What is the optimal timing for implant placement in oral cancer patients?
​A scoping literature review

Alberga, J., Vosselman, N., Korfage, A., Delli, K., Witjes, M., Raghoebar, G., & Vissink, A. (2020). ​PubMed.

Terms:

• Maxillary implant: Implants anchored into the bone that forms your upper jaw
• Mandibular implant: Implants anchored into the lower jaw
• Zygomatic implant: Implants anchored into the zygomatic bone, or “cheek bones”
• Primary implant placement: Dental implants placed during an oncologic treatment/procedure
• Secondary implant placement: Dental implants placed during an additional procedure, after oncologic treatment

What is this research about?:

• Dental implants have been proven to greatly benefit oral cancer patients by increasing oral function, nutritional health, and quality of life post treatment. 
• Research in the area of ideal timing for dental implants in regards to implant survival and functional outcomes is lacking and no recommendations have been made. 
• The purpose of this systematic review is to determine optimal timing for dental implant placement in oral cancer patients and devise a recommendation guideline for clinical practice. 

 
Methods/Methodology:

• 16 studies were collected from MEDLINE. Studies were included if they were published in English, considered primary or secondary implant placement in oral cancer patients, and were cohort studies, case-control studies, or controlled trials. 
• The review collected data on patient demographics, type of oncological treatment, placement timing, implant system, site of placement and type of tissue they were inserted in, time between surgeries, implant survival rate and loss, complications, perioperative measurements, type of prosthesis, and the period of follow-up. 
• Studies that reported 5-year survival rates for primary and secondary placed implants were subject to quantitative data-synthesis. 

​Results:

• The 5-year survival rate for primary placed implants (92.8%) was higher than the survival rate for secondary placed implants (86.4%), however this trend is not statistically significant. 
• Implant survival rate for maxillary bone implants ranged from 57.1 to 95.3%, while zygomatic implants had a survival rate of 92%. 
• Overall oral function was found to be improved across all studies. 
• The most common complication reported by the studies was osteoradionecrosis (ORN) in irradiated patients at 1.8 to 7.7%.

 
Discussion:

• The study concludes that both primary and secondary implant placements regardless of placement timing have high survival rates. However, due to primary implant placements offering advantages such as an earlier start on prosthetic rehabilitation post treatment and nixing the need to have a second surgery, the timing of primary implant placements is preferrable. 
• Implants in the mandible tended to have higher survival rates than implants in the maxilla.
• Functional results and survival rates of implants indicate that zygomatic implants work well and have low complication rates, but more research is necessary to determine optimal working. 
• Employing 3D technology could be useful in improving implant placement to reduce complications and “loss of resources” caused by incorrect implant positioning in more complex cases. 

 
Possible questions to ask your doctor:

• What does recovery post-placement look like? How is it different for primary vs. secondary placement? 
• If I develop another tumor, how would treatment affect my implant function and survival? 
• What factors in my case would determine what type of implant is used, where it is placed, and the timing of the placement? What are the risks and side effects?
• What factors increase my likelihood of developing ORN and can I prevent or minimize them?
• Will I be seen for follow-up appointments to check for complication developments post-placement? For how long?

 
Reference: Alberga, J., Vosselman, N., Korfage, A., Delli, K., Witjes, M., Raghoebar, G., & Vissink, A. (2020). What is the optimal timing for implant placement in oral cancer patients? A scoping literature review. Oral Diseases. doi:10.1111/odi.13312  

Summary written by Avery Singson; Edited by Wendy Liang
November 30, 2020