Implants in Radiated Site?
Dr. N. asks:
I am a prosthodontist and have just had a patient referred to me for implant overdentures. She has received 70K rads of radiation therapy to the mandible, tongue and tonsils. I am planning on extracting her remaining teeth and placing implants. We will be referring her for hyperbaraic oxygen dives and I will be prescribing heavy and long doses of antibiotics. She has experienced multiple oral infections with thrush [Candida]. She also has severe xerostomia so I am planning on making complete maxillary and mandibular dentures and lining them with a soft, tissue conditioning material. What kind of success or failure should I expect with the implants? What are your experiences with dentures and mini or conventional implants in these radiated sites?
13 Comments on Implants in Radiated Site?
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Dr. IDRISSI
2/8/2010
however the taken precautions, the risk of ostéo-radio-necrose is omnipresent.
Extractions and\or implants in these cases, stay a very risky adventure.
Dr. IDRISSI
2/8/2010
whatever the taken precautions, the risk of ostéo-radio-necrose is omnipresent.
Extractions and\or implants in these cases, stay a very risky adventure.
osurg
2/8/2010
I believe there are several papers dealing with your question.If you have the ability to do a medlars search or even a Google search I would suggest you do. HBO(not the Cable) does not eliminate the possibility of ORN. If there is a Maxillo Facial Pros person in your area they would have a lot of experience with radiation and restoration. You might do well to pick their Brain. The other choice is to do as the Medical services say and Turf the Case. That means send it to a center where they deal with such cases on a daily basis
David Nelson DDS
2/9/2010
OMFS Dr Robert Marx has quite a few articles on ONJ. You might want the surgon to graft the extraction sites, let everything heal for a 9 months or so, then revisit.
A.Romano dr.med.dr.dent I
2/9/2010
in these cases the greater risk of implants failure is the osteo-radio-necrosis in the middle-short period, but in the long period (10-15 years) the worst complication is the osteo-involution so that the implant can loose mm. and mm. in few years and mandibula too.
Dr M
2/9/2010
I think even with extractions you run a very high risk of osteoradionecrosis. Particularly with the dosage and the xerostomia that you describe. I would consider whether it is absolutely necessary to ext her teeth. Are endos, root amps and attachments a possibility? If the problem is perio then it is unfortunate that the teeth were not ext pre radiation.
Dr Richard Bullock is a prosthodontist practicing in the desert area of Palm Springs Calif--he has years of experience with radiation patients..you might look him up and give him a call.
Good luck
Brian Hart DDS
2/9/2010
If I were that patient, I wouldn't let any dentist get near me unless my teeth were symptomatic. I have treated some ORN cases where the patients where I had to resect the entire hemi-mandible, have the reconstructive flaps fail and necrose, and it is not worth the risk--and these cases are from simple extractions in patients with only 5-6k RADS. Do not take this case lightly--first thing I would do is turf it to the OMFS as it could keep you sleepless for years.
Again, if I am that patient I would rather live my life as a dental cripple than risk ORN from the extractions and/or implants.
John Clark
2/10/2010
Dr Hart is spot on! This is a no brainer. ORN arises from near obliteration of the vasculature within the bone - no blood flow, no new bone. Her only chance would have been to have had a clearance and implants placed months before the irradiation (why does this keep on happening!!). Too, too late. Cut your losses and show her the door. If you do this, you will forever regret it. If you want to do some good after you advise her of your decision to cancel the implants, make sure she is aware of the need for aggressive physio to minimise the restriction in mouth opening that is going to occur.
regards John
I have inherited two ORN patients - absolutely dreadful for the patient and disgusting to deal
Don Callan
2/11/2010
John Clark is 100% correct.
Richard Hughes, DDS, FAAI
2/12/2010
Drs. Callan, Clark and Hart, you are most correct!
Bob Schneider
2/16/2010
As a prosthodontist who treats these types of patients daily at a large cancer center, I would suggest you get her to a center that does this type of treatment on a routine basis. This will save you a possible "never ending" headache. Treating ORN is not anybodys idea of a good time, especially when dental implants are invovled following a "curative" dose of XRT.
Periodoc
2/16/2010
Generally, surgical dental treatment for these patients is contraindicated. As a prosthodontist, you must know this. Instead of extracting hopeless teeth, endodontic treatment is sometimes recommended on teeth which will be lost. You let them exfoliate, shortening them as needed. She also requires very conservative periodontal treatment, so that she can maintain as many teeth as possible and will also require flouride trays. Far better to be a dental cripple, as stated above, than suffer the devastating effects of ill considered surgery. Just because a patient desires or demands a particular course of therapy doesn't mean they should receive it. There are safer alternatives than implant therapy for irradiated patients.
Michael W. Johnson DDS, M
2/23/2010
If the teeth are hopeless/infected and need removal, hyperbaric oxygen is a must. As a prosthodontist, I would not even think about doing the surgery myself but referring the patient to an exerienced surgeon to plan the O2 therapy and extractions. In regards to the xerostomia and candida, I would not recommend soft liners as they are rougher than polished acrylic, more difficult to clean and more liable to collect candida colonies and irritate the already friable tissues. Instead, if the extractions are successful, 5 implants can be placed and a hybrid restoration fabricated that is not tissue borne. This is the treatment of choice for any xerostomic individual: a non tissue supported prosthesis.
