Radiation effects on bone healing and reconstruction: interpretation of the literature.
OBJECTIVE
Reconstructing irradiated mandibles with biomaterials is still a challenge but little investigated. We collected data that could help us understand studies in the field of regeneration with biomaterials and irradiated bone.


METHODS
Systematic review of the literature.


RESULTS
Delay and duration of radiation delivery and total equivalent dose are the most variable parameters in the various studies, resulting in confusion when interpreting the literature. Most reproducible experiments show that radiation reduces osteogenic cell numbers, alters cytokine capacity, and delays and damages bone remodeling. Interindividual variations and how such changes become irreversible lesions are still uncertain. In the case of regeneration using biomaterials, most studies have addressed the question of reconstruction in previously irradiated bone. The results show that osseointegration is often possible, although the failure rate is higher. The sooner the implantation takes place after the end of the radiation, the higher the likelihood of failure. Few studies have focused on primary reconstruction followed by early irradiation, and most of the currently available engineering models would be altered by radiation. Good outcomes have been obtained with bone morphogenetic protein and with total bone marrow transplanation.


CONCLUSIONS
This review points out the difficulties in achieving reproducible experiments and interpreting literature in this underinvestigated field.
Jegoux
Franck
F
INSERM U791, Nantes, France.
Malard
Olivier
O
Goyenvalle
E
E
Aguado
E
E
Daculsi
G
G
D000818:Animals; D001846:Bone Development / Q000528:radiation effects; D016026:Bone Marrow Transplantation; D019485:Bone Morphogenetic Proteins / Q000627:therapeutic use; D016723:Bone Remodeling / Q000528:radiation effects*; D018786:Bone Substitutes; D016025:Bone Transplantation / Q000502:physiology; D001842:Bone and Bones / Q000528:radiation effects*; D016371:Cranial Irradiation / Q000009:adverse effects*; D004307:Dose-Response Relationship, Radiation; D016557:Guided Tissue Regeneration, Periodontal; D006801:Humans; D007573:Jaw Neoplasms / Q000532:radiotherapy / Q000601:surgery; D008334:Mandible / Q000528:radiation effects / Q000601:surgery*; D008339:Mandibular Neoplasms / Q000532:radiotherapy / Q000601:surgery*; D019857:Osteogenesis, Distraction; D010025:Osteoradionecrosis / Q000209:etiology; D019651:Plastic Surgery Procedures; D023822:Tissue Engineering
D019485:Bone Morphogenetic Proteins; D018786:Bone Substitutes