Dental aspects of osteoradionecrosis

Osteoradionecrosis of the jaws: definition, epidemiology, staging and clinical and radiological findings. A concise review

“…ORN is not usually detectable radiographically in early stages. Imaging features are not correlated to the severity of ORN. The described radiographic features range from normal appearance, to localised osteolytic areas, extensive osteolytic areas, sequestra and fracture ( Figure b ).…”

Osteoradionecrosis of the mandible: A ten year single-center retrospective study

“…There is controversy in the literature regarding the initial treatment of choice. Some surgeons have concluded that conservative treatment should always be tried first, because in cases of failure a more radical approach can be performed (Niebel andNeeman, 1957, Hahn andGorgill, 1966); others claim that a radical approach should be instituted at the initial diagnosis (MacDougall et al, 1963, Marchetta et al, 1967.…”

Incidence and prevention of osteoradionecrosis after dental extraction in irradiated patients: a systematic review

“…This procedure attempts to trim off sharp bony spicules and provide soft tissue cover for the sockets to prevent bone exposure 3,21,75 . NIEBEL and NEENAN suggested that alveoloplasty should be done to reduce the clot size 63 . Another reason is that the alveolar ridge will not readily remodel in this compromised tissue resulting in an irregular ridge that would cause increased risk of bony exposure when wearing a denture in the future 6,14 .…”

“…Limiting the number of teeth extracted per-session has been suggested to prevent ORN by avoiding overburdening the already limited blood supply 9,14,59 . Other less popular suggestions include avoiding lidocaine or adrenaline-containing local anesthesia 16,50,59 , the use of a nasogastric tube during the postoperative period 39 , elastic or orthodontic extraction 63,72 and chlorhexidine mouthwash 50,81 . These measures have not been supported by evidence as no specific studies have been performed to assess their effectiveness in preventing ORN in post-radiation extraction.…”