Review Article
Oral Rehabilitation in Irradiated Patients; A Review on Prosthetic Treatment Options
693
Views & Citations10
Likes & Shares
Head and neck radiotherapy has some intraoral side effects that affect treatment planning for oral rehabilitation. some treatment options with their success have been discussed in articles. Choosing the right treatment should be based on the patient's oral conditions affected by radiotherapy.
Keywords: Radiotherapy, Oral rehabilitation, Treatment options
INTRODUCTION
Many patients with head and neck cancers receive maxillofacial radiotherapy (RT) that have some side effects, they also may require intraoral reconstructive treatment after RT. Most common intraoral side effects of RT are: xerostomia, mocositis, tooth decay and osteoradionecrosis. Side effects can reduce the success of treatment and increase prosthetic complications [1].
Based on literature that considered Oral rehabilitation in irradiated patient, prosthetic intraoral treatments can be divided into three main categories:
Implant supported prosthesis, removable prosthesis, tooth supported prosthesis.
Most articles considered oral rehabilitation with implant supported prosthesis after radiotherapy, but up to our research there isn’t any literature that discusses all types of treatment options; therefore, the purpose of this article is to review literatures that have addressed this issue.
REVIEW
Implant supported prosthesis:
Radiotherapy isn’t considered as a contraindication for implant insertion. However, the waiting period of 13 to 24 months after radiotherapy is recommended. The success rate of treatment in irradiated mandibles was similar to the success rate in areas of the jaw that did not receive radiotherapy [2].
Shaw [3] concluded that Mandibular implants were more successful and with the exception of a few soft tissue problems, most patients have successful prosthetic treatment, more failures were detected with bone grafted implants and maxillary implants. Radiotherapy does not appear to have a negative effect on implant longevity. It seems hyperbaric oxygen has not been of much benefit [3].
For better osteointegration, loading of the prosthesis should be delayed for six months instead of the traditional three to four months for mandible [4].
It is also recommended that primary placement of implants before radiotherapy leads to predictable osteointegration [5,6].
Removable tooth and/or tissue supported prosthesis:
Radiotherapy reduces the amount of saliva and due to the vascular changes, that occur, the patient's mucosa becomes atrophic and sensitive and prone to ulcers.
Considering these conditions, to avoid causing trauma, Oelgiesser [2a] advised, it is better to prevent the administration of removable dentures to the patient to avoid soft tissue damage and bone exposure and osteonecrosis, so fixed prostheses are preferred [2].
Gerngross [7] found that post-prosthesis insertion complications in patients who had received complete denture after radiation therapy were 1.7 times more than others, while most of these patients had greater than 5000 cGy. Curtis [8] believed removable prosthesis are acceptable with Some consideration in irradiated patients: Use of non-pressure technique and spaced trays for impression making, use of monoplane teeth, instruction to patient to remove denture during night and when detecting soreness, removing rough projection from tissue surface and use of soft liners [8].
Tooth supported prosthesis:
Brauner [9] believed that fixed tooth supported prosthesis is better than removable because of lower risk of soft tissue ulceration.
Due to the high risk of tooth decay and soft tissue inflammation around fixed prosthesis, tooth supported prosthesis should be selected based on less complexity and accessibility for examination in follow-up sessions [1].
In patient who have low motivation and ability regarding oral hygiene and in situation where there is no possibility of supragingival margin for fixed prosthesis, it is better to extract teeth and consider implant supported prosthesis [10]. All articles have addressed different dental condition of patient who received different dose and site for radiation therapy, so there is a need for a systematic review in this field, also more articles about irradiated patients who received different types of removable dentures and fixed dental prostheses is needed.
CONCLUSION
Choosing the right treatment plan should be based on the patient's condition. Oral hygiene situation, dose of radiation and period of time that passes after that, quality and quantity of available teeth affect treatment planning.
- Ray-Chaudhuri A, Shah K, Porter RJ (2013) The oral management of patients who have received radiotherapy to the head and neck region. Br Dent J 214(8): 387-393.
- Oelgiesser D, Levin L, Barak S, Schwartz-Arad D (2004) Rehabilitation of an irradiated mandible after mandibular resection using implant/tooth-supported fixed prosthesis: A clinical report. J Prosthet Dent 91(4): 310-314.
- Shaw RJ, Sutton AF, Cawood JI, Howell RA, Lowe D, et al, (2005) Oral rehabilitation after treatment for head and neck malignancy. Head Neck 27(6): 459-470.
- Salama H, Rose LF, Salama M, Betts NJ. (1995) Immediate loading of bilaterally splinted titanium root form implants in fixed prosthodontics - a technique re-examined: Two case reports. Int J Periodontics Restorative Dent 15: 345-361.
- Schepers RH, Slagter AP, Kaanders JH, van den Hoogen FJ, Merkx MA (2006) Effect of postoperative radiotherapy on the functional result of implants placed during ablative surgery for oral cancer. Int J Oral Maxillofac Surg 35: 803-808.
- Schoen PJ, Reintsema H, Raghoebar GM, Vissink A, Roodenburg JLN (2004) The use of implant retained mandibular prostheses in the oral rehabilitation of head and neck cancer patients. A review and rationale for treatment planning. Oral Oncol 40: 862-871.
- Gerngross PJ, Martin CD, Ball JD, Engelmeier RL, Gilbert HD, et al, (2005) Period between completion of radiation therapy and prosthetic rehabilitation in edentulous patients: A retrospective study. J Prosthodont 14(2): 110-121.
- Curtis TA, Griffith MR, Firtell DN (1976) Complete denture prosthodontics for the radiation patient. J Prosthet Dent 36(1): 66-76.
- Brauner E, Cassoni A, Battisti A, Bartoli D, Valentini V (2010) Prosthetic rehabilitation in post-ontological patients: Report of two cases. Ann Stomatol (Roma) 1(1): 19-25.
- Allahyari S (2019) Oral Rehabilitation in Irradiated Patients: Implant-or Tooth-Supported Fixed Prosthesis? A Clinical Report. Front Dent 16(4): 319-324.
QUICK LINKS
- SUBMIT MANUSCRIPT
- RECOMMEND THE JOURNAL
-
SUBSCRIBE FOR ALERTS
RELATED JOURNALS
- Chemotherapy Research Journal (ISSN:2642-0236)
- Journal of Rheumatology Research (ISSN:2641-6999)
- Advance Research on Endocrinology and Metabolism (ISSN: 2689-8209)
- Journal of Neurosurgery Imaging and Techniques (ISSN:2473-1943)
- Journal of Carcinogenesis and Mutagenesis Research (ISSN: 2643-0541)
- Advance Research on Alzheimers and Parkinsons Disease
- Journal of Ageing and Restorative Medicine (ISSN:2637-7403)
