The influence of dental treatment on the development of osteoradionecrosis after radiotherapy by modern irradiation techniques.

Abstract

The aim of this study was to analyze the influence of dental treatment on the development of osteoradionecrosis (ORN) of the jaw. This study included the data of 776 patients who underwent 3D-CRT or IMRT because of head and neck cancer. Sex, dental status before and after radiotherapy (RT), tumor site, bone surgery during tumor operation, concomitant chemotherapy, and the development of an advanced ORN were documented for each patient. The patients' dentitions before and after RT were classified into four groups with regard to the number and localization of the remaining teeth. Differences between the patients with ORN and patients without ORN with regard to the teeth's condition before and after RT, and with regard to the extent of dental treatment were determined descriptively. Cox proportional hazards regression to study the association between dentition and the development of ORN. The extent of dental treatment in patients with and without ORN did not differ in a clinically relevant way. The highest risk of developing ORN was observed in patients who had undergone primary bone surgery during the tumor operation (HR=5.58, 95%CI 2.91-10.7) and patients who had a tumor in the oral cavity (HR=4.84, 95%CI 1.37-17.11). Based on the results of this study, tumor localization and its required treatment are prognostic factors for the development of ORN. After implementing a consequent dental treatment scheme, no influence of dentition on the risk of developing ORN could be demonstrated. Patients with a lower risk could prospectively benefit from a more moderate dental treatment scheme.