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

Nabil, Syed; Samman, N

doi:10.1016/j.ijom.2010.10.005

Cited by 282 publications

(337 citation statements)

References 79 publications

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“…However, another systematic review with meta-analysis by Nabil and Samman 35 (2011) found a 7% incidence of ORN after tooth extraction. When extractions were performed along with HBO the incidence was 4%, while extraction in conjunction with antibiotics presented an incidence of 6%.…”

Section: Hbo Therapy In Preventionmentioning

confidence: 99%

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Maxillary osteoradionecrosis – review of published literature: incidence, classification, risk factors, physiopathology and prevention

Berthold

Zanella²,

Heitz³

2013

Rev. da Fac. de Odontologia, UPF

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Section: Hbo Therapy In Preventionmentioning

confidence: 99%

“…However, it depends on the quality of the studies reviewed. There are systematic reviews regarding the incidence and prevention of ORN 32,34,35,37 . However, most studies included are retrospective analysis and represent weak evidence.…”

Section: Final Considerationsmentioning

confidence: 99%

Maxillary osteoradionecrosis – review of published literature: incidence, classification, risk factors, physiopathology and prevention

Berthold

Zanella²,

Heitz³

2013

Rev. da Fac. de Odontologia, UPF

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“…There is weak evidence to suggest that the use of antibiotics in general confers a 1% absolute risk reduction in ORN compared to no antibiotics. Despite only weak evidence, prophylactic antibiotic use is still common following extractions [61]. The authors do not encourage use of antibiotics where there is no infection.…”

Section: Post-radiotherapy Management: Orn Antibiotics and Prpmentioning

confidence: 92%

“…A minimal trauma technique is especially indicated in the irradiated patient and therefore experienced clinicians should perform the procedure. In addition, investigators have proposed that the number of teeth removed in a single session should be limited, and specific local anaesthetics should be avoided, however data for these recommendations appear to be lacking and should be further investigated before they have an impact on clinical practice [3,61,62].…”

Section: Table 11 Selected Staging Systems For Ornmentioning

confidence: 99%

“…A recent systematic review showed weak evidence that HBO reduced the rate of post-radiotherapy extraction related ORN from 7% to 4% [61], a Cochrane review published in 2012 showed some benefit for therapeutic HBO in regards to mucosal cover and prevention of wound dehiscence but concluded that more and better quality data was needed [67]. It is promising therefore, that larger trials are underway [68].…”

Section: Post-radiotherapy Management: Orn and Hyperbaric Oxygenmentioning

confidence: 99%

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Pre-radiotherapy dental extractions and osteoradionecrosis: a retrospective analysis and cross-sectional study on quality of life

Beech¹

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Primary vs Secondary Endosseous Implantation After Fibular Free Tissue Reconstruction of the Mandible for Osteoradionecrosis

Menapace

Abel

Jackson

et al. 2018

JAMA Facial Plast Surg

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The clinical and financial implications of the timing of dental rehabilitation after a fibula free tissue transfer (FFTT) for osteoradionecrosis (ORN) and osteonecrosis (ON) of the mandible have yet to be established. OBJECTIVE To compare the outcomes of primary implantation vs secondary implantation after FFTT for ORN and ON of the mandible. DESIGN, SETTING, AND PARTICIPANTS A retrospective review was conducted of 23 patients at a single tertiary academic referral center undergoing primary implantation or secondary implantation after FFTT for ORN and ON from January 1, 2006, to November 10, 2015. INTERVENTIONS All patients underwent FFTT with primary implantation (n = 12) or secondary implantation (n = 11). MAIN OUTCOMES AND MEASURES Outcomes of FFTT, dental implantation, implant use, diet, speech, and disease-free survival were reviewed. Fixed unit costs were estimated based on the mean cost analysis. RESULTS Twenty-three patients (7 women and 16 men; mean [SD] age, 62.4 [8.2] years [range, 24-81 years]) met the inclusion criteria. Of these, 18 had ORN and 5 had ON. Dental implantation was performed at the time of FFTT for 12 patients and was performed secondarily for 11 patients. There were a mean of 5.2 implants per patient performed, for a total of 121 implants. There was 1 complete flap failure in the primary implantation group. Neither flap nor implant complications were affected by the timing of the implantation. Overall, the implant survival rate was 95% (55 of 58) in the primary implantation group and 98% (62 of 63) in the secondary implantation group. Time from FFTT to abutment placement (primary implantation, 19.6 weeks; secondary implantation, 61.0 weeks) was significantly shorter after primary implantation (P < .001). There was no clinical difference in postoperative complications and implant outcomes for ORN vs ON. Improvement in speech and oral competence in the primary implantation group vs the secondary implantation group was not statistically significant, given an experiment-adjusted P = .001 set as significant (normal speech, 9 vs 3; P = .02; and normal oral competence, 9 vs 3; P = .02). Disease-free survival was 91% (20 of 22 patients) overall. Fixed unit (U) costs were 1.0 U for primary implantation and 1.24 U for secondary implantation. CONCLUSIONS AND RELEVANCE Patients undergoing primary implantation after FFTT for ORN and ON had a similar rate of complications compared with those undergoing secondary implantation. However, primary implantation allowed a faster return than secondary implantation to oral nutrition and prosthesis use. The fixed unit cost was reduced for those undergoing primary implantation. Although dental implantation was safe and effective in both groups, the decreased time to use and the decreased overall cost should prompt surgeons to consider primary implantation after FFTT for ORN and ON. LEVEL OF EVIDENCE 3.

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

Cited by 282 publications

References 79 publications

Maxillary osteoradionecrosis – review of published literature: incidence, classification, risk factors, physiopathology and prevention

Maxillary osteoradionecrosis – review of published literature: incidence, classification, risk factors, physiopathology and prevention

Pre-radiotherapy dental extractions and osteoradionecrosis: a retrospective analysis and cross-sectional study on quality of life

Primary vs Secondary Endosseous Implantation After Fibular Free Tissue Reconstruction of the Mandible for Osteoradionecrosis

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