For individuals with head and neck cancer, radiation therapy is frequently the initial choice of treatment, and it may be used in addition to surgical excision. External beam radiation, brachytherapy, and radioisotope treatment are the three basic forms of radiotherapy. External beam approaches are the most prevalent procedures for treating head and neck cancer, followed by brachytherapy. External beam techniques such as conventional external beam radiation therapy and 3-dimensional conformal radiation therapy were once the most popular. However, intensity-modulated radiation therapy (IMRT) is gaining popularity in hospital and academic settings due to the controlled dose distributions that are impossible to achieve with other methods. IMRT employs CT or magnetic resonance imaging to target radiation more accurately on the tumor while lowering its exposure to normal surrounding structures. Radiotherapy works by disrupting the DNA of tumor cells.

Complications post-radiation therapy-

Persistent hyposalivation, radiation caries, periodontal disease progression, soft tissue fibrosis, and trismus are some of the long-term or late consequences of radiation treatment. The consequences can be seen in both soft and hard tissues, where decreasing oxygen tension impairs tissue repair and can last a lifetime. The principal long-term impact of radiation therapy is a vascular alteration that depletes bone nutrition, resulting in an osteoporotic-like state that can jeopardize dental implant durability. Soft tissues are more prone to dehiscence, but the bone is more susceptible to osteoradionecrosis (ORN), the most serious chronic consequence after radiation therapy. Spontaneous ORN is defined as an outright source of cell death that occurs at the clinical threshold, where tissue damage exceeds the healing capability. This kind of ORN usually develops after very high doses (>74 Gy) of radiation and appears 6 to 18 months later. After early trauma (within 4 months after radiation) or late damage, traumatic-induced ORN occurs when the wound cannot heal (at least 4 months after radiotherapy).

Dental implants and radiation-

According to studies, the relative risk of developing ORN with implant implantation in the irradiated canine jaw was low for doses less than 55 Gy and high for doses greater than 65 Gy. The reported implant survival diminishes as the radiation exposure increases. A similar dosage response for implant survival was also discovered, with the survival rate being much lower (73%) when implants were put in bone irradiated with higher than 50 Gy than when implants were implanted in bone with a history of less than 50 Gy (84 percent).

Hyperbaric oxygen therapy (HBO) has been recommended in combination with implant insertion to lower the risk of ORN onset. HBO is hypothesized to enhance wound healing in irradiated tissues by enhancing microvascular perfusion, despite the fact that there are no definitive indications for its usage. HBO stimulates macrophages to release cytokines that are involved in angiogenesis (vascular endothelial growth factor) and collagen production (basic fibroblast growth factor). Adjuvant HBO has been found to minimize the failure rate of implants in radiotherapy patients, despite the fact that it is controversial. Early research has indicated that implants implanted in the maxilla and mandible failed at rates as high as 45 percent and 33 percent, respectively, without this therapy.

Final thought-

In terms of scheduling, implant therapy is strongly discouraged during the ongoing irradiation therapy since the danger of ORN increases with trauma at this time. To minimize bone necrosis, high-risk dental procedures should be undertaken before radiation treatment. If implant therapy is only possible after radiation, it is recommended that treatment begin 6 to 18 months after the radiation is finished. Normal healing processes can still take place at this period, and the late effects of radiation haven't fully manifested. To lower the incidence of ORN after this "golden time," prophylactic treatments such as HBO therapy should be implemented.

'Dental implant & periodontal surgeons P.C by Dr. Sam Khoury' is a well-known dental clinic that specializes in dental implants Bucks County PA in the United States. Our dental team's implant success rate, at 98 percent, is far greater than the national average. All patients interested in dental implant therapy are entitled to a free consultation. This comprises a comprehensive dental examination and implant consultation, a panoramic X-ray of the entire mouth, a 3D CT scan (if necessary), a gum condition evaluation and bites analysis, and the creation of a complete treatment plan.