Survival of dental implants in patients with oral cancer treated by surgery and radiotherapy: a retrospective study

BACKGROUND: The aim of this retrospective study was to evaluate the survival of dental implants placed after ablative surgery, in patients affected by oral cancer treated with or without radiotherapy. METHODS: We collected data for 34 subjects (22 females, 12 males; mean age: 51 ± 19) with malignant oral tumors who had been treated with ablative surgery and received dental implant rehabilitation between 2007 and 2012. Postoperative radiation therapy (less than 50 Gy) was delivered before implant placement in 12 patients. A total of 144 titanium implants were placed, at a minimum interval of 12 months, in irradiated and non-irradiated residual bone. RESULTS: Implant loss was dependent on the position and location of the implants (P = 0.05-0.1). Moreover, implant survival was dependent on whether the patient had received radiotherapy. This result was highly statistically significant (P < 0.01). Whether the implant was loaded is another highly significant (P < 0.01) factor determinin

Muskeltransfer bei chronisch irreparablen postero-superioren Rotatorenmanschettenmassenrupturen

Massive irreparable posterosuperiore Rotatorenmanschettenrupturen können mit schwerer funktioneller Beeinträchtigung und heftigen Schmerzen einhergehen. In diesen Fällen, meist nach frustraner konservativer Therapie stehen verschiedene operative Möglichkeiten zur Verfügung. Als etabliertes Verfahren gilt der Latissimus dorsi Muskeltransfer. Anatomische und biomechanische Studien zeigten, dass der M. teres major Flap hinsichtlich seines Kraftvektors und seiner Sehnenlänge und –breite Vorteile bieten könnte. Wobei der Muskel Latissimus dorsi beim Transfer relativ gesehen weniger verlängert wird. Ziel dieser Arbeit ist es in einer prospektiv randomisierten Studie das klinische Outcome zwischen beiden OP- Verfahren bei massiven irreparablen posterosuperioren Rotatorenmanschettenrupturen zu vergleichen und Unterschiede heraus zu arbeiten. Es wurden 20 Patienten (sieben weiblich/ 13 männlich) mittels einem Latissimus dorsi Flap versorgt und 25 Patienten (sieben weiblich/ 18 männlich) mit einem Teres major Muskeltransfer. Alle Patienten wiesen eine posterosuperiore Massenruptur der Rotatorenmanschette auf mit einer Sehnenretraktion Grad drei nach Patte [92] und einer Muskelatrophie Grad drei nach Thomazeau.[94] Vorausgesetzt wurde ein intakter M. subscapularis und M. deltoideus. Beide Patientengruppen wurden nach einem Mindestzeitraum von zwei Jahren nachuntersucht. In der Gruppe mit Latissimus dorsi Transfer fand dies durchschnittlich nach 29 Monaten und mit Teres major Flap im Median nach 30 Monaten statt. Beurteilt wurde in der klinischen Untersuchung die Funktionalität, Kraft und Schmerzhaftigkeit des betroffenen Schultergelenks. Radiologisch wurde der Arthrosegrad nach Hamada [105] bestimmt, sowie der Akromiohumerale Abstand gemessen zur Dokumentation der Kranialisierung des Humeruskopfes. Zuletzt fand eine sonographische Bewertung der Integrität des transferierten Muskels und Rotatorenmanschette statt. Beide Operationsmethoden mit M. teres major als auch mit M. latissimus dorsi Muskeltransfer erzielten sehr zufriedenstellende Ergebnisse auch bei älteren sowie voroperierten Patienten. Es konnte gezeigt werden, dass sich in beiden Gruppen der gesamte Constant Murley Score, sowie die aktive Flexion und Abduktion signifikant (P<0,05) im Verlauf verbesserte. Außerdem wurde in beiden Gruppen ein Fortschreiten der Arthrose verhindert. Vielmehr konnte radiologisch in der Nachuntersuchung eine leichte (P≥0,05) Zunahme des akromiohumeralen Abstands innerhalb der Gruppe mit M. Latissimus dorsi Flap nachgewiesen werden. In der Kategorie ROM zeigte sich im Vergleich ein signifikant höherer Bewegungsumfang in der Gruppe mit Latissimus dorsi Transfer. Während die aktive Aussenrotation bei Patienten mit M. teres major Transfer unverändert blieb, verbesserte sie sich bei denjenigen mit M. latissimus dorsi Transfer signifikant (P<0,05). Zusätzlich war bei LD Transfer das ARO-lag Zeichen signifikant (P<0,05) vermindert wobei es bei M. teres major Transfer unverändert blieb. Optimale Ergebnisse erzielten beide Operationstechniken. Die Komplikationsrate lag bei der Gruppe mit M. teres major Transfer bei einer Flapruptur und einem Ankerausriss. Während in der Gruppe mit M. latissimus doris Transfer es zu keinen Rupturen kam. In Bezug auf das funktionelle Versagen erreichten bei intaktem Flap mit Latissimus dorsi Flap zwei Patienten keine 90 Grad bei Abduktion und Flexion, während es bei drei Patienten mit M. teres major Transfer der Fall war. Aufgrund der Ergebnisse dieser Studie ist die aktuelle Empfehlung bei gut vorselektierten Patienten mit massiven irreparablen posterosuperioren Rotatorenmanschettenrupturen die Durchführung des Latissimus dorsi Muskeltransfers

Muskeltransfer bei chronisch irreparablen postero-superioren Rotatorenmanschettenmassenrupturen

Massive irreparable posterosuperiore Rotatorenmanschettenrupturen können mit schwerer funktioneller Beeinträchtigung und heftigen Schmerzen einhergehen. In diesen Fällen, meist nach frustraner konservativer Therapie stehen verschiedene operative Möglichkeiten zur Verfügung. Als etabliertes Verfahren gilt der Latissimus dorsi Muskeltransfer. Anatomische und biomechanische Studien zeigten, dass der M. teres major Flap hinsichtlich seines Kraftvektors und seiner Sehnenlänge und –breite Vorteile bieten könnte. Wobei der Muskel Latissimus dorsi beim Transfer relativ gesehen weniger verlängert wird. Ziel dieser Arbeit ist es in einer prospektiv randomisierten Studie das klinische Outcome zwischen beiden OP- Verfahren bei massiven irreparablen posterosuperioren Rotatorenmanschettenrupturen zu vergleichen und Unterschiede heraus zu arbeiten. Es wurden 20 Patienten (sieben weiblich/ 13 männlich) mittels einem Latissimus dorsi Flap versorgt und 25 Patienten (sieben weiblich/ 18 männlich) mit einem Teres major Muskeltransfer. Alle Patienten wiesen eine posterosuperiore Massenruptur der Rotatorenmanschette auf mit einer Sehnenretraktion Grad drei nach Patte [92] und einer Muskelatrophie Grad drei nach Thomazeau.[94] Vorausgesetzt wurde ein intakter M. subscapularis und M. deltoideus. Beide Patientengruppen wurden nach einem Mindestzeitraum von zwei Jahren nachuntersucht. In der Gruppe mit Latissimus dorsi Transfer fand dies durchschnittlich nach 29 Monaten und mit Teres major Flap im Median nach 30 Monaten statt. Beurteilt wurde in der klinischen Untersuchung die Funktionalität, Kraft und Schmerzhaftigkeit des betroffenen Schultergelenks. Radiologisch wurde der Arthrosegrad nach Hamada [105] bestimmt, sowie der Akromiohumerale Abstand gemessen zur Dokumentation der Kranialisierung des Humeruskopfes. Zuletzt fand eine sonographische Bewertung der Integrität des transferierten Muskels und Rotatorenmanschette statt. Beide Operationsmethoden mit M. teres major als auch mit M. latissimus dorsi Muskeltransfer erzielten sehr zufriedenstellende Ergebnisse auch bei älteren sowie voroperierten Patienten. Es konnte gezeigt werden, dass sich in beiden Gruppen der gesamte Constant Murley Score, sowie die aktive Flexion und Abduktion signifikant (P<0,05) im Verlauf verbesserte. Außerdem wurde in beiden Gruppen ein Fortschreiten der Arthrose verhindert. Vielmehr konnte radiologisch in der Nachuntersuchung eine leichte (P≥0,05) Zunahme des akromiohumeralen Abstands innerhalb der Gruppe mit M. Latissimus dorsi Flap nachgewiesen werden. In der Kategorie ROM zeigte sich im Vergleich ein signifikant höherer Bewegungsumfang in der Gruppe mit Latissimus dorsi Transfer. Während die aktive Aussenrotation bei Patienten mit M. teres major Transfer unverändert blieb, verbesserte sie sich bei denjenigen mit M. latissimus dorsi Transfer signifikant (P<0,05). Zusätzlich war bei LD Transfer das ARO-lag Zeichen signifikant (P<0,05) vermindert wobei es bei M. teres major Transfer unverändert blieb. Optimale Ergebnisse erzielten beide Operationstechniken. Die Komplikationsrate lag bei der Gruppe mit M. teres major Transfer bei einer Flapruptur und einem Ankerausriss. Während in der Gruppe mit M. latissimus doris Transfer es zu keinen Rupturen kam. In Bezug auf das funktionelle Versagen erreichten bei intaktem Flap mit Latissimus dorsi Flap zwei Patienten keine 90 Grad bei Abduktion und Flexion, während es bei drei Patienten mit M. teres major Transfer der Fall war. Aufgrund der Ergebnisse dieser Studie ist die aktuelle Empfehlung bei gut vorselektierten Patienten mit massiven irreparablen posterosuperioren Rotatorenmanschettenrupturen die Durchführung des Latissimus dorsi Muskeltransfers

The sympathetic nervous system in dental implantology

The sympathetic nervous system plays a vital role in various regulatory mechanisms. These include the well-known fight-or-flight response but also, for example, the processing of external stressors. In addition to many other tissues, the sympathetic nervous system influences bone metabolism. This effect could be highly relevant concerning osseointegration, which is responsible for the long-term success of dental implants. Accordingly, this review aims to summarize the current literature on this topic and to reveal future research perspectives. One in vitro study showed differences in mRNA expression of adrenoceptors cultured on implant surfaces. In vivo, sympathectomy impaired osseointegration in mice, while electrical stimulation of the sympathetic nerves promoted it. As expected, the beta-blocker propranolol improves histological implant parameters and micro-CT measurements. Overall, the present data are considered heterogeneous. However, the available publications reveal the potential for future research and development in dental implantology, which helps to introduce new therapeutic strategies and identify risk factors for dental implant failure

Hard and soft tissue regeneration of severe peri-implantitis defects with the laser-assisted peri-implant defect regeneration technique : 3-year results

Purpose This retrospective cohort study evaluates the regeneration of severe peri-implantitis deficiencies treated with the laser-assisted peri-implant defect regeneration (LAPIDER) approach within a 3-year follow-up. Methods Twenty-four implants with severe peri-implantitis in 18 patients were treated according to the LAPIDER technique. In contrast to classic techniques for reconstructive peri-implantitis surgery with a marginal incision, a buccal split-flap preparation avoiding papillae separation was used. After a coronal flap elevation and a laser-assisted peri-implant defect cleaning, connective tissue and autogenous bone grafting was performed. Primary outcomes were the changes of the marginal bone levels (MBL) and the buccal bone thickness. Secondary outcomes included implant survival, peri-implant probing depths (PPD), bleeding on probing (BOP), recession, width of keratinized mucosa (KMW), thickness of keratinized mucosa (KMT), soft tissue esthetics (PES), and implant success. Results MBL improved interproximal by 3.10 ± 2.02 mm (p < 0.001), buccal by 3.49 ± 2.89 mm (p < 0.001), and lingual by 1.46 ± 1.98 mm (p = 0.003); buccal bone thickness by 0.55 ± 0.60 mm (p = 0.005), and 1.01 ± 1.25 mm (p = 0.001) at 1 and 3 mm below reference level. Two implants were removed; 22 implants were still in function at a mean follow-up of 36 months. PPD changed from 5.05 ± 1.39 to 3.08 ± 0.71 mm (p < 0.001); recession was reduced from 2.07 ± 1.70 to 0.91 ± 1.13 mm (p = 0.001); KMW increased from 2.91 ± 1.81 to 4.18 ± 1.67 mm (p = 0.006); KMT improved from 1.73 ± 0.50 to 2.44 ± 0.43 mm (p < 0.001); PES changed from 7.7 ± 2.8 to 10.7 ± 1.9 (p < 0.001). 45.8% to 54.2% of the implants met the criteria of implant success. Conclusions The favorable results document the proof of principle for the regeneration of severe peri-implant hard and soft tissue deficiencies by the LAPIDER treatment approach

Dental implants in patients with head and neck cancer : a systematic review and meta-analysis of the influence of radiotherapy on implant survival

Purpose The purpose of this meta-analysis was to compare implant survival in irradiated and non-irradiated bone and to investigate potential risk factors for implant therapy in oral cancer patients. Material and methods An extensive search in the electronic databases of the National Library of Medicine was performed. Systematic review and meta-analysis were conducted according to PRISMA statement. The meta-analysis was performed for studies with a mean follow-up of at least three and five years, respectively. Results The systematic review resulted in a mean overall implant survival of 87.8% (34%–100%). The meta-analysis revealed a significantly higher rate of implant failure in irradiated bone compared to non-irradiated bone (p < .00001, OR 1.97, CI [1.63, 2.37]). The studies also showed that implants placed into irradiated grafted bone were more likely to fail than those in irradiated native bone (p < .0001, OR 2.26, CI [1.50, 3.40]). Conclusion Even though overall implant survival was high, radiotherapy proves to be a significant risk factor for implant loss. Augmentation procedures may also increase the risk of an adverse outcome, especially in combination with radiotherapy. Clinical relevance The treatment of patients receiving radiotherapy of any form requires precise individual planning and a close aftercare. Implants should be placed in local bone rather than in bone grafts, if possible

Comprehensive update on implants in patients with head and neck cancer (2021–2024): systematic review and meta-analysis of the impact of radiotherapy and chemotherapy on implant survival

Objectives: This study aimed to investigate implant outcomes in patients with head and neck cancer undergoing radiotherapy or chemotherapy by incorporating the latest research findings. Methods: The present review was conducted to update the focused question: What is the survival rate of implants placed in patients with head and neck cancer receiving radiotherapy or chemotherapy compared to non-irradiated patients? It built upon two previous systematic reviews (2014 and 2022) and provided an updated synthesis of the literature, focusing on clinical studies published between 2021 and 2024. The earlier reviews were included in the quantitative synthesis only to offer a broader longitudinal perspective. Results: Nine studies were identified, with seven included in the quantitative synthesis and meta-analysis. The implant survival rate was significantly lower in irradiated patients (85.6%) compared to non-irradiated patients (90.0%) (RR = 1.62, 95% CI: 1.33-1.98, p < 0.0001, I2 = 0.2%). Additionally, implant failure risk was higher in grafted bone (RR = 2.03, 95% CI: 1.39-2.96, p = 0.0018, I2 = 21.9%) than in native bone. Among irradiated patients, those receiving radiochemotherapy exhibited an even greater risk of implant failure (RR = 1.97, 95% CI: 1.09-3.56, p = 0.0331, I2 = 0%) compared to non-irradiated patients. Conclusions: Current evidence indicates that radiotherapy/chemotherapy significantly increases the risk of implant loss in patients with head and neck cancer, with higher radiation doses possibly being associated with increased peri-implant bone loss, while implants placed in native bone exhibit a lower risk of failure compared to those placed in grafted bone

Treatment concepts of horizontally deficient ridges : a retrospective study comparing narrow-diameter implants in pristine bone with standard-diameter implants in augmented bone

Objectives To compare clinical and radiological outcomes of narrow-diameter implants (NDI) placed in pristine bone to standard-diameter implants placed in combination with horizontal bone augmentation procedures (SDI+A) for horizontally deficient alveolar ridges. Material and Methods For this retrospective study, the outcome of 597 NDI (∅ 3.3 mm, 272 patients), inserted in pristine bone, were compared with 180 SDI (∅ 4.1 mm, 83 patients), inserted in combination with horizontal augmentation procedures. Oral health-related quality of life was assessed in patients available for recall. Results After a mean follow-up of 37.6 ± 40 months for the NDI and of 42.4 ± 49 months for the SDI+A, survival rates were 96.1% for NDI and 95.6% for SDI+A. Cumulative 5-year and 10-year implant survival rates were 94.3% and 92.2% for the NDI group and 97.0% and 88.3% for the SDI+A group, indicating no significant difference (p = .89). According to the criteria of Buser et al., an implant success rate of 84.3% was obtained for the NDI and an implant success rate of 81.3% for the SDI+A (p = .79). Regarding oral health-related quality of life, a similar and high patient satisfaction could be observed in both groups. Conclusions NDI without augmentation procedures showed a similar clinical outcome as SDI in combination with augmentation procedures after a follow-up of more than 3 years. Therefore, NDI might be a reasonable alternative in cases of horizontal bone atrophy (no clinical trial registration as patient inclusion started 2003)

Does vitamin D have an effect on osseointegration of dental implants? a systematic review

Purpose: The aim of this study was to systematically review the available evidence to evaluate the efficacy of vitamin D supplementation or vitamin D depletion on the osseointegration of implants in animals and humans. Methods: The focus questions addressed were “Do vitamin D deficient subjects treated with (dental) implants have an inferior osseointegration than subjects with adequate serum vitamin D level?” and “Do vitamin D supplemented subjects treated with (dental) implants have a superior osseointegration than subjects with adequate serum vitamin D level?” Humans and animals were considered as subjects in this study. Databases were searched from 1969 up to and including March 2021 using different combination of the following terms: “implant”, “bone to implant contact”, “vitamin D” and “osseointegration”. Letters to the editor, historic reviews, commentaries and articles published in languages other than English and German were excluded. The pattern of the present systematic review was customize to primarily summarize the pertinent data. Results: Thirteen experimental studies with animals as subject, two clinical studies and three case reports, with humans as subjects, were included. The amount of inserted titanium implants ranged between 24 and 1740. Results from three animal studies showed that vitamin D deficiency has a negative effect on new bone formation and/or bone to implant contact (BIC). Eight animal studies showed that vitamin D supplementation has a enhancing effect on BIC and/or new bone formation around implants. Furthermore, enhancing the impact of vitamin D supplementation on the osseointegration of implants in subjects with diabetes mellitus, osteoporosis and chronic kidney disease (CKD) were assessed. Studies and case reports involving human subjects showed that patients with a low serum vitamin D level have a higher tendency to exhibit an early dental implant failure. When supplemented with vitamin D the osseointegration was successful in the case reports and a beneficial impact on the changes in the bone level during the osseointegration were determined. Conclusions: Vitamin D deficiency seems to have a negative effect on the osseointegration of implants in animals. The supplementation of vitamin D appears to improve the osseointegration in animals with systemic diseases, such as vitamin D deficiency, diabetes mellitus, osteoporosis, and CKD. Slight evidence supports the hypothesis that humans similarly benefit from vitamin D supplementation in terms of osseointegration. Further investigation is required to maintain these assumptions

The German S3 guideline on titanium hypersensitivity in implant dentistry : consensus statements and recommendations

Background There is currently a lack of guidelines for clinicians regarding titanium hypersensitivity in implant dentistry. Diagnostic tests such as the epicutaneous test or the lymphocyte transformation test showed inconsistent results regarding reliability and validity and thus, evidence-based consensus recommendations regarding diagnostic and therapeutic options may be helpful in clinical decision-making. Therefore, the German S3 guideline on titanium hypersensitivity in implant dentistry was developed. Findings In the objectives, procedure, voting method and venue were defined and the consensus participants were invited. A systematic literature research was performed, and the overall quality of the evidence was rated according to the GRADE working group. Eight recommendations were formulated within the framework of a structured consensus conference under independent moderation and could be voted on with strong consensus (> 95% agreement). The formulated statements and recommendations were developed in small groups according to the guidelines of the Association of the Scientific Medical Societies in Germany (AWMF) and were discussed and agreed upon in the plenum. Conclusions For reasonable decision-making, a patient’s clinical symptoms should be regarded as leading parameters, which are usually expressed by a local inflammatory reaction with subsequent disturbed osseous integration. Allergy tests, such as the epicutaneous test or the lymphocyte transformation test are not helpful in titanium intolerance assessments, since these tests indicate T cell-mediated allergies, which are not observed in titanium intolerance reactions. Other metals and impurities that might be present in superstructures or alloys also need to be considered as the cause of an intolerance reaction and a trigger for contact sensitization. In the case of a suspected titanium particle-related, local immunologically induced inflammatory reaction with subsequent impaired osseous integration, dental ceramic implants can be considered as a therapeutic option