[Surgical tooth reconstruction in conjunction with irradiation of malignant tumors]

An infected osteoradionecrosis (IORN) is one of the most problematic sequelae of radiation in the course of cancer treatment in the head and neck. To prevent this, prophylactic dental extractions have been demanded before radiation, as well as specific measures (epiperiostalplastic cover, perioperative antibiotic treatment) if a tooth has to be extracted after the radiation treatment has been carried out. From 1980 until 1993, 812 Patients who had to be irradiated underwent a prophylactic dental extraction programme. Only in 0.5% of these cases an infected osteoradionecrosis developed later on. 167 patients were treated after the radiation had been applied, using perioperative antibiotic treatment and meticulous soft tissue cover following epiperiostal preparation of the gingiva. In spite of 25% of localised dehiscences no immediate infection of the bone was observed. At the same time 53 infected osteoradionecrosis were treated, 43% of which were of dental origin. Most of these were seen in the lower molar area. The results show the high value of prophylactic dental extractions before radiation as well as the benefit of careful extractions with epiperiostal gingival cover, after the radiation treatment, especially in the area of the posterior lower alveolus.