Dental extractions after radiation therapy in the head and neck area and hard tissue replacement (HTR) therapy: a preliminary study.
BACKGROUND
Dental extractions in patients who had radiation therapy for cancer in the head and neck region carry with them the risks of delayed healing, prolonged alveolar bone exposure, infection, and osteoradionecrosis. Among the precautions to minimize these risks are antibiotic coverage, limited extractions at any one time, soft tissue closure, and hyperbaric oxygen treatment. Rapid epithelization and minimal bone exposure are essential after extractions in irradiated patients.


OBJECTIVE
This study examined the effects of hard tissue replacement on head and neck cancer patients who were treated with radiation therapy.


METHODS
In a series of eight patients who had radiation doses from 4000 cGy to 7440 cGy in the head and neck area and who had 44 teeth extracted, hard tissue replacement material mixed with tetracycline powder was placed in the extraction sites.


RESULTS
Of the 44 teeth extracted, 19 mandibular molars and premolars were in the direct field of radiation in seven patients. One patient also had 6 mandibular anterior teeth and 12 maxillary teeth extracted that received minimal radiation exposure. One patient had 6 mandibular anterior teeth extracted that were not in the area of direct exposure. One patient had a mandibular first molar extracted in an area that received minimal radiation exposure. Clinically, complete epithelization occurred in all patients. No infections developed. Radiographically no bone dissolution could be identified in the extraction area(s). The follow-up times ranged from 7 months to 18 months when the patients were seen last.


CONCLUSIONS
The hard tissue replacement particles appears to provide a matrix for fibrous connective tissue formation.
Carl
W
W
Department of Dentistry and Maxillofacial Prosthetics, Roswell Park Cancer Institute, Buffalo, N.Y., USA.
Ikner
C
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D000900:Anti-Bacterial Agents / Q000008:administration & dosage; D001672:Biocompatible Materials / Q000494:pharmacology; D018786:Bone Substitutes; D016371:Cranial Irradiation; D004338:Drug Combinations; D006258:Head and Neck Neoplasms / Q000532:radiotherapy; D006801:Humans; D008768:Methylmethacrylates / Q000494:pharmacology; D010012:Osteogenesis / Q000187:drug effects; D011102:Polyhydroxyethyl Methacrylate / Q000494:pharmacology; D011879:Radiotherapy Dosage; D013752:Tetracycline / Q000008:administration & dosage; D014081:Tooth Extraction / Q000379:methods*; D016896:Treatment Outcome
D000900:Anti-Bacterial Agents; D001672:Biocompatible Materials; D018786:Bone Substitutes; D004338:Drug Combinations; D008768:Methylmethacrylates; D011102:Polyhydroxyethyl Methacrylate; C040206:HTR composite; D013752:Tetracycline