Long-Term Results of Endosteal Implants Following Radical Oral Cancer Surgery with and without Adjuvant Radiation Therapy

Authors

  • Sabine S. Linsen Dr. med. dent.,

    Corresponding author
    1. Associate professor, Department of Prosthodontics, Preclinical Education and Dental Materials Science, Rheinische Friedrich-Wilhelms University of Bonn, Bonn, Germany;
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  • Markus Martini Dr. med., Dr. med. dent.,

    1. associate professor, Department of Oral and Maxillofacial Surgery, Rheinische Friedrich-Wilhelms University of Bonn, Bonn, Germany;
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  • Helmut Stark Prof. Dr. med. dent.

    1. professor and head of department, Department of Prosthodontics, Preclinical Education and Dental Materials Science, Rheinische Friedrich-Wilhelms University of Bonn, Bonn, Germany
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Dr. Sabine S. Linsen, Rheinische Friedrich-Wilhelms University of Bonn, Welschnonnenstr. 17, D-53111 Bonn, Germany; e-mail: sabinelinsen@web.de

ABSTRACT

Purpose: The aim of this study was to analyze the long-term survival of implants and implant-retained prostheses in patients after ablative surgery of oral cancer with or without adjunctive radiation therapy.

Materials and Methods: Between 1997 and 2008, 66 patients who had undergone ablative tumor surgery in the oral cavity were treated with dental implants (n = 262). Thirty-four patients received radiation therapy in daily fractions of 2 Gy administered on 18 to 30 days. Implants were inserted in the maxilla (49; 18.7%) or mandible (213; 81.3%), in non-irradiated residual (65; 24.8%) or grafted bone (44; 16.8%) and in irradiated residual (15.6%) or grafted bone (39; 14.9%). Seventeen fixed protheses and 53 removable dentures (34 bar attachments, 9 telescopic and 10 ball retained dentures) were inserted.

Results: Mean follow-up after implant insertion was 47.99 (±34.31) months (range 12–140 months). The overall 1-, 5-, and 10-year survival rates of all implants were 96.6%, 96.6%, and 86.9%, respectively. Fourteen implants were lost in nine patients (5.3% of all implants); eight implants were primary losses, and five secondary losses because of an operation of tumor recurrence. There was no significantly lower implant survival for implants inserted into irradiated bone (p = .302), bone and/or soft-tissue grafts (p = .436), and maxilla or mandible (p = .563). All prosthetic restorations in patients without tumor recurrence could be maintained during the observation period.

Conclusions: Implant survival is not significantly influenced by radiation therapy, grafts (bone and/or soft tissue), or location (maxilla or mandible). However, implants placed in irradiated bone exhibit a higher failure rate during the healing period than those placed in non-irradiated bone. No superstructure was particularly favorable. Osseointegrated implants can be used successfully in patients with prior history of ablative surgery with and without additional radiation therapy.

Ancillary