Medium-term outcome of Astra Tech implants in head and neck oncology patients

Survival of osseointegrated implants in head and neck cancer patients submitted to multimodal treatment: a systematic review and meta-analysis

PURPOSE

To investigate the survival rate in implants placement in irradiated and non-irradiated bone in patients undergoing head and neck cancer (HNC) treatment. We focused on the consequences of the main complications, such as osteoradionecrosis and peri-implantitis.

METHODS

An electronic search conducted by PRISMA protocol was performed. Full texts were carefully assessed, and data were assimilated into a tabular form for discussion and consensus among the expert panel. The quality assessment and the risk of bias are verified by Joanna Briggs Institute checklist (JBI) and The Newcastle-Ottawa Scale (NOS), and Risk of Bias in Non-Randomized Studies of Interventions (ROBINS-I) assessment tool.

RESULTS

A total of 452 records were identified in the based on our PICOs strategy and after screening, 19 articles were included in the descriptive analysis of the review. Totaling 473 implants placed in irradiated and non-irradiated bone, and 31.6% of the patients were over 60 years of age. 57.9%) performed implant placement in a period of 12 months or more after the ending of radiotherapy. Only 5 studies had a follow-up period longer than 5 years after implant placement, of which three were used for the meta-analysis. In the meta-analysis of 5-year survival rate, analysis of implants in irradiated bone was assessed; a random effect model was used and a weighted proportion (PP) of 93.13% (95% CI: 87.20-99.06; p < 0.001), and in the 5-year survival rate, analysis of implants in non-irradiated bone was analysed; a fixed effect model was used and a weighted proportion (PP) of 98.52% survival (95% CI: 97.56-99.48, p < 0.001).

CONCLUSIONS

Survival rates of implants placed in irradiated bone are clinically satisfactory after a follow-up of 5 years, with a fewer percentage than in implants placed in non-irradiated bone after metanalyses performed.

Dental implants in patients with head and neck cancer-A systematic review and meta-analysis of the influence of radiotherapy on implant survival

PURPOSE

The purpose of this meta-analysis was to compare implant survival in irradiated and non-irradiated bone and to investigate potential risk factors for implant therapy in oral cancer patients.

MATERIAL AND METHODS

An extensive search in the electronic databases of the National Library of Medicine was performed. Systematic review and meta-analysis were conducted according to PRISMA statement. The meta-analysis was performed for studies with a mean follow-up of at least three and five years, respectively.

RESULTS

The systematic review resulted in a mean overall implant survival of 87.8% (34%-100%). The meta-analysis revealed a significantly higher rate of implant failure in irradiated bone compared to non-irradiated bone (p < .00001, OR 1.97, CI [1.63, 2.37]). The studies also showed that implants placed into irradiated grafted bone were more likely to fail than those in irradiated native bone (p < .0001, OR 2.26, CI [1.50, 3.40]).

CONCLUSION

Even though overall implant survival was high, radiotherapy proves to be a significant risk factor for implant loss. Augmentation procedures may also increase the risk of an adverse outcome, especially in combination with radiotherapy.

CLINICAL RELEVANCE

The treatment of patients receiving radiotherapy of any form requires precise individual planning and a close aftercare. Implants should be placed in local bone rather than in bone grafts, if possible.

Precision of 30 guided implants in complex tumour situations

Implant born prosthetic rehabilitation of tumour patients can be difficult to perform. Challenges in treating such patients include disrupted anatomy with limited mouth opening due to previous ablative surgery as well as free-flaps or simple bone grafts, adjuvant therapy such as radiotherapy and, in general, poorer general health. Combining classical knowledge of ideal prosthesis placement and current virtual planning possibilities the positioning and in consequence the survival of dental implants can be optimised. Since prosthetic rehabilitation has a positive effect on the patients' quality of life and general health, we propose performing such surgeries as early as possible. All patients at our institution receiving pre-planned guided implant reconstruction and postoperative evaluation with Cone Beam Computed Tomography (CBCT) between 2015 and 2018 were evaluated for inclusion. Eight patients with a total of 30 implants met the inclusion criteria. The planned implant position was compared to the outcome position by fusing the two and deviations in entry-point position, apex-position, angular deviation and depth error were recorded. The mean (SD) discrepancy at entry-point was 2.28 (1.45) mm and 2.89 (1.53) mm at the apex, respectively. Mean (SD) angulation discrepancy was 9.5˚ (4.13˚) and the mean (SD) depth deviation was 1.52 (0.86) mm. Our results demonstrate the feasibility of pre-planned implant placement in challenging clinical situations and that only few concessions have to be made for precision.

Smoking and dental implants: A systematic review and meta-analysis

OBJECTIVE

Recent studies implicate smoking as a significant factor in the failure of dental implants. This review aims to test the null hypothesis of no difference in the implant failure rates, risk of postoperative infection, and marginal bone loss for smokers versus non-smokers, against the alternative hypothesis of a difference.

DATA

Main search terms used in combination: dental implant, oral implant, smoking, tobacco, nicotine, smoker, and non-smoker.

SOURCES

An electronic search was undertaken in September/2014 in PubMed/Medline, Web of Science, Cochrane Oral Health Group Trials Register plus hand-searching.

STUDY SELECTION

Eligibility criteria included clinical human studies, either randomized or not. The search strategy resulted in 1432 publications, of which 107 were eligible, with 19,836 implants placed in smokers, with 1259 failures (6.35%), and 60,464 implants placed in non-smokers, with 1923 failures (3.18%).

CONCLUSIONS

The insertion of implants in smokers significantly affected the failure rates, the risk of postoperative infections as well as the marginal bone loss. The results should be interpreted with caution due to the presence of uncontrolled confounding factors in the included studies.

CLINICAL SIGNIFICANCE

Smoking is a factor that has the potential to negatively affect healing and the outcome of implant treatment. It is important to perform an updated periodic review to synthesize the clinical research evidence relevant to the matter.