Patient needing implants with past history of Cancer and radiation to the jaw. Whats the protocol?

Sun, 01/24/2010 - 20:00 — Dr. Cohen

I have a 57 year old patient who has a past history of head and neck cancer treated with radiation and chemotherapy 6 years ago. The patient hasrampant caries and poor salivary flow. Several teethn are going to be extracted and replaced by implants in the teeth 30, 29 and 8 position.

What are your concerns?

Does the patient need hyperbaric oxygen and whats the protocol.

Comments

Wed, 02/03/2010 - 06:23 — sagddsmd

Radiation and tooth extraction

Before answering, one must know what are the portals of irradiation and the radiation dose. Gather that information to know if the area you are thinking about treating was even affected by the radiation.

Wed, 02/03/2010 - 14:21 — Dr. Cohen

Sagddsmd: Radiation dose and ports

Patient received IMRT

Lateral head and neck 4500cgy

Mandible - 5500cgry

IMRT boost to tumor 2520 cgy

Hope that gives you what you need

Mon, 02/08/2010 - 18:38 — Gregori M Kurtz...

To treat or not to treat

Implants are "luxury" the extractions are a neccessity. meaning the implants dont have to be placed if the med hx contraindicates it but the carious non restorable teeth need to be removed. I would get a consult from the radiation oncologist and see if 2 weeks of hyperbaric O2 therapy before extractions is recommended then do the extractions and see how he heals. continue the hyperbaric for 2 weeks after tx. if he heals well then you can with the oncologist look at implant placement.

Consider placing the pt on Salagen to improve salivary flow and FL2 trays to be used daily to prevent additional teeth from rampant decay and keep them on 3 month recall