A review of interaction of radiotherapy and implants in head and neck cancer — implications and strategies to improve outcomes

Oral rehabilitation after the curative treatment of oral cancer is challenging. Improvement of functional and cosmetic rehabilitation following surgery and radiotherapy for head and neck cancers has been continuously attempted. Advances in dental and prosthetic implants have significantly improved quality of life. To achieve the best oncological, functional, and aesthetic outcomes, a multidisciplinary approach should be used to treat patients with oral cancer. Oral surgeons, reconstructive surgeons, implantologists, and radiation oncologists should have a good understanding of each other's specialties. Radiation can interact with metallic implants and potentially increase the dose to tissues close to the implant, leading to undesirable complications, such as osteoradionecrosis. Radiation decreases implant survival by affecting osseointegration. Implant survival depends on the location and timing of the implant placement and the radiation dose received. Outcomes can be improved using adjunct hyperbaric oxygen, robust dental care before and during radiation, and modern radiotherapy techniques such as intensity-modulated radiotherapy.