Invited Review Paper
Head and Neck Oncology
Incidence and prevention of osteoradionecrosis after dental extraction in irradiated patients: a systematic review

https://doi.org/10.1016/j.ijom.2010.10.005Get rights and content

Abstract

This systematic review aims to identify and review the best available evidence to answer the clinical question ‘What are the incidence and the factors influencing the development of osteoradionecrosis after tooth extraction in irradiated patients?’. A systematic review of published articles on post-irradiation extraction was performed via electronic search of the Medline, Ovid, Embase and Cochrane Library databases. Additional studies were identified by manual reference list search. Evaluation and critical appraisal were done in 3 stages by two independent reviewers and any disagreement was resolved by discussion with a third party. 19 articles were selected for the final analysis. The total incidence of osteoradionecrosis after tooth extraction in irradiated patients was 7%. When extractions were performed in conjunction with prophylactic hyperbaric oxygen, the incidence was 4% while extraction in conjunction with antibiotics gave an incidence of 6%. This systematic review found that while the incidence of osteoradionecrosis after post-irradiation tooth extractions is low, the extraction of mandibular teeth within the radiation field in patients who received a radiation dose higher than 60 Gy represents the highest risk of developing osteoradionecrosis. Based on weak evidence, prophylactic hyperbaric oxygen is effective in reducing the risk of developing osteoradionecrosis after post-radiation extractions.

Section snippets

Materials and methods

A systematic review of the best evidence available in the literature was performed to answer the following clinical question: ‘What are the incidence and the factors influencing the development of ORN of the jaw bones after tooth extraction in irradiated head and neck cancer patients?’

An initial electronic search was performed using MEDLINE (1950 to April 2010) via Pubmed and Ovid. Further search was performed through Embase and The Cochrane Library database. A broad search strategy was

Results

The electronic database search last updated on 30 April 2010 yielded 518 hits from Pubmed, 384 hits from Ovid, 167 hits from Embase and 2 from the Cochrane Library. 121 articles were considered relevant to the topic after title and/or abstract screening. A manual reference list search of the 121 selected articles yielded a further 23 articles. Full texts of these 144 articles were evaluated for the reporting of clinical data on tooth extraction in irradiated jaws. 47 articles were selected and

Discussion

ORN has been a clinical problem in irradiated patients since the introduction of radiotherapy as a treatment modality for malignancy. ORN of the maxillofacial region was reported as early as 1922 by Regaud66. In the typical presentation, ORN starts with an exposed devitalized part of the jaw bone, later progressing to sequestrum formation, oro-cutaneous fistula11, 28 and finally to pathologic fracture11, 28, 79, 85. Occasionally, the sufferer remains asymptomatic, but many complain of pain,

Funding

None.

Competing interests

None declared.

Ethical approval

Not required.

Acknowledgments

The authors would like to thank Dr Firdaus Hariri for participating in this systematic review as the reviewer. They would also like to thank Dr George Anastassov and Dr Roger Zwahlen for the translation of articles.

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