Osseo integrated dental implants and radiotherapy: Evaluating the risk of osteoradionecrosis: A scoping review

Background: Head and neck cancer (HNC) primarily affects the upper aerodigestive tract and is often treated with surgery, radiotherapy (RT), and chemotherapy (CHT). Dental implants (DIs) are commonly used for oral rehabilitation after tumor resection, but RT can adversely affect implant survival and increase the risk of osteoradionecrosis (ORN), a severe complication characterized by nonhealing exposed bone.Objective: This review aims to evaluate the impact of RT on osseointegrated dental implants, identify the incidence of ORN following RT, and analyze optimal clinical protocols for managing patients with implants undergoing radiotherapy.Materials and Methods: A scoping review was conducted following PRISMA-ScR guidelines. Relevant literature was identified using keywords related to dental implants, radiotherapy, and osteoradionecrosis. Studies involving patients with implants placed before or at the time of tumor resection and subsequent RT were included. Data on implant survival, failure rates, ORN incidence, radiation dose, timing of implant placement, and prosthetic rehabilitation were extracted and analyzed.Results: Thirteen studies comprising 667 patients and 2,409 implants were included. Implant survival rates were higher when placed prior to RT compared to placement after RT. The overall implant failure rate was 5.8%. ORN was reported in 19 implants in two studies and was associated with radiation dose, peri-implantitis, and implant condition prior to RT. Prosthetic rehabilitation was generally delayed longer in irradiated patients. Recommendations include delaying RT for at least six weeks after implant placement and removing metal prosthetic components before RT to reduce complications.Conclusions: RT negatively impacts the survival of dental implants and increases the risk of ORN, particularly when implants or peri-implant tissues are compromised. The timing of implant placement relative to RT and careful management of prosthetic components are critical for improving outcomes. Multidisciplinary collaboration and standardized protocols are needed to optimize care for patients with implants undergoing radiotherapy.