Challenges in irradiated bone implantation

Abstract

Introduction. Implantation in irradiated bone is very challenging due to many factors: implant therapy parameters, irradiated tissue, and the patient's general health. Implantologists have to consider all of these aspects when planning implant therapy and during the postsurgical recovery period. Case outline. A case presented in this paper is a 54-year old male, who was admitted to the Clinic for maxillofacial surgery, School of dental medicine in Belgrade, for implant anchored orbital prosthesis. One year previously, the patient had orbital exenteration and postoperatively received radiotherapy with an overall dose of 60 Gy. After planning, three disk implants - two double and one triple disk were placed (Ihde Dental, Switzerland). Implant stability was clinically satisfactory with immediate ISQ of 37, 46, and 51, respectively. After osseointegration implant retained prosthesis was manufactured. After six years due to osteoradionecrosis (ORN) implant stability was compromised. The patient received conservative and hyperbaric chamber treatment. The implants regained stability, and the patient was in remission for four years. Afterwards due to ORN two implants were explanted, and the third implant was stable enough to anchor the prosthesis. The prosthetic plan had to be modified for one implant anchorage, afterwards successful prosthetic rehabilitation was achieved. Conclusion. Implantation in irradiated bone is very delicate, and careful planning of implant insertion and prosthetic rehabilitation is essential. The possible occurrence of osteoradionecrosis should also be taken into account, as a result of which the implant may be lost, which compromises the retention of the prosthesis.