Dental implants in the oncologic patient

What are dental implants and what does their placement consist of?

Dental implants are metallic structures of pure titanium, many of them coated with substances that enhance the union of the implant to the bone and have the shape of a screw. The surgical technique is very simple, it is the insertion of the screw in the edentulous areas of the maxilla or mandible.

What are the advantages of implants over crowns or bridges?

The advantages of dental implants in patients who are partially edentulous is that they avoid having to grind the adjacent pieces to replace the gap, which means that the patient’s front tooth and back tooth do not have to be touched. And in total edentulous people, the placement of implants will allow them to wear very comfortable fixed prostheses without any palate and that will allow a perfect chewing without any mobility.

What types of implants can be placed in people who have suffered cancer?

In people who have suffered maxillary or mandibular resections due to oncologic processes, the same type of implants can, and in my opinion should, be placed as in any normal person. These implants in patients who have undergone oncological resections can be placed in the remaining healthy bones, either of the maxilla or mandible, or in those microvascularized bone flaps that we have used to restore the bone that has been removed. Normally these flaps are the iliac crest flap, the fibula flap or the scapular flap.

Is the process the same and what do you have to take into account?

In fact, the surgical technique for implant placement is the same in the normal patient as in the oncologic patient. Patients who are operated for oncological processes, for cancer, who have to have the maxilla or mandible removed, if implants are placed in the remaining bone, they should be placed in the same surgical act of the ablative surgery. And in some of the flaps such as the iliac crest, when the maxillary or mandibular bone is reconstructed, they should also be placed in the same surgical time. There are other flaps such as the fibula free flap or scapular free flap, which for technical reasons it is better to place the implants in a second time, in a deferred time.

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How does radiotherapy affect?

In head and neck oncology patients, radiotherapy has some early or immediate effects on the soft tissues and mucosa. And then it has some late effects on the bone. So, if the implants are placed in the same surgical act both in the remaining bone and in the iliac crest flap, when the effects of the radiotherapy start to appear in the bone, a series of months have already passed and the implants are totally osseointegrated in the bone. That is why it is always preferable to place the implants if possible in the same surgical act. When they are placed in the fibula or scapular flap, they must be placed deferred because the amount of metallic plates and screws that are placed to conform it, do not allow to place them in the same surgical act. In these cases they should not be placed before 18 months after the end of radiotherapy.

Is the osseointegration percentage the same as in normal patients?

The percentage of osseointegration of implants in oncological patients is slightly lower than the percentage of osseointegration in normal patients. It is true that we have to make a division here. Those oncologic patients who receive the implants in the same act of the surgical intervention, such as those who are placed in the iliac crest flap or in the remaining bone, in our series, which is one of the largest in the world, we have an osseointegration result of around 94-95%. In those patients who are reconstructed with a fibula or scapular flap and who have implants placed 18 months after completion of radiotherapy, the percentage drops to around 92%.