The Prophylactic Use of Pentoxifylline and Tocopherol to Avoid Osteoradionecrosis for Dental Implant Placement in Irradiated Head and Neck Cancer Patients

Treatment of oral cancer with surgery or radiotherapy can have a significant bearing on the oral cavity with altered anatomy, xerostomia, trismus and deterioration of the teeth. These multi-factorial issues have a subsequent effect on important functions such as chewing, swallowing and speech. Deterioration of these functions can affect patient’s quality of life.

Dental implants can play a vital role in the dental rehabilitation of head and neck oncology patients when faced with many of the difficulties outlined. Unfortunately there remains a risk of increased failure rates as well as osteoradionecrosis (ORN), which can have devastating and debilitating consequences. ORN once established can be treated with pentoxifylline and tocopherol¹ (PVe) and is showing positive outcomes. Its recognised benefits have lead to its use prophylactically to reduce the risk of ORN.² We investigated the use of prophylactic use of PVe in irradiated head and neck oncology patients undergoing dental implant treatment.

Prospective data collection was undertaken for all head and neck oncology patients undergoing dental implant treatment between January 2011 until November 2014. All patients treated by head and neck radiotherapy were commenced on PVe 1 month prior to implant treatment and continued for 3 months post-surgery during the osteointegration phase. Treatment was carried out under local anesthesia, local anaesthesia with intravenous sedation or general anaesthesia. Implants were placed as per manufactures guidance protocols. All patients were given post-operative antibiotics and analgesia and reviewed 2 weeks, 4 weeks and 3 months following surgery. Following 3-month review, restorative treatment was commenced and at this stage PVe was stopped.

In this study, 50 patients were included with a total of 194 dental implants being placed. No cases of ORN were seen in this group which consisted of 2 patients who had had a previous history of ORN successfully treated. A total of 10 (5.2%) implants failed in 8 patients. All 10 implants were removed and all surgical sites healed uneventfully. Patients reported no major adverse side effects associated with PVe. Three patients (6%) complained of mild gastric irritation related to pentoxifylline and elected to stop the medication.

The use of prophylactic PVe has been used with great success within the department of Oral Surgery at Guys Dental Hospital. Early clinical outcomes suggest promising results with few side effects. This study reports an implant survival of 94.8%, which is equivalent to the commonly accepted survival rates of 95-98% in standard and routine cases. If PVe can reduce the risk of ORN and provide higher implant survival rates in this group of patients, then it has important and significant implications for them. It could allow for dental rehabilitation to be carried out with better success, which as a consequence has the potential to improve patients’ quality of life. Further work is required to explore these early and promising results for the use of PVe prophylactically in irradiated head and neck oncology patients undergoing dental implant surgery.

References

1. Delanian S, Depondt J, Lefaix JL. Major healing of refractory mandible osteoradionecrosis after treatment combining pentoxifylline and tocopherol: a phase II trial. Head Neck 2005;27: 114–23.

2. Lyons A, Ghazali N. Osteoradionecrosis of the jaws: current understanding of its pathophysiology and treatment. Br J Oral Maxillofac Surg. 2008 Dec;46(8):653-60.