J Adv Prosthodont.  2016 Oct;8(5):363-371. 10.4047/jap.2016.8.5.363.

Postoperative irradiation after implant placement: A pilot study for prosthetic reconstruction

• Doh RM
• Kim S
• Keum KC
• Kim JW
• Shim JS
• Jung HS
• Park KM
• Chung MK

• KMID: 2355440
• DOI: http://doi.org/10.4047/jap.2016.8.5.363

Abstract

PURPOSE
On maxillofacial tumor patients, oral implant placement prior to postoperative radiotherapy can shorten the period of prosthetic reconstruction. There is still lack of research on effects of post-implant radiotherapy such as healing process or loading time, which is important for prosthodontic treatment planning. Therefore, this study evaluated the effects of post-implant local irradiation on the osseointegration of implants during different healing stages.
MATERIALS AND METHODS
Custom-made implants were placed bilaterally on maxillary posterior edentulous area 4 weeks after extraction of the maxillary first molars in Forty-eight Sprague-Dawley rats. Experimental group (exp.) received radiation after implant surgery and the other group (control) didn't. Each group was divided into three sub-groups according to the healing time (2, 4, and 8 week) from implant placement. The exp. group 1, 2 received 15-Gy radiation 1 day after implant placement (immediate irradiation). The exp. group 3 received 15-Gy radiation 4 weeks after implant placement (delayed irradiation).
RESULTS
The bone mineral density (BMD) was significantly lower in the immediate irradiation groups. BMD was similar in the delayed irradiation group and the control group. The irradiated groups exhibited a lower bone-to-implant contact ratio, although the difference was not statistically significant. The irradiated groups also exhibited a significantly lower bone volume and higher empty lacuna count than the control groups. No implant failure due to local irradiation was found in this study.
CONCLUSION
Within the limits of this study, the timing of local irradiation critically influences the bone healing mechanism, which is related to loading time of prostheses.

Keyword

Postoperative radiotherapy; Head and neck cancer; Local irradiation; Implant; Empty lacuna

MeSH Terms

Bone Density
Head and Neck Neoplasms
Humans
Molar
Osseointegration
Pilot Projects*
Prostheses and Implants
Radiotherapy
Rats, Sprague-Dawley

Figure

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  Fig. 1 Surgical procedures. (A) Maxillary first molar of the rat (white arrow). (B) Implant was placed in the first molar space after 4-week later (white arrow).

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  Fig. 2 Local irradiation procedures. (A, B) Verifying radiation fields using an external beam simulator (Nucletron, Veenendaal, the Netherlands). (C, D) Radiation administration using a 6.0-MV linear accelerator (Elekta, Stockholm, Sweden) to marked position (white arrow). Field size of 2 × 2 cm (see light window).

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  Fig. 3 Microcomputed tomography analysis. (A) Three-dimensional (3D) image reconstruction using OnDemand 3D software. (B) Bone mineral density (BMD) in the region of interest (ROI). Red stars indicate a significant difference between the exp. and control groups (P < .05); orange stars indicate a significant difference between the control groups (P < .05).

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  Fig. 4 Histologic images of the implant sites. Upper: Hematoxylin-and-eosin (H&E)-stained images at lower magnification (12.5×). Scale bar = 500 µm. A - C: Exp. groups. D - F: Control groups. A, D: 2 weeks after implant placement. B, E: 4 weeks after implant placement. C, F: 8 weeks after implant placement. Black arrows indicate empty lacunae (H&E, original magnification 100×. Scale bar = 200 µm).

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  Fig. 5 Fluorescence microscopic images of the implant sites. (A) H&E-stained image, green and red emitting regions ofexp. group 3. (B) H&E-stained image, green and red emitting regions of control group 3. Injection time of fluorescence expression agents after implant surgery are shown on the upper left (original magnification 50×. Scale bar = 200 µm).

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