Rehabilitation of oral function in head and neck cancer patients after radiotherapy with implant-retained dentures: Effects of hyperbaric oxygen therapy

Abstract

Surgical treatment of malignancies in the oral cavity and subsequent radiotherapy often result in an anatomic and physiological oral condition unfavorable for prosthodontic rehabilitation. The objective of this prospective study was to assess the effect of hyperbaric oxygen therapy on treatment outcome (condition of peri-implant tissues, implant survival, oral functioning and quality of life) of prosthodontic rehabilitation with implant-retained lower dentures in radiated head and neck cancer patients 6 weeks and 1 year after placing the new dentures. The treatment outcome was assessed in a group of 26 head neck cancer patients who were subjected to radiotherapy after tumour surgery. Standardized questionnaires were completed and clinical and radiographic assessments were performed. After randomization, endosseous Brånemark implants were placed in the anterior part of the mandible either under antibiotic prophylaxis (13 patients) or under antibiotic prophylaxis combined with pre and postsurgery hyperbaric oxygen (HBO) treatment (13 patients). In the HBO and non-HBO group eight implants (implant survival 85.2%) and three implants (implant survival 93.9%) were lost, respectively. Peri-implant tissues had a healthy appearance in both groups. Osteoradionecrosis developed in one patient in the HBO group. All patients functioned well with their implant-retained lower denture. The quality of life related to oral functioning and denture satisfaction were improved to a comparable extent in the HBO and non-HBO group. Implant-retained lower dentures can improve the quality of life related to oral functioning and denture satisfaction in head and neck cancer patients. Adjuvant hyperbaric oxygen therapy could not be shown to enhance implant survival in radiated mandibular jaw bone.

A national survey of oral and maxillofacial surgeons' attitudes towards the treatment and dental rehabilitation of oral cancer patients

“…In this study patients treated with HBO performed worse in every aspect when compared to patients not subjected to HBO therapy. 49 Eight implants failed in fi ve patients subjected to HBO therapy versus three implants in two patients in the control group. Two postoperative complications (one osteoradionecrosis and the other soft tissue complications) developed in two patients subjected to HBO therapy.…”

“…Two postoperative complications (one osteoradionecrosis and the other soft tissue complications) developed in two patients subjected to HBO therapy. 49 The conclusion of the systematic review, with consideration to the limited amount of research available, is that hyperbaric oxygen (HBO) therapy in irradiated patients requiring dental implants may not offer any appreciable clinical benefi ts. 48 As it is diffi cult to obtain the best quality of evidence in such a patient cohort, research into the relative benefi ts of HBO will need further investigation as at present there seem to be differing opinions on its benefi t. A recent survey of maxillofacial surgeons revealed that most consider HBO to be part of the management of osteoradionecrosis, but their knowledge about delivery was weak and the protocols used varied.…”

Rehabilitation of Partial Mandibulectomy Using Implant-Supported Removable Prosthesis in an Irradiated Patient: Case Report

“…29 Despite the high rate of implant loss, radiotherapy can not be considered as a contraindication for the insertion of mandibular dental implants. 30,31 Radiotherapy was associated with higher rates of implant loss and surface texture may be a key factor in the success of implants placed in irradiated bone. 32 Placement of implants after radiotherapy prevents failure of implants in patients with a poor prognosis.…”

Untitled

“…63 In this regard, the interval between the end of cancer therapy and placement of dental implants may contribute to the success or failure of osseointegration. studies [64][65][66] have investigated the required time interval between radiotherapy and implant installation that may influence osseointegration; however the results remain debatable. In a systematic review, Zen Filho et al 67 assessed the safety of dental implants placed in irradiated bone and to discuss their viability when placed post-radiotherapy.…”