Planned Dental Extractions After Radiation Therapy

Area of Science:

• Oral and Maxillofacial Surgery
• Oncology
• Radiation Oncology

Background:

• Pre-radiation therapy (RT) dental extractions are standard for nonrestorable teeth.
• Delays in RT initiation can occur with pre-RT extractions.
• Post-RT dental extractions present an alternative but with uncertain outcomes.

Purpose of the Study:

• To assess the feasibility and safety of performing dental extractions immediately after radiation therapy.
• To evaluate the risk of complications, specifically exposed alveolar bone, following post-RT extractions.

Main Methods:

• A prospective cohort study involving 50 patients who postponed recommended pre-RT dental extractions.
• Patients underwent dental extractions post-RT, ideally within 4 months.
• The primary outcome was the cumulative incidence of exposed alveolar bone, analyzed using the Gray method with death as a competing risk.

Main Results:

• Of 50 patients, 30 underwent a median of 8.5 extractions at a median of 64.5 days post-RT.
• The 2-year cumulative incidence of exposed bone was 27% overall.
• Patients with post-RT extractions had a 40% incidence of exposed bone, compared to 7% in those who did not have post-RT extractions. Eight cases of osteoradionecrosis were confirmed.

Conclusions:

• Post-radiation dental extractions, even within 4 months, are associated with a considerable risk of exposed alveolar bone.
• The findings suggest that delaying dental extractions until after radiation therapy may increase the risk of complications like osteoradionecrosis.
• Careful patient selection and risk-benefit assessment are crucial when considering post-radiation dental procedures.