Influence of Radiotherapy on Dental Implant Prognosis: A Scoping Review

ABSTRACT Background Radiotherapy is an integral component of head and neck cancer management but produces lasting changes in bone and soft tissues, including hypovascularity, hypocellularity, fibrosis, and a predisposition to osteoradionecrosis, all of which can compromise osseointegration and long‐term stability of dental implants. At the same time, implant‐supported prostheses offer substantial functional and quality‐of‐life benefits to cancer survivors, particularly in the presence of xerostomia and altered oral anatomy. The expanding population of irradiated patients seeking implant rehabilitation has generated a heterogeneous and sometimes conflicting body of literature regarding implant prognosis. Objectives This scoping review aimed to map and synthesize the available evidence on the influence of radiotherapy on dental implant prognosis, identify key clinical and treatment‐related factors affecting outcomes, and highlight gaps in current knowledge to guide future research and clinical decision‐making. Results Across the included sources, implant survival in irradiated patients was generally high but consistently lower than in non‐irradiated controls. Reported survival rates commonly ranged from approximately 75% to over 90%, with substantial variability related to radiation dose, timing of implant placement, anatomic site, and type of supporting bone. Implants placed in the mandible showed better outcomes than those in the maxilla, and implants placed in native bone outperformed those in grafted bone. Higher radiation doses, placement after radiotherapy, and the presence of grafted or poorly vascularized bone were recurrently associated with increased failure and complications, including osteoradionecrosis. Conclusions Dental implants remain a viable option for oral rehabilitation in irradiated head and neck cancer patients, but radiotherapy is a significant modifier of prognosis. Careful patient selection, attention to dose distribution, timing of implant placement, and preference for native bone are critical for optimizing outcomes. The existing literature is limited by heterogeneity and a predominance of retrospective data, underscoring the need for well‐designed prospective studies to establish evidence‐based clinical protocols.