Vergleichende Untersuchungen von Brånemark-Implantaten im bestrahlten und nicht bestrahlten Unterkiefer

Abstract

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.

Dental Implants Installed in Irradiated Jaws

“…Thirteen case series were considered eligible for inclusion (Albrektsson et al, 1988;Eckert et al, 1996;Niimi et al, 1997;Andersson et al, 1998;Brogniez et al, 1998;Esser et al, 1999;Granstrom et al, 1999;Werkmeister et al, 1999;Goto et al, 2002;Visch et al, 2002;Landes and Kovacs, 2006 Excluded publications, not fulfilling inclusion criteria (n = 7): Alsaadi et al, (2008) included only two subjects of an overall sample of 700 patients Schliephake et al, (1999) did not report number of implants lost Weischer et al, (1996), Keller et al, (1997), Ihara et al, (1998), Meriscke-Sterm et al, (1999) and Linsen et al, (2012) …”

“…Among the observational studies that were included, 3 were of medium quality (Esser et al, 1999;Visch et al, 2002;Landes and Kovacs, 2006), whereas the remaining were of low quality (Figure 2). The findings regarding the domains of the modified Newcastle-Ottawa scale were as follows: 1: none of the studies reported sample size calculations; 2 and 3: in all of the studies, the representativeness of the irradiated and nonirradiated (when described) patients was considered to be adequately addressed; 4: assessment of peri-implant conditions was considered adequate in 8 studies (Albrektsson et al, 1988;Andersson et al, 1998;Brogniez et al, 1998;Esser et al, 1999;Granstrom et al, 1999;Goto et al, 2002;Visch et al, 2002;Landes and Kovacs, 2006) and unclear for the remaining articles; 5: only Albrektsson et al (1988) and Granstrom et al (1999) did not describe whether radiotherapy was performed before or after implant placement; 6: none of the studies reported training or calibration of the examiners of clinical outcome; 7: 2 studies had a prospective design (Visch et al, 2002;Landes and Kovacs, 2006); 8: 2 studies reported that all patients received similar implant therapy (Esser et al, 1999;Schepers et al, 2006); 9: 1 publication described statistical assessment performed with control for confounders (Visch et al, 2002); 10: none of the authors described whether independent blind assessment of peri-implant conditions was used; An approximate number of implants was calculated based on the survival rate (%), as well only data from implants placed in residual bone were extracted from the study.…”

“…Thirteen case series were considered eligible for inclusion (Albrektsson et al, 1988;Eckert et al, 1996;Niimi et al, 1997;Andersson et al, 1998;Brogniez et al, 1998;Esser et al, 1999;Granstrom et al, 1999;Werkmeister et al, 1999;Goto et al, 2002;Visch et al, 2002;Landes and Kovacs, 2006;Schepers et al, 2006;Katsoulis et al, 2013), Articles included in the review (n = 15), but 14 -could be included into meta analyses Articles excluded on basis of title and abstract (n = 1,029) Excluded publications, not fulfilling inclusion criteria (n = 7): Alsaadi et al, (2008) included only two subjects of an overall sample of 700 patients Schliephake et al, (1999) did not report number of implants lost Weischer et al, (1996), Keller et al, (1997), Ihara et al, (1998), Meriscke-Sterm et al, (1999) and Linsen et al, (2012) as were 2 RCTs (Schoen et al, 2007;Heberer et al, 2011) (Tables 1-3). A total of 10,150 implants were assessed in the included studies, and of these, 1,689 (14.3%) were installed in irradiated jaws.…”

“…Among the observational studies that were included, 3 were of medium quality (Esser et al, 1999;Visch et al, 2002;Landes and Kovacs, 2006), whereas the remaining were of low quality (Figure 2). The findings regarding the domains of the modified Newcastle-Ottawa scale were as follows: 1: none of the studies reported sample size calculations;…”

“…The findings regarding the domains of the modified Newcastle-Ottawa scale were as follows: 1: none of the studies reported sample size calculations; 2 and 3: in all of the studies, the representativeness of the irradiated and nonirradiated (when described) patients was considered to be adequately addressed; 4: assessment of peri-implant conditions was considered adequate in 8 studies (Albrektsson et al, 1988;Andersson et al, 1998;Brogniez et al, 1998;Esser et al, 1999;Granstrom et al, 1999;Goto et al, 2002;Visch et al, 2002;Landes and Kovacs, 2006) and unclear for the remaining articles; 5: only Albrektsson et al (1988) and Granstrom et al (1999) did not describe whether radiotherapy was performed before or after implant placement; 6: none of the studies reported training or calibration of the examiners of clinical outcome; 7: 2 studies had a prospective design (Visch et al, 2002;Landes and Kovacs, 2006); 8: 2 studies reported that all patients received similar implant therapy (Esser et al, 1999;Schepers et al, 2006); 9: 1 publication described statistical assessment performed with control for confounders (Visch et al, 2002); 10: none of the authors described whether independent blind assessment of peri-implant conditions was used; An approximate number of implants was calculated based on the survival rate (%), as well only data from implants placed in residual bone were extracted from the study. Goto et al 11: all of the studies described the radiation doses used for oncologic treatment, except for Albrektsson et al (1988); 12: in 2 publications, > 70% of the treated patients were followed during the entire study period (Landes and Kovacs, 2006;Katsoulis et al, 2013); 13: Esser et al (1999), Granstrom et al (1999), Schepers et al (2006), Werkmeister et al (1999), Goto et al (2002) and Visch et al (2002) compared their outcomes using statistical analyses; and 14: all authors defined the number of patients and/or implants per group as the unit of analysis.…”