Radiotherapy and the survival of dental implants: a systematic review

For patients with head and neck cancer, the effects of treatment with adjuvant radiotherapy can be devastating. Frequently there is loss of function due to tooth loss, pain and discomfort from xerostomia and mucositis, and a significant psychosocial impact. Dental implants provide an effective means of rehabilitation for many, but irradiation poses a unique set of challenges that can affect the outcome of treatment. The aims of this review were to find out whether radiotherapy in these patients affects the survival of dental implants, and to discuss details of pertinent influencing factors. An electronic search of the Medline, Web of Science, and CENTRAL databases was done to identify studies on the survival of implants in irradiated patients within specified inclusion and exclusion criteria. No restriction was placed on the year of publication. The primary outcome measure was implant survival. Seven studies involving 441 participants and 1502 implants placed into irradiated bone were included. Meta-analysis indicated that survival was significantly higher in the mandible compared with the maxilla (p = 0.04), and in non-irradiated cases compared with irradiated cases (p < 0.001). Other factors that showed a strong association with survival were radiation dose and timing of surgery. Implant-based rehabilitation is a viable option for head and neck cancer patients who have undergone radiotherapy. Whilst the short to medium-term implant survival in these cases is high, multiple factors require careful consideration for a favourable outcome. Further high-quality research and randomised controlled trials are required in this field.