Implant placement before head and neck radiation therapy?

No implants. This is an advanced case best handled by an OMS in coordination with the radiation oncologist. Don't pull the teeth either there is a protocol here. This is above your pay grade. Refer it. This is in the patient's best interest in this life threatening illness. Do the right thing. Or did I forget to mention that chemotherapy may be in the future. Need to save the patient's life first. Thanks for posting.

The Patient is my mother in law who lives in another state. The OMS over there recommended that per patient request because she is willing to keep her bad teeth rather than wearing regular denture. The OMS suggested extractions and immediate Implants followed by the radiation then hyperbaric oxygen later on, hoping that will raise the survival rate of the implants. I am a prosthodontist and I faced many complication in the past with patients who placed Implants after radiation and this situation is new for me since the plan is radiation after implant placement not before. I am the restorative partner in this case and wanted to clarify this and to get an idea about what i will be facing from the restorative aspect. I posted this post for second opinion as it might be something new from the surgical aspect that I am not aware of. Thank you for your input.

Dear Mounir, I am very sorry about your mother in law and I need to be more careful about who I might be addressing on these post so I ask your forgiveness for the harshness of the comments. Of course patients can decline treatment but I would only offer implants after extractions, radiation and HBO.The radiation will severely affect the bone and osteoradionecrosis is a big possibility I don't think your mother in law has a choice here, what type of resection did she have and what is the prognosis? The bone will be essentially necrotic after the radiation. Perhaps offering a compromise of mandibular implants so she will feel she still has teeth since this area won't be in the line of fire. I still would not place the implants prior to radiation unless the surgeon is relying on the 8-12 week window, it's still risky.

Dear Dr Mounir, Sorry about your mother in law. I agree with performing the extractions and placing the implants prior to radiation and perhaps HBO. The ones to consult are the oncologist. Some chemo agents contradict HBO. You most likely will have to wait a significant time to place implants after radiation tx. I always confer with the oncologist and other physicians before attempting these cases. This is one for the team approach. Keep the prosthesis off the shot tissue if possible, like CRS said its complex.

You have a window of opportunity here which is worth using. If the extractions are performed now and the implants are placed at the same time, then they are liable to be integrated quite well by the time the radiation starts. Four implants could help support a good prosthesis and help avoid trauma on a healing ridge. As salivary flow will be decreased post-radiation it may be very difficult for her to wear a normal denture. Of course this need to be integrated into a total treatment plan, but this would seem very well worth trying.

A consideration that has not been mentioned is that if the implants are placed prior to the irradiation, then they will act as secondary sources of irradiation and can cause virtually immediate osteonecrosis of the surrounding bone. One needs to coordinate with the radiation oncologist to determine the portals and dose of radiation that will be utilized.

Melanoma is a very aggressive type of malignant cancer......it usually starts from exposure to sunlight...and look in this case where the cancerous cells ended up....in the Schneiderian membrane. Cancer cells are attracted to areas where blood supply has been increased, and that is usually in areas that are in a healing phase especially where trauma to tissues has been caused i.e. surgery of any kind. Years ago I had placed dental implants into the symphysis of a patient, who six weeks after my intervention, was diagnosed with squamous cell carcinoma in his stomach. He called me to his hospital bed to show me severe swelling and bleeding next to his recently placed implants, and I was astonished to see cancerous lesions in the area I had worked in, which at the time was healthy..... the patient passed away. If the existing natural teeth can be maintained with minimal intervention, let your mother in law regain her health before doing implant surgery or extractions if it can be helped. God bless her, I hope she makes it, and she should know she has a very caring son in law who sought other people's opinions before intervening. Gerry Rudick dds AFAAID. F. D .ICOI Montreal