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In our study hemoglobin level after radio-chemotherapy was identified for the first time to be also a significant prognostic factor (univariate analysis) in head and neck cancer patients who underwent combined radio-chemotherapy. Besides chemotherapy plus low-dose irradiation achieved similar results in comparison with radical resection and high-dose radiotherapy at least for the first 2 years after therapy. Relapsing disease could be treated with 1 additional course of radiotherapy which is supposed to be well tolerated.

A comparative study was carried out of 276 Brånemark fixtures in the irradiated and nonirradiated anterior mandible with a mean follow-up period of 58.2 months. Postoperative radiotherapy with 60 Gy and 100% isodose for the anterior mandible using a 6-MV linear accelerator, conventional fractioning, and a split-course technique was administered in the irradiated patient group. HBO therapy was not applied. A statistical difference in the 5-year success rate between the irradiated and nonirradiated group was not found. Nevertheless, a significantly higher rate of perioperative soft tissue complications at implant insertion was seen in the irradiated group. The statistical analysis showed no significance for sex, interval between radiation and implant insertion (with a minimum of 10 months), or type of periimplant soft tissue (regional vs. flap). The prognosis for implants in the irradiated mandible was, however, statistically improved (n = 0.0035) when the healing period was longer than 4 months. Mobile periimplant soft tissue proved to be the main problem regardless of radiation load. Late complications have not been observed so far. The available results and clinical studies support a positive assessment of the regenerative potential of the irradiated mandible with regard to osteointegration of endosseous implants. A preceding radiotherapy up to 60 Gy should therefore not be considered as a contraindication for an implant/prosthetic rehabilitation.

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Endosseous osseointegrated implants have become an integral part of the treatment scheme for the prosthetic reconstruction and rehabilitation of masticatory function following scientific studies of the reactions between implant and soft and hard tissues. Furthermore, implants offer good chances for prosthetic rehabilitation in the insufficient bone site, if the extremely atrophic jaw is to be reconstructed by grafting procedures with avascular and vascular grafts, by guided bone regeneration, by distraction osteogenesis, by bone substitutes and in the future by osteoinductive proteins in order to prepare the conditions for implant insertion. Those reconstruction procedures combined with implants become often necessary, if complicated hard and soft tissue defects of the skull have to be reconstructed to create the prerequisites for the stabilisation of epitheses or to insert implant-supported devices.

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