10.25241/stomaeduj.2018.5(3).art.5 – abstract

MAXILLOFACIAL SURGERY

Efficacy of a dental extraction policy designed to prevent osteoradionecrosis: a retrospective study in 100 oral cancer patients treated with intensity-modulated radiotherapy

DOI: https://doi.org/10.25241/stomaeduj.2018.5(3).art.5

Abstract

Introduction: The aim was to determine the efficacy of an extraction policy designed to prevent osteoradionecrosis (ORN) in dentate areas of the jaw after intensity-modulated radiotherapy (IMRT). A secondary aim was to establish whether our extraction policy risked unnecessary tooth extractions for areas designated to be not-at-risk of ORN.

Methodology: Data were retrospectively collected from 100 oral cancer patients, including the fate of 1430 individual teeth, from diagnosis to follow-up.

Results: Eight percent of IMRT-treated patients developed ORN; spontaneous cases (5) outnumbered those provoked by dental issues (3). All cases of ORN arose in regions irradiated with > 60 Gy, with the posterior mandible as preferred location, with non-spontaneous cases primarily due to progressive periodontitis. No correlation was found between the likelihood of extraction and cancer stage.

Conclusions: A more robust extraction policy of teeth affected with periodontitis and pocket depths of 4 – 5 mm might be advocated in molar areas predicted to receive > 60 Gy. Unfortunately, our study’s retrospective design precluded any detailed analyses of the underlying reasons for the 88 extractions that occurred at lower radiation dose thresholds; a more conservative approach may therefore be warranted for these low-risk areas.

Keywords: osteoradionecrosis, intensity-modulated radiotherapy, dosimetric distribution, tooth extraction, oral cancer.

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