Implant placement after radiation in pateint with CA

[adwait]

I had a patent who had undergone surgical treatment for th CA of tongue on rt side ,same time the teeth were extracted .
He has also went through thesessions of radiation for 1 month .
one yr has passed after last dose of raditaion ,now he wats to go for replacemats of teeth with the implants .
Please elaborate on the dos and donts for the same
Adwait

        

[Anonymous]

I think send the patient for a cat scan. see the density of the bone in hounsefield units. than u can arrive at a conclusion. speak to the patients oncologist. find out the probability of the carcinoma recurring. if the chances of carcinoma recurring are less than you could consider an implant.

Thereafter speak to the patient and make hime aware of all the issues and risk factors .

Let the patient than decide.

The occlusion of the patient , the state of the remaining dentition , the patients salivary flow are some other factors that you need to look into.

Hope this helps.

Regards,

Veerendra Darakh

        

[Anonymous]

As of now i do not have enough knowledge on this particular case report but what i have compiled below is from few dentists blogs,,this should be of help::

REFER THE PATIENT TO AN ORAL AND MAXILLOFACIAL SURGEON. Work with the OMFS to plan how to proceed. This is a case where you need to stick to the restorative aspects of the case and let the surgeon do the surgery.

This is not a case for people who cannot manage the complications associated with the risks from previous radiation therapy, namely Osteoradionecrosis (ORN).

When a patient reports a history of radiation therapy it is important to know the Radiation Dosages Received, The location and ports of radiation therapy. The complications from Radiation Therapy INCREASE OVER TIME… THEY GET WORSE! The tissues become HYPOXIC, HYPOCELLULAR, and HYPOVASCULAR, increasingly so over time.

Bottom line… Do what is best for the patient. This means help them receive the best care possible, and in this case YOU STICK TO BEING THE RESTORATIVE DENTIST and let someone else assume the risks of Surgery.I know many General Dentists who are capable of treating these cases, and sometimes they do… BUT THEY ARE ADDITIONALLY QUALIFIED, because 1) They have Significant Hospital and Oncology Training Backgrounds 2) They work very closely with OMFS, Radiation Oncology, the Oncologists, and the Hyperbaric Oxygen Team.
3) They have proper informed consent paperwork as well.
4) They have hospital privileges as well. They take these “full-mouth extractions” to the Hospital OR (not because they aren’t capable of doing it in their office) but to help the patient understand the gravity of the situation and the risks they are taking.

        

[sushantpatel_doc]

Osteoradionecrosis is a real nasty complication of the radiotherapy in the treatment of head and neck cancer. Clinical manifestations of osteoradionecrosis may include continuous disturbing pain, orofacial fistula, exposed necrotic bone, pathologic jaw fracture, and purulence. It is more commonly seen in the mandible than in the maxilla due to the relatively decreased vascularity and increased bone density of the mandible. The mandible often receives a greater dose of radiation than the maxilla for the latter reason. Radiation dose is a contributing factor to the development of osteoradionecrosis as well as tumor location, dental trauma, the premorbid dentition and neglected oral health, or concomitant chemoradiotherapy if ever done. Sometimes, the question is that what happens when a patient already having implants in his/her mouth, develops a cancer, needing irradiation to the jawbone and what would the effect of these implants on the surrounding bone during radiotherapy of oral, nasal, and paranasal neoplasms be? Radiation scatter can cause both soft and hard tissue complications in the oral cavity making scattered radiation an important factor in head and neck region radiotherapy planning. It has not been even proved that a local overdose on the order of 15% to 21% will cause a significant increase in the incidence of bone necrosis around the osteo-integrated titanium implants, hence, they do not need to be removed before radiotherapy. As the primary osseous complication arising from radiation injury, osteoradionecrosis has clinically been defined in the literature as irradiated bone that has failed to heal in twelve weeks. As a matter of fact, it is a non-healing wound or a slow-healing radiation-induced ischemic necrosis of the bone with associated soft tissue necrosis even without having any sign of tumor cell seeding or metastasis. Dose enhancement factor that may contribute to osteoradionecrosis are always higher than 6000 cGy delivered by 25-MV x-ray machines. To handle these cases, a pre-surgical HBO diving protocol is mandatory, and no doubt that only a specialist oral and maxillofacial surgeon should take care of them. For those cases that the amount of received radiation is equal to 4000 cGy or less, and a time lapse(of twenty years for your patient), then go for it, and don’t be afraid of losing any litigation.

        

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