The irradiated human mandible: A quantitative study on bone vascularity

Dekker, Hannah; Bravenboer, N.; Dijk, Dennis van; Bloemena, Elisabeth; Rietveld, D.; Bruggenkate, Chr.M. ten; Schulten, E.A.J.M.

doi:10.1016/j.oraloncology.2018.10.030

Cited by 19 publications

(21 citation statements)

References 23 publications

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“…The study by Dekker et al 38 comparing irradiated mandibles vs controls using CD34 antibody stain to detect endothelial cells identified similar findings to the current study. They found mean vascular perimeter and mean vascular diameter were higher in samples with a local radiation dose of ≥50 Gy, whereas the percentage of small vessels was lower 38 . Based on these findings, Dekker et al 38 concluded radiation dosages higher than 50 Gy mainly affect the smaller vessels.…”

Section: Discussionsupporting

confidence: 89%

“…In contrast, the use of ORN resections to assess vascularity is likely to identify profound lack of blood supply, hence, leading to bone death. The study by Dekker et al 38 comparing irradiated mandibles vs controls using CD34 antibody stain to detect endothelial cells identified similar findings to the current study. They found mean vascular perimeter and mean vascular diameter were higher in samples with a local radiation dose of ≥50 Gy, whereas the percentage of small vessels was lower 38 .…”

Section: Discussionsupporting

confidence: 89%

“…They found mean vascular perimeter and mean vascular diameter were higher in samples with a local radiation dose of ≥50 Gy, whereas the percentage of small vessels was lower 38 . Based on these findings, Dekker et al 38 concluded radiation dosages higher than 50 Gy mainly affect the smaller vessels. In contrast, our study identified this threshold to be in excess of 30 Gy.…”

Section: Discussionmentioning

confidence: 97%

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The impact of intensity‐modulated radiation treatment on dento‐alveolar microvasculature in pharyngeal cancer implant patients

Patel

Silvio

Kwok

et al. 2020

J of Oral Rehabilitation

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Objectives Dental rehabilitation post‐radiotherapy often requires the consideration of dental implants. However, these are tentatively prescribed due to the concern of hypovascularisation and possible osteoradionecrosis. Hence, the current study assessed the microvasculature of the dento‐alveolar bone at implant sites taking into consideration the exact radiotherapy dose received to the region. Materials and methods Bone cores were taken from nine patients during implant treatment and compared to nine control patients. Specimens were stained using CD31 and digitalised using a high‐resolution scanner for qualitative and quantitative assessment of the microvasculature. Monaco® treatment planning system was used to volume the implant site providing mean dose (Dmean) and maximum dose (Dmax). Results A total of 23 bone cores were retrieved for analysis. The cohort had a Dmean of 38.4 Gy (59.6‐24.3 Gy). Qualitative analysis identified a clear reduction in the miniscule terminal capillaries and high incidence of obliterated lumens with increasing radiotherapy. Microvasculature density of irradiated patients was markedly reduced (P = .0034) compared to the control group with an inverse correlation to RT doses (P < .0001). Specifically, doses up to 30 Gy appear to preserve sufficient vascularisation (~77% in comparison with control) and tissue architecture. By contrast, exposure to higher doses 40%‐61% of the micro‐vessels were lost. Conclusion Intensity‐modulated radiotherapy doses above 30 Gy identified reduction in microvasculature which is a lower threshold than previously accepted. In pharyngeal cancer patients’ doses to the jaw bones often exceed this threshold. Coupled with favourable survival in certain oropharyngeal and nasopharyngeal cancer, dental rehabilitation via implants provides a significant clinical challenge.

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Section: Discussionsupporting

confidence: 89%

Section: Discussionsupporting

confidence: 89%

Section: Discussionmentioning

confidence: 97%

See 1 more Smart Citation

The impact of intensity‐modulated radiation treatment on dento‐alveolar microvasculature in pharyngeal cancer implant patients

Patel

Silvio

Kwok

et al. 2020

J of Oral Rehabilitation

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“…Since the artery branches and narrows towards the periphery, inadequate blood supply easily occurs in the anterior margin [ 45 ]. In addition, smaller vessels diminished over time after irradiation, causing necrosis [ 46 ]. This could be the reason for the necrotic change differences between these margins.…”

Section: Discussionmentioning

confidence: 99%

Factors Associated with Treatment Outcomes and Pathological Features in Patients with Osteoradionecrosis: A Retrospective Study

Tadokoro¹,

Hasegawa²,

Takeda³

et al. 2022

IJERPH

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A standard treatment for osteoradionecrosis (ORN) has not yet been established because of the diversity. Therefore, identifying the risk factors for a poor prognosis is essential. This study retrospectively investigated the factors associated with the prognosis of ORN in 68 patients. Relevant clinical data of all patients were obtained. Of the patients, 16 who underwent extensive surgery underwent histopathological analysis. The necrotic changes of the anterior and posterior margins in the cortical and cancellous bones were investigated. Multivariate analyses showed statistically significant associations between poor prognosis in patients with ORN and high radiation dose (hazard ratio [HR] 1.15), orocutaneous fistula (HR 2.93), and absence of sequestration (HR 2.49). Histopathological analysis showed a viable anterior margin of the middle portion of the cortical bone for all recovered cases; in contrast, most cases (75%) with a poor prognosis showed necrotic changes. The anterior margin of the cancellous bone was viable and resilient to high irradiation, regardless of the prognosis. These results suggest that patients with orocutaneous fistula should receive early surgical intervention, even if the affected area is limited or asymptomatic. In extensive surgery, a sufficient safety margin of necrotic bone, particularly in the anterior region, is required to improve the prognosis.

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“…In our study, the buccal site of the irradiated jaw in the lamellar bone is presented with a significant decrease in veins, whereas the lingual site changes are minimal both at the periosteum and in the lamellar bone and statistically insignificant. Dekker et al 35 in their recent study on the irradiated human jaw, proposed that radiation dosage of more than 50 Gy affects the smaller vessels more than the larger vessels either due to a direct effect of radiation or due to inhibition of new blood vessel formation. In addition, vascularization promotes the survival of osteocytes after irradiation has been demonstrated.…”

Section: Discussionmentioning

confidence: 99%

Effects of irradiation in the mandibular bone loaded with dental implants. An experimental study with a canine model

Padala

Asikainen²,

Ruotsalainen

et al. 2021

Ultrastructural Pathology

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Radiation therapy may compromise the quality of bone around dental implants, and its ability to regenerate, remodel, and revascularize. This study aimed to describe the irradiation effect on the bone microstructure of the mandible using dental implants in a canine model. Five beagle dogs were exposed to 40 Gy fractionated radiation. In total, 20 dental implants were inserted, two in the irradiated and two in the non-irradiated side. The mandible bone blocks were subjected to 3D micro-computed tomography (µCT) imaging, later evaluated histomorphometrically by light microscopy and scanning electron microscopy. Alterations in irradiated bone were observed under µCT imaging showing an increased anisotropy, porosity, and pore volume. Bone surface-to-bone volume decreased. The bone to implant contact index was significantly reduced in the irradiated bone (75.6% ± 5.8%) as compared to the non-irradiated bone (85.1% ± 6.8%). In the irradiated mandible, osteocytes with their filopodial processes, the bone beneath the periosteum, and subperiosteal veins showed structural differences but were not significant, whereas the diameter of Haversian canals were smaller statistical significant as compared to the control side. The study highlights that radiation dosage of fractioned 40 Gy causes alterations in the alveolar bone microstructure with compatible osseointegration and clinically stable dental implants.

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The irradiated human mandible: A quantitative study on bone vascularity

Cited by 19 publications

References 23 publications

The impact of intensity‐modulated radiation treatment on dento‐alveolar microvasculature in pharyngeal cancer implant patients

The impact of intensity‐modulated radiation treatment on dento‐alveolar microvasculature in pharyngeal cancer implant patients

Factors Associated with Treatment Outcomes and Pathological Features in Patients with Osteoradionecrosis: A Retrospective Study

Effects of irradiation in the mandibular bone loaded with dental implants. An experimental study with a canine model

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