Abstract
Simple SummaryTeeth extractions before or after radiotherapy (RT) could be procedures at high risk for osteoradionecrosis (ORN) onset. This systematic review was performed to investigate the ORN incidence following teeth extractions during and after RT for head and neck (H&N) cancer and to evaluate any other possible risk factor. The results highlight how post-RT teeth extractions are a major risk factor for ORN onset (ORN incidence of 5.8%), especially in the mandible, with a diminishing trend in the last years.Teeth extractions before or after radiotherapy (RT) could be procedures at high risk for osteoradionecrosis (ORN) onset. This systematic review was performed to investigate the ORN incidence following teeth extractions during and after RT for head and neck (H&N) cancer and to evaluate any other possible risk factor. Methods: This systematic review was conducted according to PRISMA protocol, and the PROSPERO registration number was CRD42018079986. An electronic search was performed on the following search engines: PubMed, Scopus, and Web of Science. A cumulative meta-analysis was performed. Results: Two thousand two hundred and eighty-one records were screened, and nine were finally included. This systematic review revealed an ORN incidence of 5.8% (41 patients out of 462, 95% CI = 2.3–9.4); 3 ORN developed in the maxilla. No other clinical risk factors were detected. Conclusion: Post-RT teeth extractions represent a major risk factor for ORN development, especially in the mandible, with a diminishing trend in the last years. Further research on other possible risk factors might improve this evidence.
Highlights
Among the most common malignancies worldwide, head and neck (H&N) cancers represent the seventh one [1], and almost 75% of patients are treated with radiotherapy (RT), which is either curative or adjuvant or palliative [2]
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This systematic review highlights that dental extractions after RT are procedures at high risk of ORN, especially in the mandible
Summary
Among the most common malignancies worldwide, head and neck (H&N) cancers represent the seventh one [1], and almost 75% of patients are treated with radiotherapy (RT), which is either curative or adjuvant or palliative [2]. ORN can be defined as exposed irradiated bone that fails to heal over a period of three months without evidence of persisting or recurrent tumor; the ORN definition remains a debated topic, due to the following issues: the possibility of ORN onset without bone exposure and the duration of bone exposure necessary to achieve a definite diagnosis, which varies from 1 to 6 months, according to the literature [5,6]. Definitions retrieved in literature do not mention the possibility that patients could present jaw bones necrosis due to antiresorptive therapy (medication-related osteonecrosis of the jaws—MRONJ) [7], which may be administered for other tumors and must be excluded in the differential diagnosis or, at least, taken into debt consideration.
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