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Jain R, Ghosh M, Goel R, Gupta R, Golhait P, Ghosh B. A challenging journey of maxillofacial implants placement and rehabilitation in an irradiated exenterated socket. J Oral Biol Craniofac Res 2022; 12:319-323. [DOI: 10.1016/j.jobcr.2022.03.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2021] [Revised: 08/02/2021] [Accepted: 03/18/2022] [Indexed: 10/18/2022] Open
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2
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Schliephake H. The role of systemic diseases and local conditions as risk factors. Periodontol 2000 2022; 88:36-51. [PMID: 35103330 DOI: 10.1111/prd.12409] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Affiliation(s)
- Henning Schliephake
- Department of Oral Maxillofacial Surgery, University Medicine George-Augusta-University, Göttingen, Germany
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Padala SR, Kashyap B, Dekker H, Mikkonen JJW, Palander A, Bravenboer N, Kullaa AM. Irradiation affects the structural, cellular and molecular components of jawbones. Int J Radiat Biol 2021; 98:136-147. [PMID: 34855558 DOI: 10.1080/09553002.2022.2013568] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
PURPOSE Emerging evidence shows that changes in the bone and its microenvironment following radiotherapy are associated with either an inhibition or a state of low bone formation. Ionizing radiation is damaging to the jawbone as it increases the complication rate due to the development of hypovascular, hypocellular, and hypoxic tissue. This review summarizes and correlates the current knowledge on the effects of irradiation on the bone with an emphasis on jawbone, as these have been a less extensively studied area. CONCLUSIONS The stringent regulation of bone formation and bone resorption can be influenced by radiation, causing detrimental effects at structural, cellular, vascular, and molecular levels. It is also associated with a high risk of damage to surrounding healthy tissues and an increased risk of fracture. Technological advances and research on animal models as well as a few human bone tissue studies have provided novel insights into the ways in which bone can be affected by high, low and sublethal dose of radiation. The influence of radiation on bone metabolism, cellular properties, vascularity, collagen, and other factors like inflammation, reactive oxygen species are discussed.
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Affiliation(s)
- Sridhar Reddy Padala
- Institute of Dentistry, Faculty of Health Sciences, University of Eastern Finland, Kuopio, Finland
| | - Bina Kashyap
- Institute of Dentistry, Faculty of Health Sciences, University of Eastern Finland, Kuopio, Finland
| | - Hannah Dekker
- Amsterdam University Medical Centers, Academic Centre for Dentistry Amsterdam (ACTA), Department of Oral and Maxillofacial Surgery/Oral Pathology, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Jopi J W Mikkonen
- Institute of Dentistry, Faculty of Health Sciences, University of Eastern Finland, Kuopio, Finland
| | - Anni Palander
- Institute of Dentistry, Faculty of Health Sciences, University of Eastern Finland, Kuopio, Finland
| | - Nathalie Bravenboer
- Amsterdam UMC, Department of Clinical Chemistry, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands.,Department of Internal Medicine, Division of Endocrinology and Center for Bone Quality, Leiden University Medical Center, Leiden, The Netherlands
| | - Arja M Kullaa
- Institute of Dentistry, Faculty of Health Sciences, University of Eastern Finland, Kuopio, Finland
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Padala SR, Asikainen P, Ruotsalainen T, Mikkonen JJ, Silvast TS, Koistinen AP, Schulten EAJM, Ten Bruggenkate CM, Kullaa AM. Effects of irradiation in the mandibular bone loaded with dental implants. An experimental study with a canine model. Ultrastruct Pathol 2021; 45:276-285. [PMID: 34423726 DOI: 10.1080/01913123.2021.1962467] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
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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Affiliation(s)
- Sridhar Reddy Padala
- Clinical Research, Faculty of Health Sciences, University of Eastern Finland, Kuopio, Finland
| | | | - Timo Ruotsalainen
- Institute of Dentistry, Faculty of Health Sciences, University of Eastern Finland, Kuopio, Finland
| | - Jopi Jw Mikkonen
- Institute of Dentistry, Faculty of Health Sciences, University of Eastern Finland, Kuopio, Finland.,SIB Labs, Faculty of Science and Forestry, University of Eastern Finland, Kuopio, Finland
| | - Tuomo S Silvast
- SIB Labs, Faculty of Science and Forestry, University of Eastern Finland, Kuopio, Finland
| | - Arto P Koistinen
- SIB Labs, Faculty of Science and Forestry, University of Eastern Finland, Kuopio, Finland
| | - Engelbert A J M Schulten
- Department of Oral and Maxillofacial Surgery/ Oral Pathology, Amsterdam University Medical Centers, Academic Centre for Dentistry Amsterdam (ACTA), Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Chris M Ten Bruggenkate
- Department of Oral and Maxillofacial Surgery/ Oral Pathology, Amsterdam University Medical Centers, Academic Centre for Dentistry Amsterdam (ACTA), Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Arja M Kullaa
- Institute of Dentistry, Faculty of Health Sciences, University of Eastern Finland, Kuopio, Finland
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Bone Healing Evaluation Following Different Osteotomic Techniques in Animal Models: A Suitable Method for Clinical Insights. APPLIED SCIENCES-BASEL 2020. [DOI: 10.3390/app10207165] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Osteotomy is a common step in oncological, reconstructive, and trauma surgery. Drilling and elevated temperature during osteotomy produce thermal osteonecrosis. Heat and associated mechanical damage during osteotomy can impair bone healing, with consequent failure of fracture fixation or dental implants. Several ex vivo studies on animal bone were recently focused on heating production during osteotomy with conventional drill and piezoelectric devices, particularly in endosseous dental implant sites. The current literature on bone drilling and osteotomic surface analysis is here reviewed and the dynamics of bone healing after osteotomy with traditional and piezoelectric devices are discussed. Moreover, the methodologies involved in the experimental osteotomy and clinical studies are compared, focusing on ex vivo and in vivo findings.
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Systemic and local effects of radiotherapy: an experimental study on implants placed in rats. Clin Oral Investig 2019; 24:785-797. [PMID: 31154539 DOI: 10.1007/s00784-019-02946-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2018] [Accepted: 05/03/2019] [Indexed: 12/28/2022]
Abstract
OBJECTIVES Evaluate the modulating effect of ionizing radiation, blood cytokine levels, and bone remodeling of the interface around the implant to understand the radiation mechanisms which can impair the implants receptor site. MATERIAL AND METHODS Sixty rats were submitted to grade V titanium implants in the femurs and were divided into the following groups: no-irradiation (N-Ir): control group with implant only; early-irradiation (E-Ir): implant + irradiation after 24 h; late-irradiation (L-Ir): implant + irradiation after 4 weeks; and previous-irradiation (P-Ir): irradiation + implant after 4 weeks. The animals in the E-Ir, L-Ir, and P-Ir groups were irradiated in two fractional stages of 15 Gy. At 3 days, 2 weeks, and 7 weeks after the final procedure, five animals were randomly euthanized per group. Serum levels of TNF-ɑ, IL-1β, TGF-β, IL-6, M-CSF, and IL-10 were measured from blood collected prior to euthanasia using the ELISA test. The pieces containing the implants were subjected to immunohistochemical labeling using the tartrate acid resistant to phosphatase, osteocalcin, and caspase-3 markers and mCT. The ANOVA test was used for statistical analysis, and the Tukey multiple comparison test (p < 0.05) was applied. RESULTS The results indicated that ionizing radiation modifies the production of pro- and anti-inflammatory serum cytokines, the expression of proteins involved in bone remodeling and cellular apoptosis, as well as changes in bone formation. CONCLUSIONS The results suggests that a longer period between radiotherapy and implant placement surgery when irradiation occurs prior to implant installation would allow the recovery and renewal of bone cells and avoid future failures in osseointegration. CLINICAL RELEVANCE The search for modifications caused by ionizing irradiation in bone tissue can indicate the ideal period for implant placement without affecting the osseointegration process.
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Patel SY, Kim DD, Ghali GE. Maxillofacial Reconstruction Using Vascularized Fibula Free Flaps and Endosseous Implants. Oral Maxillofac Surg Clin North Am 2019; 31:259-284. [DOI: 10.1016/j.coms.2018.12.005] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Amifostine Suppresses the Side Effects of Radiation on BMSCs by Promoting Cell Proliferation and Reducing ROS Production. Stem Cells Int 2019; 2019:8749090. [PMID: 30728842 PMCID: PMC6343176 DOI: 10.1155/2019/8749090] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2018] [Revised: 10/02/2018] [Accepted: 10/21/2018] [Indexed: 02/07/2023] Open
Abstract
This study is aimed at investigating the effect of amifostine (AMI) on rat bone marrow stromal stem cells (BMSCs) exposed to 2 Gy radiation. The BMSCs were divided into four groups, namely, group A that received 0 Gy radiation, group B that received 0 Gy radiation and AMI, group C that received 2 Gy radiation, and group D that received 2 Gy radiation and AMI. The proliferation, apoptosis, and distribution of BMSCs in the cell cycle, along with their osteogenesis ability, adipogenesis ability, and ROS production, were subsequently examined. The levels of ALP, PPARγ, P53, and TNFα were determined by Western blotting. The results demonstrated that the proliferation of BMSCs and the levels of ALP in group C were much lower than those in group A. The production of ROS and levels of PPARγ, P53, and TNFα in the group that received 2 Gy radiation were much higher than those in group A. Furthermore, the production of ROS and the levels of PPARγ, P53, and TNFα were much lower in group D than in group C. Additionally, the levels of ALP and extent of cell proliferation were much higher in group D than in group C. The results demonstrated the potential of AMI in reducing the side effects of radiation in BMSCs and in treatment of bone diseases caused by radiation.
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Combination Use of BMP2 and VEGF165 Promotes Osseointegration and Stability of Titanium Implants in Irradiated Bone. BIOMED RESEARCH INTERNATIONAL 2018; 2018:8139424. [PMID: 30627574 PMCID: PMC6304532 DOI: 10.1155/2018/8139424] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/17/2018] [Revised: 10/14/2018] [Accepted: 11/14/2018] [Indexed: 02/05/2023]
Abstract
Background Clinical data demonstrated that failure rate of titanium implant in irradiated bone was 2-3 times higher than that in nonirradiated bone and it is difficult to get the ideal results in irradiated bone. Purpose The aim of the study was to investigate the effects of HBO, BMP2, VEGF165, and combined use of BMP2/VEGF165 on osseointegration and stability of titanium implant in irradiated bone. Materials and Methods Sixty rabbits were randomly assigned to 5 groups (control group, HBO group, VEGF165 group, BMP2 group, and BMP2/VEGF165 group) after receiving 15 Gy radiation. Implant surgery was performed on tibias eight weeks later. They were sacrificed at two or eight weeks after operation. Implant stability, calcium, and ALP activity in serum, the ratio of bone volume to total volume, the rate of bone growth, and gene expression were assessed. Result There was no mortality and no implants failed during the experiment. Implant stability was significantly compromised in the control group compared to the other four experimental groups, and the BMP2/VEGF165 group had the highest implant stability. HBO, BMP2, and VEGF165 significantly increased BV/TV and the rate of bone growth, while the BMP2/VEGF165 showed the best effect among groups. The expression of RUNX2 in HBO, BMP2, and VEGF165/BMP2 group was higher than that in the VEGF165 and control groups at two weeks. The expression of OCN in HBO, BMP2, VEGF165, and VEGF165/BMP2 groups was higher than that in the control group, and the gene expression of CD31 was higher in HBO, VEGF165, and BMP2/VEGF165 groups than that in control and BMP2 groups. Conclusion HBO, BMP2, and VEGF165 could increase bone formation around the implant and improved the implant stability in irradiated bone. The combination use of BMP2 and VEGF165 may be promising in the treatment of implant patients with radiotherapy.
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Poort LJ, Ludlage JH, Lie N, Böckmann RA, Odekerken JC, Hoebers FJ, Kessler PA. The histological and histomorphometric changes in the mandible after radiotherapy: An animal model. J Craniomaxillofac Surg 2017; 45:716-721. [DOI: 10.1016/j.jcms.2017.02.014] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2016] [Revised: 01/15/2017] [Accepted: 02/13/2017] [Indexed: 02/07/2023] Open
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Aboushelib MN, Arnaout MA, Elsafi MH, Kassem YM. Two-stage implant placement technique for the management of irradiated jaws: An animal study. J Prosthet Dent 2017; 118:546-550. [PMID: 28343674 DOI: 10.1016/j.prosdent.2017.01.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2016] [Revised: 01/24/2017] [Accepted: 01/24/2017] [Indexed: 11/28/2022]
Abstract
STATEMENT OF PROBLEM Radiotherapy results in diminished bone remodeling capacity and an elevated risk of osteoradionecrosis, which can negatively influence the survival rate of dental implants. Patients receiving radiotherapy are advised not to receive dental implants during or soon after completing their radiotherapy. PURPOSE The purpose of this animal study was to investigate a 2-stage implant placement technique designed to diminish applied trauma on irradiated bone. MATERIAL AND METHODS Two groups of white New Zealand rabbits received radiotherapy in ascending doses (2, 4, 8 Gy), while a nonirradiated group served as control. Three weeks after completion of the last radiotherapy session, one of the irradiated groups and the control group received titanium dental implants bilaterally in the femur head. For the second irradiated group, an osteotomy was performed, and the surgical wound was left to heal for 2 weeks before implant placement. All animals were sacrificed 4 weeks after implant placement, and histomorphometric analysis was used to study bone-implant contact (n=14, α=.05). RESULTS Statistical analysis revealed significantly higher (F=159, P<.001) bone-implant contact in the 2-stage (40.2 ±1.9) implant placement technique than in the immediately placed implants (21.2 ±2.3) in irradiated bone. Both of the groups had a significantly lower bone-to-implant contact ratio than the non-irradiated control (64.2 ±3.8). CONCLUSIONS Within the limitations of this animal study, the 2-stage implant placement technique could be used to reduce trauma in irradiated bone and to improve wound healing around dental implants.
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Affiliation(s)
- Moustafa N Aboushelib
- Associate Professor, Department of Dental Materials, Faculty of Dentistry, Alexandria University, Alexandria, Egypt.
| | - Mohamed A Arnaout
- Lecturer, Department of Conservative and Prosthetic Dentistry, School of Dentistry, College of Health Science, Moi University, Eldoret, Kenya
| | - Mohamed H Elsafi
- Researcher, Fine Measurement Lab, Department of Dental Material, Faculty of Dentistry, Alexandria University, Alexandria, Egypt
| | - Youssef M Kassem
- Demonstrator, Department of Dental Materials, Faculty of Dentistry, Alexandria University, Alexandria, Egypt
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Smith Nobrega A, Santiago JF, de Faria Almeida DA, dos Santos DM, Pellizzer EP, Goiato MC. Irradiated patients and survival rate of dental implants: A systematic review and meta-analysis. J Prosthet Dent 2016; 116:858-866. [DOI: 10.1016/j.prosdent.2016.04.025] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2015] [Revised: 04/26/2016] [Accepted: 04/28/2016] [Indexed: 10/21/2022]
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Doh RM, Kim S, Keum KC, Kim JW, Shim JS, Jung HS, Park KM, Chung MK. Postoperative irradiation after implant placement: A pilot study for prosthetic reconstruction. J Adv Prosthodont 2016; 8:363-371. [PMID: 27826386 PMCID: PMC5099128 DOI: 10.4047/jap.2016.8.5.363] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/29/2016] [Revised: 06/08/2016] [Accepted: 08/08/2016] [Indexed: 11/23/2022] Open
Abstract
PURPOSE On maxillofacial tumor patients, oral implant placement prior to postoperative radiotherapy can shorten the period of prosthetic reconstruction. There is still lack of research on effects of post-implant radiotherapy such as healing process or loading time, which is important for prosthodontic treatment planning. Therefore, this study evaluated the effects of post-implant local irradiation on the osseointegration of implants during different healing stages. MATERIALS AND METHODS Custom-made implants were placed bilaterally on maxillary posterior edentulous area 4 weeks after extraction of the maxillary first molars in Forty-eight Sprague-Dawley rats. Experimental group (exp.) received radiation after implant surgery and the other group (control) didn't. Each group was divided into three sub-groups according to the healing time (2, 4, and 8 week) from implant placement. The exp. group 1, 2 received 15-Gy radiation 1 day after implant placement (immediate irradiation). The exp. group 3 received 15-Gy radiation 4 weeks after implant placement (delayed irradiation). RESULTS The bone mineral density (BMD) was significantly lower in the immediate irradiation groups. BMD was similar in the delayed irradiation group and the control group. The irradiated groups exhibited a lower bone-to-implant contact ratio, although the difference was not statistically significant. The irradiated groups also exhibited a significantly lower bone volume and higher empty lacuna count than the control groups. No implant failure due to local irradiation was found in this study. CONCLUSION Within the limits of this study, the timing of local irradiation critically influences the bone healing mechanism, which is related to loading time of prostheses.
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Affiliation(s)
- Re-Mee Doh
- Department of Advanced General Dentistry, Dankook University College of Dentistry, Cheonan, Republic of Korea
| | - Sungtae Kim
- Department of Periodontology, Dental Research Institute, Seoul National University School of Dentistry, Seoul, Republic of Korea
| | - Ki Chang Keum
- Department of Radiation Oncology, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Jun Won Kim
- Department of Radiation Oncology, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - June-Sung Shim
- Department of Prosthodontics, Yonsei University College of Dentistry, Seoul, Republic of Korea
| | - Han-Sung Jung
- Division in Anatomy and Development Biology, Department of Oral Biology, Yonsei University College of Dentistry, Seoul, Republic of Korea
| | - Kyeong-Mee Park
- Department of Advanced General Dentistry, Yonsei University College of Dentistry, Seoul, Republic of Korea
| | - Moon-Kyu Chung
- Division in Anatomy and Development Biology, Department of Oral Biology, Yonsei University College of Dentistry, Seoul, Republic of Korea
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Wu Y, Huang W, Zhang Z, Zhang Z, Zou D. Long-term success of dental implant-supported dentures in postirradiated patients treated for neoplasms of the maxillofacial skeleton: a retrospective study. Clin Oral Investig 2016; 20:2457-2465. [PMID: 26907545 DOI: 10.1007/s00784-016-1753-z] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2015] [Accepted: 02/11/2016] [Indexed: 11/29/2022]
Abstract
OBJECTIVES The reconstruction of oral function in irradiated patients with craniofacial tumors is a significant challenge. The aim of this study was to detect long-term success of dental implant-supported dentures in postirradiated patients treated for neoplasms of the maxillofacial skeleton. MATERIALS AND METHODS From 2004 to 2011, 36 irradiated patients underwent oral function reconstruction using implant-supported prostheses. Bone augmentation was completed using vascularized bone grafts in 22 patients. Fourteen patients were treated by hyperbaric oxygen therapy (HBO). A total of 198 dental implants were used in jaw rehabilitation. After loading, implant success rates, biological and prosthetic complications, patient satisfaction, and psychological changes were recorded. RESULTS Bone augmentation of the jaw was successful and vascularized grafts provided an additional vascular supply in compromised irradiated tissue. Rehabilitation was successful in all of the patients after loading. Thirty-eight dental implants failed, and 35 implants were removed. The success rate of the implants was 93.6 % for 10 years after loading. It was not a significant difference in implant success rate between the HBO group and the other groups. The prosthodontic maintenance results and complication rates showed that patients required intervention 0.19 times per year. All patients were satisfied with the oral restoration results. CONCLUSION The restoration of oral function in radiotherapy patients with tumor resection using implant-supported prostheses is a viable treatment option. CLINICAL RELEVANCE Either alone or in combination with HBO, dental implant-supported prostheses can be used an effective therapeutic approach for irradiated patients with oral function reconstruction.
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Affiliation(s)
- Yiqun Wu
- Department of Oral Implants, School of Medicine, Ninth People's Hospital affiliated with Shanghai Jiao Tong University, Shanghai, China
| | - Wei Huang
- Department of Oral Implants, School of Medicine, Ninth People's Hospital affiliated with Shanghai Jiao Tong University, Shanghai, China
| | - Zhiyong Zhang
- Department of Oral Implants, School of Medicine, Ninth People's Hospital affiliated with Shanghai Jiao Tong University, Shanghai, China
| | - Zhiyuan Zhang
- Department of Oral and Maxillofacial Surgery, School of Medicine, Ninth People's Hospital affiliated with Shanghai Jiao Tong University, Shanghai, China
| | - Duohong Zou
- Department of Implants Dentistry, School of Medicine, Ninth People's Hospital affiliated with Shanghai Jiao Tong University, Shanghai, China.
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Poort L, Lethaus B, Böckmann R, Buurman D, Jong JD, Hoebers F, Kessler P. Experimental Studies on the Irradiation of Facial Bones in Animals: A Review. ACTA ACUST UNITED AC 2014. [DOI: 10.4236/ijohns.2014.33022] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Chambrone L, Mandia J, Shibli JA, Romito GA, Abrahao M. Dental implants installed in irradiated jaws: a systematic review. J Dent Res 2013; 92:119S-30S. [PMID: 24158336 DOI: 10.1177/0022034513504947] [Citation(s) in RCA: 71] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
The aim of this study was to assess the survival rate of titanium implants placed in irradiated jaws. MEDLINE, EMBASE, and CENTRAL were searched for studies assessing implants that had been placed in nongrafted sites of irradiated patients. Random effects meta-analyses assessed implant loss in irradiated versus nonirradiated patients and in irradiated patients treated with hyperbaric oxygen (HBO) therapy. Of 1,051 potentially eligible publications, 15 were included. A total of 10,150 implants were assessed in the included studies, and of these, 1,689 (14.3%) had been placed in irradiated jaws. The mean survival rate in the studies ranged from 46.3% to 98.0%. The pooled estimates indicated a significant increase in the risk of implant failure in irradiated patients (risk ratio: 2.74; 95% confidence interval: 1.86, 4.05; p < .00001) and in maxillary sites (risk ratio: 5.96; 95% confidence interval: 2.71, 13.12; p < .00001). Conversely, HBO therapy did not reduce the risk of implant failure (risk ratio: 1.28; 95% confidence interval: 0.19, 8.82; p = .80). Radiotherapy was linked to higher implant failure in the maxilla, and HBO therapy did not improve implant survival. Most included publications reported data on machined implants, and only 3 studies on HBO therapy were included. Overall, implant therapy appears to be a viable treatment option for reestablishing adequate occlusion and masticatory conditions in irradiated patients.
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Affiliation(s)
- L Chambrone
- Division of Periodontics, Department of Stomatology, School of Dentistry, University of São Paulo, São Paulo, SP, Brazil
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Thoma DS, Martin IS, Mühlemann S, Jung RE. Systematic review of pre-clinical models assessing implant integration in locally compromised sites and/or systemically compromised animals. J Clin Periodontol 2012; 39 Suppl 12:37-62. [PMID: 22533946 DOI: 10.1111/j.1600-051x.2011.01833.x] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
OBJECTIVE The aim was to systematically search the dental literature for pre-clinical models assessing implant integration in locally compromised sites (part 1) and systemically compromised animals (part 2), and to evaluate the quality of reporting of included publications. METHODS A Medline search (1966-2011) was performed, complimented by additional hand searching. The quality of reporting of the included publications was evaluated using the 20 items of the ARRIVE (Animals in Research In Vivo Experiments) guidelines. RESULTS One-hundred and seventy-six (part 1; mean ARRIVE score = 15.6 ± 2.4) and 104 (part 2; 16.2 ± 1.9) studies met the inclusion criteria. The overall mean score for all included studies amounted to 15.8 ± 2.2. Housing (38.3%), allocation of animals (37.9%), numbers analysed (50%) and adverse events (51.4%) of the ARRIVE guidelines were the least reported. Statistically significant differences in mean ARRIVE scores were found depending on the publication date (p < 0.05), with the highest score of 16.7 ± 1.6 for studies published within the last 2 years. CONCLUSIONS A large number of studies met the inclusion criteria. The ARRIVE scores revealed heterogeneity and missing information for selected items in more than 50% of the publications. The quality of reporting shifted towards better-reported pre-clinical trials within recent years.
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Affiliation(s)
- Daniel S Thoma
- Clinic of Fixed and Removable Prosthodontics and Dental Material Science, University of Zurich, Zurich, Switzerland.
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de Oliveira JAG, do Amaral Escada AL, Alves Rezende MCR, Mathor MB, Alves Claro APR. Analysis of the effects of irradiation in osseointegrated dental implants. Clin Oral Implants Res 2011; 23:511-4. [DOI: 10.1111/j.1600-0501.2010.02149.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Jegoux F, Malard O, Goyenvalle E, Aguado E, Daculsi G. Radiation effects on bone healing and reconstruction: interpretation of the literature. ACTA ACUST UNITED AC 2010; 109:173-84. [PMID: 20123406 DOI: 10.1016/j.tripleo.2009.10.001] [Citation(s) in RCA: 76] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2009] [Revised: 09/03/2009] [Accepted: 10/04/2009] [Indexed: 10/20/2022]
Abstract
OBJECTIVE Reconstructing irradiated mandibles with biomaterials is still a challenge but little investigated. We collected data that could help us understand studies in the field of regeneration with biomaterials and irradiated bone. STUDY DESIGN Systematic review of the literature. RESULTS Delay and duration of radiation delivery and total equivalent dose are the most variable parameters in the various studies, resulting in confusion when interpreting the literature. Most reproducible experiments show that radiation reduces osteogenic cell numbers, alters cytokine capacity, and delays and damages bone remodeling. Interindividual variations and how such changes become irreversible lesions are still uncertain. In the case of regeneration using biomaterials, most studies have addressed the question of reconstruction in previously irradiated bone. The results show that osseointegration is often possible, although the failure rate is higher. The sooner the implantation takes place after the end of the radiation, the higher the likelihood of failure. Few studies have focused on primary reconstruction followed by early irradiation, and most of the currently available engineering models would be altered by radiation. Good outcomes have been obtained with bone morphogenetic protein and with total bone marrow transplanation. CONCLUSION This review points out the difficulties in achieving reproducible experiments and interpreting literature in this underinvestigated field.
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Verdonck HWD, Meijer GJ, Laurin T, Nieman FH, Stoll C, Riediger D, Stoelinga PJW, de Baat C. Implant stability during osseointegration in irradiated and non-irradiated minipig alveolar bone: an experimental study. Clin Oral Implants Res 2007; 19:201-6. [PMID: 18067600 DOI: 10.1111/j.1600-0501.2007.01457.x] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
OBJECTIVES Primary implant stability is related to local bone density. After insertion of an implant, implant stability is subject to changes due to bone remodeling. In patients who have undergone radiotherapy in the head and neck region, implant stability is impaired because irradiation reduces bone vitality. The current study was designed to monitor and test implant stability immediately after implant placement and during osseointegration in irradiated and non-irradiated minipig alveolar bone. MATERIALS AND METHODS All maxillary and mandibular premolars and molars of six adult Göttingen minipigs were extracted. The maxilla and mandible of three minipigs received three irradiation exposures at a total dose of 24 Gy. After irradiation, five initial implant holes were drilled in the residual alveolar ridge of each edentulous site. In order to assess bone vascularity, laser Doppler flowmetry recordings were carried out in the initial holes. A total of 120 implants were placed in the six minipigs. Subsequently, and at 8, 16, and 24 weeks after implant placement, implant stability was recorded by resonance frequency analysis (RFA). RFA values were expressed as an implant stability quotient (ISQ). RESULTS ISQ values recorded immediately after implant placement showed no differences between irradiated and non-irradiated minipigs. Repeated measurements at the four recording moments showed a decrease of ISQ values in all minipigs, being more pronounced in irradiated bone, when compared with non-irradiated bone. The results at the third and fourth recording moments showed a stabilization or even a slight increase of ISQ values. CONCLUSIONS The results document the negative effect of irradiation on bone vascularity and hence on implant stability.
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Affiliation(s)
- Henk W D Verdonck
- Department of Oral and Maxillofacial Surgery, University Hospital Maastricht, Maastricht, The Netherlands.
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