Dental Implants and Laryngeal Cancer

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Jon, a dentist, asks:

I have a 52 year old male patient with a history of laryngeal cancer (removed 3 years ago + radiotherapy) who needs 7  dental implants placed as follows: #2, 3, 4, 14, 15, 18, 19, 30, 31.

His oral hygiene is good. He has bruxism but this is under control and he wears an anti-clenching (MCI) device. He has xerostomia, as expected. He does not have any significant medical problems.

Is there anyone who has had experience with patients with this kind of history of radiotherapy who have placed and restored implants? What is the success rate for implant restoration with these kinds of patients? What are the precautions and complications that I need to be aware of?

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4 Responses to “ Dental Implants and Laryngeal Cancer ”

• Steven A. Guttenberg, DDS, MD February 27th, 2007

  
  

  Jon:
  The key issue in the treatment of this patient is what type of irradiation he had, what was the dose, and what were the portals of irradiation. You can get this information from his radiation oncologist.
  Also you will want to evaluate how much damage may have been done to his salivary glands from the irradiation and what degree of xerostomia he may have.
  Placement of implants into bone which may have had cancericidal doses of irradiation may cause osteoradionecrosis which could lead to loss of a large part of the jaw.
  You may also want to consider the possibility of including hyperbaric oxygen therapy as part of the treatment plan.
  Each case is individual and must be considered as such.

• ABrandwein February 28th, 2007

  
  

  I have a patient with a history of cancer of the parotid and radiation therapy.
  He has had two lower implants placed successfully(about 3 years at this point).The two implants support a lower overdenture.
  There are cases in the literature that support this modality of treatment but care must be taken.

  The xerostomia is not the issue but the dosage of rradiation to the sites you plan on placing the implants.

  good luck

• G. Balogh, BSc, DDS March 4th, 2007

  
  

  The dose of radiation is usually determined by the extent of the cancer and whether there was an adjunctive surgery. It is usually classified as T1, T2, T3, T4. The one thing about laryngeal carcinoma is that the tradiation is centered only on the larynx by using a shield. It is generally only an area of about 6cm x 6cm. and well below the of the mandible. There is generally no osteoradionecrosis and no xerostomia with this treatment because the radiation is centered on the larynx.
  I would be more concerned with why he had the cancer. Usually it is smoking and alcohol and that would be more of a contraindication than the radiation. Otherwise it may not be an issue. Another thing that might be a good idea to check is the parathyroid function. This is close by and may be damaged, and then there may be bone resorption problems.

• Enis REDZEP DDS,PhD March 8th, 2007

  
  

  I recently treated a patient with 6 implants on maxilla who had undergone larynx removal with radiotherapy due to larynx cancer. 10 months after his operation he was in very good health condition and i performed the operation. after 4 months the ossteointegration of the implants was very good. most irradiated patients have xerostomia and altered healing of the tissues but the dose and type of irradiation is of key role. if irradiation is below 3000 grays,minimum six months should past before implant placement.
  these cases should be very carefully evaluated becouse there is a high risk of complications.

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Mon September 08 2008

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