This retrospective study, published in BMC Oral Health, examined the survival of dental implants placed after ablative surgery, in patients affected by oral cancer treated with or without radiotherapy. The researchers collected data for patients with malignant oral tumours who had been treated with ablative surgery and received dental implant rehabilitation between 2007 and 2012. The study reported significantly better outcomes for patients when the implant was not loaded until at least 6 months after placement. This delayed loading protocol gives the best chance of implant osseointegration, stability and, most importantly, effective dental rehabilitation.
The authors of the report write: “After radical cancer surgery, the oral rehabilitation of a patient is a demanding procedure. Following radiation and surgical resection, most patients suffer from soft and hard tissue defects resulting in functional disabilities and aesthetic deformity… However, even implant treatment in oral cancer patients is challenging because the bone into which the dental implants are placed has often been within the field of irradiation, or is grafted. Implant failure increases when they are placed in irradiated bone, in part because radiotherapy can result in progressive fibrosis of vessels and soft tissue, leading to diminished healing capacity”. The radiation problematises conventional dental rehabilitation, so the study sought to find the most effective methods whereby the implants were successful and the patient made a full recovery.
The research found that there was a highly significant relationship between the time of loading and the success of the implant in irradiated bone. Good results were obtained with an implant loading protocol of 6 months, and no implants were lost when the period of healing was greater than 6 months. Irradiated bone creates a challenging environment for implant placement, but the most success can be found with a delayed loading process.