Title : The current status of the irradiated patient regarding Dental implant treatment.
Abstract:
Oral implantology is a process that improves the patient's aesthetic and functional rehabilitation while also increasing their comfort. The local and overall conditions for osseointegration success, as well as the psychological environment and technological possibilities, are all considered before placing a dental implant. Clinical and x-ray workups are important elements of a patient's dental implant evaluation, and developments in CT equipment and software have improved implant surgical success.
In patients who have had head and neck radiotherapy, implant therapy can be more difficult than in healthy patients. Radiation has a number of effects on the oral cavity that can jeopardize the osseointegration process. To promote osseointegration and prevent implant failure, hyperbaric oxygen treatment is utilized as an adjuvant therapy.
When assessing the feasibility of placing a mandibular implant in a patient who has undergone radiation therapy, the clinician should consider several factors, including the risk of osteoradionecrosis, short and long-term implant success rates, the patient's potential lifespan, the possibility of treatment with hyperbaric oxygen therapy, and the patient's potential benefit. The radiation received by the insertion locations determines the risk of osteoradionecrosis. Furthermore, concurrent chemotherapy amplifies tissue effects and should be considered. When doses are mentioned in this discussion, the levels cited refer to dosages delivered by standard fractionation (200 cGy fractions, five fractions per week).
The doctor should apply formulas that take into consideration the dose per fraction, the number of fractions, the total dose, and the length of time the treatment is provided when considering implant therapy for a patient treated with hyper-fractionation or fast fractionation. Doses below 5500 cGy or their equivalent imply a low risk of osteoradionecrosis at the implantation sites, unless the patient is treated with hyperbaric oxygen therapy; however, doses above 6500 cGy or their equivalent imply a high risk of osteoradionecrosis at the implantation sites, unless the patient is treated with hyperbaric oxygen therapy.
Patients with edentulous jawbones: Implant-supported obturator prosthesis help all edentulous patients with maxillectomy or palatectomy abnormalities, and the authors urge their use even though success rates are lower in irradiated areas. Osteoradionecrosis is a rare complication. The volume and quality of bone at the implant location, as well as the radiation dose, affect the success rate. When implantation sites are subjected to doses larger than 5,000 cGy, the initial anchoring of the implant is very important, because it is extremely improbable that any considerable amount of bone will deposit on the implant's surface. As a result, long-term anchoring is more likely to be mechanical than biological. Some implant failures in the irradiated jaw are caused by difficulties obtaining initial anchoring during surgery, whereas others develop after loading. As a result, the physician must consider the altered biomechanics imposed by a compromised implant anchor while constructing the implant connection bar and selecting the attachments utilized for retention.
