International Journal of Oral and Maxillofacial Surgery
Invited Review PaperHead and Neck OncologyIncidence and prevention of osteoradionecrosis after dental extraction in irradiated patients: a systematic review
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.
References (87)
- et al.
Prophylactic effect of pentoxifylline on radiotherapy complications: a clinical study
Otolaryngol Head Neck Surg
(2004) - et al.
Lack of osteoradionecrosis of the mandible after intensity-modulated radiotherapy for head and neck cancer: likely contributions of both dental care and improved dose distributions
Int J Radiat Oncol Biol Phys
(2007) - et al.
Dental management of the irradiated patient
Int J Oral Surg
(1978) - et al.
Radiation complications in edentulous patients
J Prosthet Dent
(1976) - et al.
Hard and soft tissue necroses following radiation therapy for oral cancer
J Prosthet Dent
(1972) - et al.
Dental extractions after radiation therapy in the head and neck area and hard tissue replacement (HTR) therapy: a preliminary study
J Prosthet Dent
(1998) - et al.
Postradiation dental extractions
Rev Stomatol Chir Maxillofac
(2004) - et al.
Adjunctive hyperbaric oxygen in irradiated patients requiring dental extractions: outcomes and complications
J Oral Maxillofac Surg
(2001) Clinical controversies in oral and maxillofacial surgery: Part two, Management of dental extractions in irradiated jaws: a protocol without hyperbaric oxygen therapy
J Oral Maxillofac Surg
(1997)- et al.
Osteoradionecrosis of the jaws: a retrospective study of the background factors and treatment in 104 cases
J Oral Maxillofac Surg
(1997)
Management of problems of the teeth and jaw in patients undergoing irradiation
Am J Surg
In vitro effects of therapeutic ultrasound on cell proliferation, protein synthesis, and cytokine production by human fibroblasts, osteoblasts, and monocytes
J Oral Maxillofac Surg
Osteoradionecrosis: clinical experience and a proposal for classification
J Oral Maxillofac Surg
The conservative management of osteoradionecrosis of the mandible with ultrasound therapy
Br J Oral Maxillofac Surg
Radiation in dentistry—surgical comments
J Am Dent Assoc
Systematic dental management in head and neck irradiation
Int J Radiat Oncol Biol Phys
Dental preservation in patients irradiated for head and neck tumours: a 10-year experience with topical fluoride and a randomized trial between two fluoridation methods
Radiother Oncol
Analysis of mandibular dose distribution in radiotherapy for oropharyngeal cancer: dosimetric and clinical results in 18 patients
Radiother Oncol
A study of factors contributing to the development of osteoradionecrosis of the jaws
J Prosthet Dent
Clinical controversies in oral and maxillofacial surgery: Part one. Management of dental extractions in irradiated jaws: a protocol with hyperbaric oxygen therapy
J Oral Maxillofac Surg
The effect of prior radiation therapy for treatment of nasopharyngeal cancer on wound healing following extractions: incidence of complications and risk factors
Int J Oral Maxillofac Surg
Osteoradionecrosis of the jaws: current understanding of its pathophysiology and treatment
Br J Oral Maxillofac Surg
Pentoxifylline and vitamin E treatment for prevention of radiation-induced side-effects in women with breast cancer: a phase two, double-blind, placebo-controlled randomised clinical trial (Ptx-5)
Eur J Cancer
Dental extractions in relation to radiation therapy of 224 patients
Int J Oral Maxillofac Surg
Osteoradionecrosis of the jaws
J Oral Maxillofac Surg
Osteoradionecrosis: a new concept of its pathophysiology
J Oral Maxillofac Surg
Studies in the radiobiology of osteoradionecrosis and their clinical significance
Oral Surg Oral Med Oral Pathol
Prevention of osteoradionecrosis: a randomized prospective clinical trial of hyperbaric oxygen versus penicillin
J Am Dent Assoc
Postradiation dental extractions without hyperbaric oxygen
Oral Surg Oral Med Oral Pathol
Radiation necrosis of the mandible: a 10 year study. Part I. Factors influencing the onset of necrosis
Int J Radiat Oncol Biol Phys
Radiation necrosis of the mandible: a 10 year study. Part II. Dental factors; onset, duration and management of necrosis
Int J Radiat Oncol Biol Phys
Dental aspects of osteoradionecrosis
Oral Surg Oral Med Oral Pathol
Risk of osteoradionecrosis after extraction of impacted third molars in irradiated head and neck cancer patients
J Oral Maxillofac Surg
Pentoxifylline in prevention of radiation-induced lung toxicity in patients with breast and lung cancer: a double-blind randomized trial
Int J Radiat Oncol Biol Phys
Ultrasound for the treatment of osteoradionecrosis
J Oral Maxillofac Surg
Therapeutic ultrasound for osteoradionecrosis: an in vitro comparison between 1 MHz and 45 kHz machines
Eur J Cancer
Effect of ultrasound on the production of IL-8, basic FGF and VEGF
Cytokine
Osteoradionecrosis of the jaws as a side effect of radiotherapy of head and neck tumour patients—a report of a thirty year retrospective review
Int J Oral Maxillofac Surg
Tooth extraction by orthodontic force after radiation therapy: report of case
J Am Dent Assoc
Oral complications following radiation therapy: a five-year retrospective report
J Prosthet Dent
Extraction of teeth after cancericidal doses of radiotherapy to the head and neck
Am J Surg
How critical is the interval between extractions and irradiation in patients with head and neck malignancy?
Oral Surg Oral Med Oral Pathol
Dental extractions in the irradiated head and neck patient: a retrospective analysis of Memorial Sloan-Kettering Cancer Center protocols, criteria, and end results
J Oral Maxillofac Surg
Cited by (242)
Radiotherapy in the head and neck region influences the chemical and mechanical properties of intraradicular dentin
2024, Archives of Oral BiologyPrevention, diagnosis and management of osteoradionecrosis: Where do we stand?
2024, Bulletin du CancerDental considerations for head and neck cancer: A clinical review
2023, Saudi Dental JournalCan the prophylactic use of pentoxifylline and tocopherol before dental extractions prevent osteoradionecrosis? A systematic review
2023, Oral Surgery, Oral Medicine, Oral Pathology and Oral Radiology