Long-Term Follow-up Analysis of Dental Implant Success in Radiated Fibular Free Flaps and Hyperbaric Oxygen Therapy

Dental reconstruction for Head and Neck Oncology patient population allows restoration of appearance and function. Dental implants are an important component for successful dental reconstruction. Overall oncologic therapy of surgical resection along with radiation therapy may produce significant morbidity and unique healing complications. The objective of this study was to assess dental implant success in Head and Neck Oncology patients. A retrospective case series of n=38 subjects with stage I to IV squamous cell carcinoma of head and neck from April 2001 to August 2014 were evaluated who met inclusion criteria, along with Institutional Board Review and Scientific Review Committee approval. Inclusion criteria included Head and Neck Oncology patients with oral squamous cell carcinoma, dental implant placement and further subdivision of fibular flap reconstruction, radiation therapy, hyperbaric oxygen therapy with long term follow-up of a minimum of one year after dental implant placement. Results revealed n=19 subjects underwent radiation therapy and hyperbaric oxygen therapy, with 88 implants placed there was a 70.5% success rate. Analysis of n=12 subjects without radiation therapy or hyperbaric oxygen therapy showed 100% implant success with 43 implants placed, which is statistically significant (p<0.001). Subjects who had a fibular free flap prior to radiation therapy (n=10) had 64.4% implant success with 59 implants placed. When compared to fibular free flap and implant placement after radiation therapy (n=3) and 12 implants placed with a 91.7% success rate. Breakdown of the fibular free flap patients before radiation therapy (n=10) with n=7 patients under going 30 dives hyperbaric oxygen (20 preoperative and 10 postoperative) reveals a 55.8% success rate of 34 implants and those subjects that underwent 40 or more hyperbaric oxygen dives had an increased success rate of 78.6% (p<0.001) with 14 implants placed in 3 subjects.  Subjects with fibular free flaps prior to radiation therapy developed osteoradionecrosis 1 to 24 months after implant placement, with exception of 2 subjects who did not develop osteoradionecrosis. Osteoradionecrosis complication to implant failure in this group was 0 to 15 months. Conclusion from this study reveals increase success of dental implants in fibular free flap reconstruction after radiation therapy versus prior to radiation therapy. Additionally, success rate of dental implants increased in those subjects who underwent 40-50 hyperbaric oxygen dives over 30 dives if fibular free flap reconstruction was present before radiation adjuvant therapy.

References:

1. Marx, RE, and et al. Prevention of Osteoradionecrosis: A Randomized Prospective Clinical Trial of Hyperbaric Oxygen Versus Penicillin. Journal of American Dental Association (1985), 11:49-54.

2. Salinas, TJ, and et al. Clinical Evaluation of Implants in Radiated Fibula Flaps. Journal of Oral and Maxillofacial Surgery (2010), 68:524-529.