Demystifying Dental implants in head and neck oncology patients

Background: Head and neck cancer is the sixth most common malignancy worldwide, accounting for approximately 6% of all cancers thus entailing orofacial rehabilitations involving dental implants. Oral cancer treatment protocols involve one or a combination of receptive surgery, radiotherapy, chemotherapy, ablative surgery with/without surgical reconstruction. These in turn have a huge influence in restorative planning, placement and maintenance of dental implants in these patients. Aim/Hypothesis: Overview of the effect of head and neck oncology treatment on the clinical outcome of dental implants through a systematic literature search. Materials and Methods: An electronic search was conducted for studies published on head and neck cancer and dental implant between 2014 and March 2020 using Medline (via PubMed), Embase, Scopus and Cochrane. The search strategy using Boolean operators AND OR was created for PubMed and adapted for subsequent databases. An additional search was performed in Clinical Trials.gov to look for ongoing or recently completed studies. The titles and abstracts of these results were independently screened by 2 authors. Inclusion criteria were studies conducted on adults, more than 10 patients in the study, head and neck Cancer patients, dental implants and studies published in English. The exclusion criteria were studies conducted in young/pediatric patients, animal studies, in-vitro studies, case-reports or studies with less than 10 patients, language other than English, cancer other than head and neck cancer, and NO-dental implants. Results: The database searches identified 443 potentially relevant articles. After evaluation of titles and abstracts, 87 relevant articles were selected. The full texts of these articles were evaluated independently by 2 reviewers. The relevant articles that fulfilled the inclusion criteria were then selected after reviewers’ agreement. The results showed that although there may be difficulties in dental implant therapy associated with cancer treatment, these should not be considered as a contra-indication to dental implant placement. For radiotherapy, the increase in the radiation dose has shown to increase the complications and failure rate of dental implants. The type of grafts used in the reconstruction along with timings of dental implant placement also have an impact on outcome. Conclusions and Clinical Implications: Dental implant treatment is a viable option for head and neck oncology patients, but it requires careful treatment planning and comprehension of the theories and concepts associated with cancer treatment. Keywords: Head and neck cancer, dental implant, radiotherapy, Chemotherapy, Surgical reconstruction