Extra-oral craniofacial endosseous implants and radiotherapy.

Area of Science:

• Oral and Maxillofacial Surgery
• Biomaterials Science
• Radiation Oncology

Background:

• Irradiated bone presents unique challenges for dental implant success.
• Extra-oral endosseous craniofacial implants (EOECIs) offer a reconstructive option for complex craniofacial defects.
• Osteoradionecrosis (ORN) is a significant complication following radiation therapy to the head and neck.

Purpose of the Study:

• To review the survival rates of EOECIs in irradiated bone.
• To discuss the optimal timing for EOECI placement relative to radiotherapy.
• To explore strategies for improving EOECI outcomes in irradiated patients.

Main Methods:

• Literature review of studies on EOECI therapy in irradiated bone.
• Analysis of survival data for EOECIs.
• Examination of evidence regarding pre- and post-implant radiotherapy protocols.
• Review of hyperbaric oxygen (HBO) therapy's role in managing ORN and improving implant outcomes.

Main Results:

• EOECI survival rates in irradiated bone vary, influenced by factors like radiation dose and timing of placement.
• Controversy exists regarding the ideal interval between radiotherapy and EOECI implantation.
• Pre- and post-implant radiotherapy have distinct advantages and disadvantages impacting implant success.
• Hyperbaric oxygen shows potential in managing osteoradionecrosis and may enhance EOECI rehabilitation.

Conclusions:

• EOECI therapy is a viable option for craniofacial reconstruction in irradiated bone.
• Careful patient selection, optimized radiotherapy timing, and consideration of adjunctive therapies like HBO are crucial for successful outcomes.
• Further research is needed to establish definitive guidelines for EOECI placement in irradiated bone.