02980548332

Int. J. Oral Maxillofac. Surg. 2011; 40: 229–243 doi:10.1016/j.ijom.2010.10.005, available online at http://www.sciencedirect.com

Invited Review Paper Head and Neck Oncology

Incidence and prevention of osteoradionecrosis after dental extraction in irradiated patients: a systematic review
S. Nabil, N. Samman: Incidence and prevention of osteoradionecrosis after dental extraction in irradiated patients: a systematic review. Int. J. Oral Maxillofac. Surg. 2011; 40: 229–243. # 2010 International Association of Oral and Maxillofacial Surgeons. Published by Elsevier Ltd. All rights reserved. Abstract. This systematic review aims to identify and review the best available evidence to answer the clinical question ‘What are the incidence and the factors influencing the development of osteoradionecrosis after tooth extraction in irradiated patients?’. A systematic review of published articles on post-irradiation extraction was performed via electronic search of the Medline, Ovid, Embase and Cochrane Library databases. Additional studies were identified by manual reference list search. Evaluation and critical appraisal were done in 3 stages by two independent reviewers and any disagreement was resolved by discussion with a third party. 19 articles were selected for the final analysis. The total incidence of osteoradionecrosis after tooth extraction in irradiated patients was 7%. When extractions were performed in conjunction with prophylactic hyperbaric oxygen, the incidence was 4% while extraction in conjunction with antibiotics gave an incidence of 6%. This systematic review found that while the incidence of osteoradionecrosis after post-irradiation tooth extractions is low, the extraction of mandibular teeth within the radiation field in patients who received a radiation dose higher than 60 Gy represents the highest risk of developing osteoradionecrosis. Based on weak evidence, prophylactic hyperbaric oxygen is effective in reducing the risk of developing