Osteoradionecrosis incidence in pre-radiation teeth extractions: A prospective study
C Rupe1, G Gioco1, M Massaccesi2
1Head and Neck Department, Fondazione Policlinico Universitario A. Gemelli-IRCCS, School of Dentistry, Università Cattolica del Sacro Cuore, Rome, Italy.
Oral Diseases
|April 9, 2024
Summary
Tooth extraction before head and neck cancer radiotherapy increases osteoradionecrosis risk, especially with osteotomy or high radiation doses. A new algorithm guides extraction decisions to mitigate this risk.
Area of Science:
- Oral and Maxillofacial Surgery
- Radiation Oncology
- Oncology
Background:
- Osteoradionecrosis (ORN) is a potential complication following radiotherapy for head and neck cancers.
- Tooth extraction (TE) prior to radiotherapy is sometimes necessary but may influence ORN development.
Purpose of the Study:
- To evaluate the incidence of osteoradionecrosis (ORN) in patients who underwent tooth extraction (TE) before radiotherapy (RT) for head and neck cancers.
- To identify risk factors associated with ORN development after TE and RT.
Main Methods:
- A cohort of 156 patients with 610 TEs was analyzed.
- ORN was defined as exposed bone in unhealed post-extraction sockets without cancer recurrence.
- Radiation dose to the extraction site and need for osteotomy were assessed.
Main Results:
- The incidence of ORN was 2.6% in patients and 0.7% of TEs.
- Osteotomy (OR: 21.9) and higher radiation doses to the extraction site (OR: 1.1) were significantly associated with ORN.
- Mean follow-up was 567 days.
Conclusions:
- Tooth extraction is a significant risk factor for ORN, particularly when osteotomy is needed or high radiation doses are delivered to the extraction site.
- The study proposes a decision-making algorithm and surgical protocol to manage TE in head and neck cancer patients undergoing RT.
