the 2005–2014 cohort.

Figure 3

Kaplan–Meier survival curves comparing dental implant survival between maxillary and mandibular bone sites. Differences between groups were assessed using the log-rank test.

Figure 4

Kaplan–Meier survival curves comparing dental implant survival between native bone and reconstructed bone. Implant survival probability was higher in reconstructed bone compared to native sites throughout the follow-up period. Statistical differences were evaluated using the log-rank test.

Figure 5

Histogram showing dental implant survival rates stratified by bone type (native vs. reconstructed) and location (maxilla vs. mandible).

Figure 6

Histogram illustrating dental implant survival rates in irradiated versus non-irradiated patients.

Figure 7

Distribution of time to functional rehabilitation following implant placement. The histogram illustrates the variability in time intervals required to achieve functional prosthetic loading across the patient cohort.

Figure 8

Distribution of the number of implants per patient among 304 head and neck cancer patients. The orange bar and dashed line indicate the mean number of implants per patient (7.7), while the cyan bar and dashed line represent the median (8 implants). Most patients received between 6 and 10 implants to support their prosthetic rehabilitation.

Figure 9

Comparison of implant success rates between immediate and delayed loading protocols. The success rate was higher in implants subjected to delayed loading compared to those with immediate loading.

Figure 10

Implant survival over time, stratified by anatomical site (maxilla vs. mandible).

Figure 11

Kaplan–Meier survival curves illustrating dental implant survival based on bone type (native vs. grafted) and radiotherapy status (irradiated vs. non-irradiated). Implants placed in native, non-irradiated bone showed the highest survival rates over time, while implants in grafted, irradiated bone exhibited significantly lower survival rates throughout the follow-up period.

Figure 12

Kaplan–Meier survival curves comparing dental implant survival based on timing of placement. Implants placed during primary surgery demonstrated higher survival rates over the follow-up period compared to implants placed during secondary procedures.

Figure 13

Distribution of time to prosthetic rehabilitation in two patient cohorts. Patients treated between 2005 and 2014 experienced significantly longer times to prosthetic rehabilitation compared to those treated between 2015 and 2024 (p < 0.05, Mann–Whitney U test), reflecting improvements in surgical planning and prosthetic workflows over time.

Figure 14

Forest plot showing hazard ratios (HR) and 95% confidence intervals (CI) for clinical and procedural factors affecting dental implant survival and time to prosthetic rehabilitation. Reconstruction with grafted bone and prior radiotherapy were associated with a trend towards reduced survival, although statistical significance was not always achieved. No significant difference in implant survival was observed between immediate and delayed loading protocols. Patients treated more recently (2015–2024 cohort) achieved faster functional rehabilitation compared to those treated between 2005 and 2014.