Osteoradionecrosis Incidence and Dental Implant Survival in Irradiated Head and Neck Cancer Patients: A Systematic Review and Meta-Analysis.

Background and aim: The use of implants in irradiated patients has been critically questioned due to the presence of Osteoradionecrosis and other side effects of radiation therapy. Hence, our objective is to examine the likelihood of dental implant survival and the incidence of osteoradionecrosis in patients with head and neck cancer who have undergone radiation therapy. This analysis will aid in making informed therapeutic decisions on oral rehabilitation for individuals at high risk, ensuring maximal benefit.

Method: PubMed, Scopus, and Web of Science were queried until April 2024. The digital data were extracted using the Web plot digitizer. We utilized the most recent iteration of STATA (version 18) to perform a meta-analysis of the data. The studies were evaluated for quality using the New Castle-Ottawa Scale. Egger's test was used to evaluate the presence of publication bias caused by modest research effects.

Result: The study analyzed data from 21 research papers on 753 head and neck cancer patients. The majority were male, with a mean age of 60.25 years. 46% underwent radiotherapy, with 2261 dental implants inserted. The mandible was the most used implant site, accounting for 62.4%. The mean time between implant placement and radiotherapy was 5.3 weeks, with a median waiting period of 30.7 months for secondary surgery. After an average follow-up of 42.25 months, 58% of implants failed in the irradiated control group, while 6% failed in the non-irradiated control subgroup. Osteoradionecrosis was seen in 26 patients, resulting in an incident rate of 1.81%. As a result of this problem, an average of 2.5 implants per patient were not successfully retained. Radiotherapy was found to be a significant risk factor for implant survival.

Conclusion: Our research indicates that the survival rate of implants in patients who have undergone radiation therapy is lower compared to those who have not received radiation therapy. Additionally, although rare, osteoradionecrosis is a significant complication that every oral and maxillofacial surgeon should be ready to address. Enhancing the quality of care, mitigating hazards, and reducing treatment duration may hinge upon implementing a systematic approach to patient selection and therapy.