Rebuilding oral function and confidence: dental implant-based rehabilitation in cancer survivors - an in-depth analysis

Received: 20-Sep-2023, Manuscript No. OAR-23-114423; , Pre QC No. OAR-23-114423 (PQ); Editor assigned: 23-Sep-2023, Pre QC No. OAR-23-114423 (PQ); Reviewed: 25-Sep-2023, QC No. OAR-23-114423 (Q); Revised: 29-Sep-2023, Manuscript No. OAR-23-114423 (R); Published: 07-Oct-2023

Introduction

Oral cancer, a formidable adversary to health and well-being, poses a complex and multifaceted challenge to both patients and healthcare providers. Its treatment modalities, including surgery, radiation therapy, and chemotherapy, are often essential for survival but can result in significant functional and esthetic consequences. These consequences extend beyond the confines of the disease itself, affecting the fundamental aspects of a patient's life, including their ability to eat, speak, and socialize comfortably [1].

In the wake of successful cancer treatment, the concept of oral rehabilitation becomes paramount. Restoring oral function and appearance is not merely a matter of aesthetics; it is an integral component of enhancing the patient's overall quality of life. Dental implants, a revolutionary advancement in modern dentistry, have emerged as a promising solution for addressing the unique and intricate challenges presented by post-cancer treatment patients.

This comprehensive review article aims to delve into the complexities and nuances of oral rehabilitation with dental implants in the context of cancer survivorship. It seeks to provide a thorough exploration of the considerations, strategies, and outcomes associated with this specialized field of dental care. By shedding light on the critical aspects of patient evaluation, implant timing, complications, prosthetic options, and patient satisfaction, this review intends to serve as a comprehensive guide for clinicians and researchers alike.

The journey to oral rehabilitation in cancer survivors is a multifaceted one, marked by unique obstacles and opportunities. It requires a multidisciplinary approach that bridges the realms of oncology and dentistry, with a keen focus on optimizing both function and esthetics [2]. Furthermore, it necessitates a nuanced understanding of the interplay between cancer treatment effects and dental implantology, emphasizing the need for tailored treatment plans and vigilant postoperative care.

Literature Review

Challenges of oral rehabilitation with dental implants in the context of cancer survivorship

Oral tissue health

Cancer treatments, particularly radiation therapy and chemotherapy, can cause significant damage to oral tissues. Radiation therapy, in particular, can result in tissue fibrosis, reduced vascularity, and compromised healing capacity. These conditions may pose challenges for successful implant placement and osseointegration. Radiation therapy, commonly used in the treatment of head and neck cancers, can lead to irreversible damage to oral tissues. The exposure to ionizing radiation can cause tissue fibrosis, decreased vascularity, and diminished tissue elasticity, making it more challenging for tissues to heal and adapt around dental implants. Radiation therapy often results in mucositis, inflammation and ulceration of the oral mucosa. Mucositis can affect the healing process after implant placement, potentially leading to delayed wound healing and increased susceptibility to infection [3].

Many cancer survivors experience xerostomia, a condition characterized by reduced salivary flow. Saliva plays a crucial role in oral health, including maintaining the mucosal integrity and buffering against acid attacks. Xerostomia can increase the risk of oral infections and may complicate the maintenance of oral hygiene around dental implants.The altered soft tissue environment in cancer survivors can lead to complications around dental implants. Poor tissue quality, decreased tissue thickness, and impaired blood supply can increase the risk of peri-implant mucositis or peri-implantitis, conditions that can compromise the long-term stability of implants [4].

Radiation therapy can impair the body's ability to heal wounds. The compromised vascularity and tissue quality can result in delayed healing and potential implant failure.Patients who have received radiation therapy to the head and neck region are at risk of developing osteoradionecrosis, a condition characterized by the death of jawbone tissue. Dental implant surgery in these patients carries a heightened risk of complications related to poor tissue oxygenation and reduced bone healing capabilities. Cancer treatments can lead to bone loss in the jaws, which may limit the availability of suitable bone for implant placement. In some cases, bone grafting or augmentation procedures may be necessary to create a suitable foundation for implants [5].

Determining the optimal timing for implant placement is crucial. Immediate implant placement after cancer treatment might not always be feasible due to the need for tissue healing and stability. Delayed or staged approaches may be necessary, which can prolong the overall rehabilitation process. Cancer survivors often face ongoing health challenges related to their cancer history and treatment. These may include compromised immune function, xerostomia (dry mouth), and nutritional issues. These factors can influence the success of dental implant procedures and the overall well-being of the patient. The treatment planning process for cancer survivors can be complex. It requires close collaboration between oral surgeons, oncologists, prosthodontists, and other specialists to ensure a comprehensive and individualized approach to care [6].

Psychosocial factors

Cancer survivors may experience psychological and emotional challenges related to their cancer journey. Dental rehabilitation with implants can have a profound impact on self-esteem and quality of life. Addressing these psychosocial factors is an important aspect of care.

Prosthesis Design: Designing and fabricating implant-supported prostheses in cancer survivors can be challenging due to altered oral anatomy and soft tissue deficits. Achieving esthetic and functional outcomes that meet the patient's expectations can be more demanding [7].

Follow-up and maintenance

Cancer survivors may require vigilant long-term follow-up and maintenance of their dental implants to monitor for complications and ensure their continued success

Cost and insurance

The cost of dental implant treatment can be a barrier for some cancer survivors, especially if it is not covered by insurance. Navigating insurance coverage and financing options can be a challenge.

Outcomes of oral rehabilitation with dental implants in the context of cancer survivorship

Oral rehabilitation with dental implants in the context of cancer survivorship can have significant and positive outcomes for patients. These outcomes go beyond the restoration of missing teeth and extend to improving overall quality of life, oral function, and psychological well-being. Here are some of the key outcomes associated with oral rehabilitation using dental implants in cancer survivors.

Restored oral function

Dental implants provide a stable and functional solution for replacing missing teeth. Patients can regain the ability to chew, speak, and perform other essential oral functions, which may have been compromised due to cancer treatment or tooth loss.

Improved aesthetics

Dental implants can enhance the esthetic appearance of a patient's smile and facial structure. The restoration of missing teeth and the ability to use lifelike prosthetic crowns or bridges can boost selfconfidence and self-esteem [8].

Enhanced quality of life

Many cancer survivors experience a significantly improved quality of life after oral rehabilitation with dental implants. Being able to eat a wider variety of foods, enjoy social interactions without embarrassment, and feel more confident in their appearance can have a profound positive impact.

Psychosocial well-being

Dental implants can help address the psychological and emotional challenges faced by cancer survivors. Restoring a natural-looking smile can reduce self-consciousness and anxiety related to oral appearance

Improved nutritional status

The ability to eat a balanced diet that includes a variety of foods can positively impact a patient's nutritional status. This is particularly important for cancer survivors who may have experienced nutritional deficits during treatment.

Speech improvement

Dental implants can contribute to improved speech clarity and articulation, especially in cases where missing teeth or dentures were hindering speech patterns.

Long-term durability

Dental implants are known for their long-term durability and stability. When properly maintained, they can last for many years, providing patients with a reliable and lasting solution for tooth replacement.

Enhanced comfort

Unlike removable dentures, dental implants are fixed in place and do not require adhesives or removal for cleaning. This can result in increased comfort and convenience for patients [9].

Preservation of adjacent teeth

Dental implants do not rely on adjacent teeth for support, unlike traditional dental bridges. This means that adjacent healthy teeth are preserved, promoting overall oral health.

Support for prosthesis

Implants provide strong support for prosthetic restorations, allowing for improved chewing efficiency and bite force, which is essential for proper digestion.

Increased longevity

Oral rehabilitation with dental implants can contribute to the overall longevity and health of the remaining natural teeth and oral structures

Enhanced self-confidence

The ability to smile, eat, and speak comfortably and confidently can positively impact a patient's social interactions and overall sense of well-being

It's important to note that the success of oral rehabilitation with dental implants in cancer survivors depends on careful patient evaluation, treatment planning, and collaboration among healthcare providers. Regular follow-up and maintenance are also crucial to ensure the long-term success of dental implants in this unique patient population [10].

Multidisciplinary approach for oral rehabilitation with dental implants in the context of cancer survivorship Oral rehabilitation with dental implants in the context of cancer survivorship necessitates a multidisciplinary approach due to the complexity of the patients' medical history, potential complications arising from cancer treatments, and the specific requirements of dental implant procedures. A coordinated effort among various healthcare professionals is essential to ensure the best outcomes for these patients. Here's an overview of the key members of the multidisciplinary team involved in oral rehabilitation for cancer survivors using dental implants. [11].

Oral surgeon/implantologist

The oral surgeon or implantologist plays a central role in the implant placement process. They assess the patient's oral health, determine the suitability of implant placement, perform surgical procedures, and oversee the healing and integration of dental implants.

Oncologist

The oncologist, who may be a medical oncologist, radiation oncologist, or surgical oncologist, is responsible for the cancer treatment and management. They provide critical information about the patient's cancer history, treatment plan, and any ongoing medical considerations that may impact the timing and safety of dental implant procedures

Prosthodontist

Prosthodontists are dental specialists in the restoration and replacement of teeth. They collaborate with the oral surgeon to plan and design the prosthetic component of the rehabilitation, including crowns, bridges, or dentures that will be attached to the dental implants.

Periodontist

Periodontists specialize in the health of the gums and supporting structures of the teeth. In cases where there are gum-related concerns or the need for soft tissue grafting, periodontists can provide expertise and treatment [12].

Radiologist

Radiological imaging, such as CT scans or Cone-Beam Computed Tomography (CBCT), is crucial for accurate treatment planning and assessment of bone quality and quantity. Radiologists interpret these images to assist in the implant placement process.

Nutritionist/dietitian

Nutritional counseling may be necessary for cancer survivors who have experienced changes in dietary habits or nutritional deficiencies during treatment. A nutritionist or dietitian can provide guidance on maintaining a balanced diet to support overall health and oral rehabilitation.

Speech-Language Pathologist: Some cancer survivors may experience speech or swallowing difficulties as a result of their treatment. Speech-language pathologists can assess and provide therapy to improve speech and swallowing function [13].

Psychologist/counselor

The psychological and emotional aspects of oral rehabilitation in cancer survivors are significant. Psychologists or counselors can offer support and counseling to help patients cope with any anxieties, body image concerns, or psychological challenges related to their cancer journey and dental implant procedures.

Dental hygienist

Dental hygienists are essential for long-term maintenance and care of dental implants. They can educate patients about oral hygiene practices, perform professional cleanings, and monitor the health of peri-implant tissues [14].

Patient coordinator/navigator

A patient coordinator or navigator can assist cancer survivors in scheduling appointments, coordinating care among various specialists, and ensuring that all aspects of their treatment plan are synchronized and communicated effectively [15, 16]

Primary care physician

The patient's primary care physician should be informed about the dental implant procedure and the patient's cancer history to provide holistic medical care and address any systemic health issues.

Effective communication and collaboration among these healthcare professionals are paramount to the success of oral rehabilitation with dental implants in cancer survivors. Each team member brings unique expertise to address the specific needs and challenges of these patients, ensuring a comprehensive and patient-centred approach to care [17].

Conclusion

In the realm of healthcare, few journeys are as complex and emotionally charged as that of cancer survivorship. The challenges and triumphs experienced by individuals who have conquered oral cancer are remarkable and underscore the resilience of the human spirit. Oral rehabilitation with dental implants, as comprehensively explored in this review, stands as a beacon of hope and restoration in the lives of these survivors. The multifaceted nature of oral rehabilitation in the context of cancer survivorship has been illuminated through a thorough examination of the considerations, challenges, outcomes, and the multidisciplinary approach required to navigate this intricate path. From the initial patient evaluation, which demands a nuanced understanding of cancer treatment history, to the meticulous timing of implant placement, every step underscores the importance of tailored, patient-centered care.

References

1. Barrowman RA, Wilson PR, Wiesenfeld D. Oral rehabilitation with dental implants after cancer treatment. Aust Dent J. 2011;56:160-165. Google Scholar | Crossref
2. Linsen SS, Martini M, Stark H. Long-term results of endosteal implants following radical oral cancer surgery with and without adjuvant radiation therapy. Clin Implant Dent Relat Res. 2012;14:250-258. Google Scholar | Crossref
3. Brogniez V, Lejuste P, Pecheur A, Reychler H. Dental prosthetic reconstruction of osseointegrated implants placed in irradiated bone. Int J Oral Maxillofac Implants. 1998;13:506-512. Google Scholar | Crossref
4. Zierden K, Wöstmann J, Wöstmann B, Rehmann P. Clinical performance of different types of dental prosthesis in patients with head and neck tumors-a retrospective cohort study. Clin Oral Investig. 2022;26:7121-7133. Google Scholar | Crossref
5. Awadalkreem F, Khalifa N, Ahmad AG, Suliman AM, Osman M. Rehabilitation of an irradiated marginal mandibulectomy patient using immediately loaded basal implant-supported fixed prostheses and hyperbaric oxygen therapy: A 2-year follow-up. Int J Surg Case Rep. 2020;71:297-302. Google Scholar | Crossref
6. Werkmeister R, Szulczewski D, Walteros-Benz P, Joos U. Rehabilitation with dental implants of oral cancer patients. J Craniomaxillofac Surg. 1999;27:38-41. Google Scholar | Crossref
7. Weischer T, Schettler D, Mohr C. Concept of surgical and implant-supported prostheses in the rehabilitation of patients with oral cancer. Int J Oral Maxillofac Implants. 1996;11:775-781. Google Scholar | Crossref
8. Chambrone L, Mandia J Jr, Shibli JA, Romito GA, Abrahao M. Dental implants installed in irradiated jaws: a systematic review. J Dent Res. 2013;92;119-130. Google Scholar | Crossref
9. MacInnes A, Lamont T. Radiotherapy associated with higher rates of dental implant loss. Evid Based Dent. 2014;15:27-28. Google Scholar | Crossref
10. Esposito M, Grusovin MG, Patel S, Worthington HV, Coulthard P. Interventions for replacing missing teeth: hyperbaric oxygen therapy for irradiated patients who require dental implants. Cochrane Database Syst Rev. 2008 . Google Scholar | Crossref
11. Printzell L, Reseland JE, Edin NFJ, Tiainen H, Ellingsen JE. The dose-dependent impact of γ-radiation reinforced with backscatter from titanium on primary human osteoblasts. Biomater Investig Dent. 2023;16;10. Google Scholar | Crossref
12. Cognetti DM, Weber RS, Lai SY. Head and neck cancer: an evolving treatment paradigm. Cancer. 2008;113:1911-1932. Google Scholar | Crossref
13. Kale PP, Mani A, Anarthe R, Pendyala G, Thakkur P, et al. Management of Surgical Complication during Dental Implant Placement. J Head Neck Physicians Surg. 2021;9:13-19. Google Scholar | Crossref
14. Schoen PJ, Reintsema H, Bouma J. Quality of life related to oral function in edentulous head and neck cancer patients posttreatment. Int J Prosthodont. 2007;20:469–477. Google Scholar | Crossref
15. Korfage A, Raghoebar GM, Slater JJ. Overdentures on primary mandibular implants in patients with oral cancer: a follow-up study over 14 years. Br J Oral Maxillofac Surg. 2014;52:798–805. Google Scholar | Crossref
16. Ettl T, Weindler J, Gosau M. Impact of radiotherapy on implant-based prosthetic rehabilitation in patients with head and neck cancer: a prospective observational study on implant survival and quality of life—preliminary results. J Craniomaxillofac Surg. 2016;44:1453–1462. Google Scholar | Crossref
17. Dholam KP, Pusalkar HA, Yadav PS. Implant-retained dental rehabilitation in head and neck cancer patients: an assessment of success and failure. Implant Dent. 2013;22:604–609. Google Scholar | Crossref