Implant in cancer survivor with radiation treatment?
I have a 50-year old female patient with a history of radiation treatment for breast cancer who needs an implant in her mandibular first molar region. She did not receive bisphosphonates or any chemotherapy. Should I be concerned about ORN? Are there any tests I should run? Should I take any special precautions?
9 Comments on Implant in cancer survivor with radiation treatment?
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Gregori Kurtzman, DDS, MA
12/8/2015
Radiation treatment is a focused exposure area and since it was breast that should not affect the mandible as it would be out of the field of exposure. How long ago was the treatment? I would ask the oncologist for a med consult indicating what is planned and get him to OK it. if he doesnt then its a no go because if something does happen your screwed. but f he Ok it and then something happens your defense is he authorized it and hes the oncologist. Personally, would wait at least a year post radiation tx
Mark Bornfeld DDS
12/8/2015
You need to consult with the radiation oncologist to determine if there was a significant absorbed dose to the mandible. With due respect to Dr. Kurtzman, the timing of radiotherapy relative to osteoradionecrosis risk is irrelevant. I have witnessed ORN occur in the clavicle over 30 years after breast CA radiotherapy. The biological effects of ionizing radiation on bone should be considered permanent, so the most salient issue is the path of the radiation beam, rather than how long ago the radiation exposure was incurred.
Gregori Kurtzman, DDS, MA
12/8/2015
My comment on waiting is related to need for supplementing the radiation with chemo. if the patient is clean a year out likelihood of needing chemo is low and I wouldnt want to have an implant in a patient that was getting to a few months later start chemo
CRS
12/8/2015
Was the mandible or maxilla irradiated? Doubtful for breast cancer, place the implant especially since there was no chemo or Bisphos. The simple answer is find out the staging and tissue diagnosis. If this were a head and neck ca patient the questions to ask the radiation oncologist is radiation dosage and if any shielding was used. Then follow the HBO treatment protocol prior to placing implants. It will be fine.
Dr Manu Bansal
12/10/2015
Whts the HBO treatment guidelines for cancer patients.?
I have a case who had been irradiated for neck region but need dental implants in maxillary arch. Any experiences on this?
CRS
12/12/2015
First find out the total amount of radiation and what structures were in the field. Any shielding of the maxilla? If the maxilla was shielded or not in the field then HBO may not be necessary. The amount of dives is usually 25 preop and sometimes an additional 10 dives post op. The protocol should be individualized in agreement with the oncologist. The guidelines vary but this will get you started. An online search for literature is advised. Implants are a good option especially since the salivary glands can be damaged making it difficult to tolerate a denture. Hope this helps.
CRS
12/12/2015
Oops it is thirty dives preop, been a while. There is ample literature on this online. Also the HBO therapy centers will also guide you.
rsdds
12/14/2015
there's a few studies that give upper 90's success rate to irradiated mandibles and upper 80's to irradiadated maxillas one is from mainz germany the other from the cleveland clinic both studied 250 plus implants placed in irradiated mandibles google them. I just completed a lower fix case successfully.
CRS
12/17/2015
It all depends on the radiation dosage and how it effects tha vascularity of the mandible or maxilla. Hyperbaric oxygen will improve the blood supply. Bone needs to be vascular for implants to integrate.
