{"product_id":"dental-implant-survival-in-head-and-neck-cancer-patients-who-received-radiation-therapy-compared-with-patients-who-did-not","title":"Dental Implant Survival in Head and Neck Cancer Patients Who Received Radiation Therapy Compared With Patients Who Did Not","description":"\u003cp\u003eThis umbrella review combined 11 systematic reviews to compare dental implant survival in head and neck cancer patients who received radiotherapy versus those who did not. Across 73,674 implants, the survival rate was 81.52% in irradiated bone and 94.64% in non-irradiated bone, a difference supported by 11 meta-analyses. Implants placed in the irradiated upper jaw (maxilla) failed more often than implants in the irradiated lower jaw (mandible). Implants in irradiated native bone survived better than implants in irradiated grafted bone. The authors caution that all included reviews had critically low methodological quality, so the findings should be interpreted with care.\u003c\/p\u003e\n\n\u003ch1\u003eDental Implant Survival in Head and Neck Cancer Patients Who Received Radiation Therapy Compared With Patients Who Did Not\u003c\/h1\u003e\n\n\u003ch2\u003eTable of Contents\u003c\/h2\u003e\n\u003cul\u003e\n\u003cli\u003e\u003ca href=\"#ddn-key-points\"\u003eKey Points\u003c\/a\u003e\u003c\/li\u003e\n\n\u003cli\u003e\u003ca href=\"#background\"\u003eBackground: Why This Research Matters\u003c\/a\u003e\u003c\/li\u003e\n\u003cli\u003e\u003ca href=\"#methods\"\u003eHow the Research Was Conducted\u003c\/a\u003e\u003c\/li\u003e\n\u003cli\u003e\u003ca href=\"#selection\"\u003eHow Studies Were Selected\u003c\/a\u003e\u003c\/li\u003e\n\u003cli\u003e\u003ca href=\"#characteristics\"\u003eCharacteristics of the Included Reviews\u003c\/a\u003e\u003c\/li\u003e\n\u003cli\u003e\u003ca href=\"#survival\"\u003eKey Finding: Implant Survival in Irradiated vs. Non-Irradiated Patients\u003c\/a\u003e\u003c\/li\u003e\n\u003cli\u003e\u003ca href=\"#jaw\"\u003eKey Finding: Upper Jaw vs. Lower Jaw in Irradiated Patients\u003c\/a\u003e\u003c\/li\u003e\n\u003cli\u003e\u003ca href=\"#bone\"\u003eKey Finding: Grafted Bone vs. Native Bone, Radiation Dose, and Timing\u003c\/a\u003e\u003c\/li\u003e\n\u003cli\u003e\u003ca href=\"#quality\"\u003eMethodological Quality of the Included Reviews\u003c\/a\u003e\u003c\/li\u003e\n\u003cli\u003e\u003ca href=\"#implications\"\u003eClinical Implications: What This Means for Patients\u003c\/a\u003e\u003c\/li\u003e\n\u003cli\u003e\u003ca href=\"#limitations\"\u003eLimitations: What the Study Could Not Prove\u003c\/a\u003e\u003c\/li\u003e\n\u003cli\u003e\u003ca href=\"#recommendations\"\u003eRecommendations\u003c\/a\u003e\u003c\/li\u003e\n\u003cli\u003e\u003ca href=\"#ddn-faq\"\u003eFrequently Asked Questions\u003c\/a\u003e\u003c\/li\u003e\n\u003cli\u003e\u003ca href=\"#source\"\u003eSource Information\u003c\/a\u003e\u003c\/li\u003e\n\u003c\/ul\u003e\n\n\u003c!-- ddn:keypoints:start --\u003e\n\u003ch2 id=\"ddn-key-points\"\u003eKey Points\u003c\/h2\u003e\n\u003cul\u003e\n\u003cli\u003eAcross 48,563 implants, survival was 81.52% in irradiated bone versus 94.64% in non-irradiated bone, a difference supported by 11 meta-analyses.\u003c\/li\u003e\n\u003cli\u003eIn irradiated patients, upper-jaw implants survived at 79.04% versus 93.55% for lower-jaw implants, based on 3,378 implants.\u003c\/li\u003e\n\u003cli\u003eIrradiated native bone showed 87.06% implant survival versus 82.21% in irradiated grafted bone, though one meta-analysis found no significant difference.\u003c\/li\u003e\n\u003cli\u003eOne meta-analysis found a non-significant tendency toward higher survival with lower radiation dose: 90.01% versus 82.05% for higher dose.\u003c\/li\u003e\n\u003cli\u003eAll 11 included systematic reviews had critically low methodological quality, so the authors urge caution and call for further well-designed clinical studies.\u003c\/li\u003e\n\u003c\/ul\u003e\n\u003c!-- ddn:keypoints:end --\u003e\n\n\n\u003ch2 id=\"background\"\u003eBackground: Why This Research Matters\u003c\/h2\u003e\n\u003cp\u003eDental implants that fuse with the jawbone (osseointegrated dental implants) are widely used. They can be a safe treatment option for patients who have lost all their teeth (edentulous patients). These implants show promising survival rates within a 5-year to 10-year follow-up period.\u003c\/p\u003e\n\n\u003cp\u003eHowever, researchers have studied the risks of implant failure extensively over the years. Several factors can raise the risk that an implant will fail:\u003c\/p\u003e\n\u003cul\u003e\n\u003cli\u003eLow insertion torque in implants planned for immediate or early loading\u003c\/li\u003e\n\u003cli\u003eInexperienced surgeons placing the implants\u003c\/li\u003e\n\u003cli\u003ePlacement of the implant into the upper jaw (maxilla)\u003c\/li\u003e\n\u003cli\u003ePatient history, including radiotherapy, teeth grinding (bruxism), gum disease (periodontitis), and previous early implant loss\u003c\/li\u003e\n\u003c\/ul\u003e\n\n\u003cp\u003eThe number of head and neck cancer cases is rising worldwide. According to the Global Cancer Observatory (GLOBOCAN), the incidence of head and neck cancer in 2022 was approximately 1.5 million new cases, with around 500,000 deaths from the disease.\u003c\/p\u003e\n\n\u003cp\u003eMore and more patients who receive radiation therapy (radiotherapy) for head and neck cancer want oral rehabilitation. The number of dental implants placed in these patients has also increased. However, radiotherapy appears to harm implant-based oral rehabilitation.\u003c\/p\u003e\n\n\u003cp\u003eRadiation causes a process called radiation-induced fibroatrophic change. This process leads to low oxygen levels in tissue (hypoxia), fewer cells (hypocellularity), fewer blood vessels (hypovascularity), and a reduced ability of bone to regenerate.\u003c\/p\u003e\n\n\u003cp\u003eEarlier umbrella reviews recognized implant-based oral rehabilitation as a feasible treatment option for patients who had undergone radiotherapy. Yet many systematic reviews on implant survival in head and neck cancer patients receiving radiotherapy have produced inconclusive findings. These reviews used various clinical analyses and reached conflicting results.\u003c\/p\u003e\n\n\u003cp\u003eStudy results are also hard to compare because the studies differ from one another (heterogeneity), and most included reports lacked a comparison group. For these reasons, the authors recommend interpreting earlier results with caution.\u003c\/p\u003e\n\n\u003cp\u003eTo address inconsistent study methods and to make research more objective, Cochrane introduced the umbrella review. An umbrella review is a study design that combines evidence from multiple systematic reviews into a single comprehensive analysis. This approach supports more reliable decision-making by systematically comparing scientific data.\u003c\/p\u003e\n\n\u003cp\u003eBecause results have been conflicting, this umbrella review aimed to analyze the available relevant systematic reviews. The review compared irradiated patients with non-irradiated patients. The goal was to determine whether head and neck radiotherapy influences dental implant survival in patients with head and neck cancer.\u003c\/p\u003e\n\n\u003ch2 id=\"methods\"\u003eHow the Research Was Conducted\u003c\/h2\u003e\n\u003cp\u003eThis study followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020 guidelines. The research protocol was registered on the International Prospective Register of Systematic Reviews (PROSPERO) database under the number CRD42023406059.\u003c\/p\u003e\n\n\u003cp\u003eThe authors used the PICO strategy to build their research question. PICO stands for Population, Intervention, Comparison, and Outcome. The research question was: \"What is the survival of dental implants installed before and\/or after radiotherapy in patients (male and female) with head and neck cancer? How does this survival compare to patients not exposed to radiation?\"\u003c\/p\u003e\n\n\u003cp\u003eThe PICO elements were defined as follows:\u003c\/p\u003e\n\u003cul\u003e\n\u003cli\u003e\n\u003cstrong\u003ePopulation:\u003c\/strong\u003e Patients undergoing radiotherapy for head and neck cancer\u003c\/li\u003e\n\u003cli\u003e\n\u003cstrong\u003eIntervention:\u003c\/strong\u003e Installation of dental implants before and\/or after radiotherapy\u003c\/li\u003e\n\u003cli\u003e\n\u003cstrong\u003eComparison:\u003c\/strong\u003e Patients with head and neck cancer (non-irradiated)\u003c\/li\u003e\n\u003cli\u003e\n\u003cstrong\u003eOutcome:\u003c\/strong\u003e Survival of dental implants\u003c\/li\u003e\n\u003c\/ul\u003e\n\n\u003cp\u003eThe inclusion criteria were systematic reviews, with or without meta-analysis. These reviews had to assess the survival of dental implants installed before and\/or after radiotherapy in patients with head and neck cancer. The comparison had to be patients with head and neck cancer whose implants were installed in non-irradiated bone.\u003c\/p\u003e\n\n\u003cp\u003eThe authors excluded several types of studies:\u003c\/p\u003e\n\u003cul\u003e\n\u003cli\u003eSystematic reviews of animal studies\u003c\/li\u003e\n\u003cli\u003eOther types of reviews that were not systematic reviews\u003c\/li\u003e\n\u003cli\u003eStudies for which the full text was unavailable\u003c\/li\u003e\n\u003c\/ul\u003e\n\n\u003cp\u003eTwo independent reviewers (MCDP and LCA) conducted the electronic search. They searched PubMed, the Cochrane Library, Embase, and Web of Science from each database's inception until February 23, 2024. They also searched the Google Scholar database for grey literature. The reviewers developed search strategies for each database using indexed terms and synonyms. They also performed a manual search of references in all included studies. A third reviewer (DVC) was consulted when there was doubt. Team members are experts in study translation, so there were no restrictions on language or year of publication.\u003c\/p\u003e\n\n\u003cp\u003eThe two reviewers selected studies independently in a two-stage process. They used the Rayyan QCRI website (Rayyan, Qatar Computing Research Institute, Al-Rayyan, Qatar). Duplicate studies were removed using reference management software (EndNote® X9; Clarivate, Philadelphia, PA, USA). In the first stage, the reviewers assessed titles and abstracts. In the next stage, they read the full text of the selected articles and excluded those that did not meet the eligibility criteria. A third reviewer (DVC) resolved disagreements. The reviewers did not need to contact authors to clarify doubts. Agreement between the reviewers was almost perfect, with a Cohen's Kappa value of 0.90.\u003c\/p\u003e\n\n\u003cp\u003eTwo reviewers (MCDP and LCA) collected data independently in April 2024. They used a customized Excel form that captured the main characteristics of the studies:\u003c\/p\u003e\n\u003cul\u003e\n\u003cli\u003eStudy and publication year\u003c\/li\u003e\n\u003cli\u003eNumber of participants and age range\u003c\/li\u003e\n\u003cli\u003eCountry of publication\u003c\/li\u003e\n\u003cli\u003eNumber of included studies and study design\u003c\/li\u003e\n\u003cli\u003ePresence of meta-analysis\u003c\/li\u003e\n\u003cli\u003eVariation in radiation dose (Gy) and implant installation time\u003c\/li\u003e\n\u003cli\u003eNumber of failed and installed implants\u003c\/li\u003e\n\u003cli\u003eImplantation site\u003c\/li\u003e\n\u003cli\u003eTime interval between radiotherapy and implant installation\u003c\/li\u003e\n\u003cli\u003eFollow-up period\u003c\/li\u003e\n\u003cli\u003eImplant characteristics\u003c\/li\u003e\n\u003cli\u003eCancer characteristics\u003c\/li\u003e\n\u003cli\u003eAdjuvant therapy\u003c\/li\u003e\n\u003cli\u003eBone crest stability\u003c\/li\u003e\n\u003cli\u003ePostoperative complications\u003c\/li\u003e\n\u003cli\u003eProsthetic rehabilitation\u003c\/li\u003e\n\u003c\/ul\u003e\n\n\u003cp\u003eA third author (DVC) reviewed the data. In cases of missing data, the authors planned to contact the original authors by email twice.\u003c\/p\u003e\n\n\u003cp\u003eTwo reviewers (MCDP and LCA) independently appraised the quality of the included systematic reviews. They used the A Measurement Tool to Assess Systematic Reviews (AMSTAR 2) tool. A third reviewer (DVC) resolved disagreements. The AMSTAR 2 tool consists of 16 items. Items 2, 4, 7, 9, 11, 13, and 15 are considered critical. Questions are answered with the options: yes, partial yes, no, or meta-analysis not conducted.\u003c\/p\u003e\n\n\u003cp\u003eThe overall confidence rating of a review's results is categorized as follows:\u003c\/p\u003e\n\u003cul\u003e\n\u003cli\u003e\n\u003cstrong\u003eHigh:\u003c\/strong\u003e no weakness or one non-critical weakness\u003c\/li\u003e\n\u003cli\u003e\n\u003cstrong\u003eModerate:\u003c\/strong\u003e more than one non-critical weakness\u003c\/li\u003e\n\u003cli\u003e\n\u003cstrong\u003eLow:\u003c\/strong\u003e one critical flaw, with or without non-critical weaknesses\u003c\/li\u003e\n\u003cli\u003e\n\u003cstrong\u003eCritically low:\u003c\/strong\u003e more than one critical flaw, with or without non-critical weaknesses\u003c\/li\u003e\n\u003c\/ul\u003e\n\n\u003cp\u003eThe authors performed a descriptive synthesis of the results of the included studies. They calculated the percentage of implant survival using the arithmetic mean.\u003c\/p\u003e\n\n\u003ch2 id=\"selection\"\u003eHow Studies Were Selected\u003c\/h2\u003e\n\u003cp\u003eThe literature search identified 1,811 articles. After removing 670 duplicates, the reviewers evaluated the remaining 1,141 publications by reading titles and abstracts. A manual search identified five additional reports. This process resulted in 45 records selected for full-text reading.\u003c\/p\u003e\n\n\u003cp\u003eThe reviewers excluded 34 references for the following reasons:\u003c\/p\u003e\n\u003cul\u003e\n\u003cli\u003eEleven did not investigate a non-irradiated control group\u003c\/li\u003e\n\u003cli\u003eEight were not systematic reviews\u003c\/li\u003e\n\u003cli\u003eSeven had no full text available\u003c\/li\u003e\n\u003cli\u003eThree did not focus on oral rehabilitation with implants in irradiated patients\u003c\/li\u003e\n\u003cli\u003eTwo included non-specific data for head and neck cancer\u003c\/li\u003e\n\u003cli\u003eTwo were editorials\u003c\/li\u003e\n\u003cli\u003eOne did not investigate implant survival\u003c\/li\u003e\n\u003c\/ul\u003e\n\n\u003cp\u003eFinally, the authors included 11 systematic reviews for qualitative synthesis.\u003c\/p\u003e\n\n\u003ch2 id=\"characteristics\"\u003eCharacteristics of the Included Reviews\u003c\/h2\u003e\n\u003cp\u003eThe 11 included systematic reviews covered a total of 16,193 patients who received 73,674 dental implants. Of these implants, approximately 31,137 were installed in irradiated sites.\u003c\/p\u003e\n\n\u003cp\u003eAll selected studies assessed the survival of dental implants installed after the diagnosis of head and neck cancer. One systematic review was an update of a previous study by the same research team. The age range of participants varied from 6 to 94 years, and one study did not report the sample age. Most of the included reviews evaluated data from retrospective studies. All included studies conducted a meta-analysis.\u003c\/p\u003e\n\n\u003cp\u003eThe minimum radiation dose among the studies ranged from 10 Gy to 40 Gy. The maximum dose ranged from 72 Gy to 145 Gy. Two studies did not mention the radiation dose.\u003c\/p\u003e\n\n\u003cp\u003eThe timing of implant installation varied across the reviews:\u003c\/p\u003e\n\u003cul\u003e\n\u003cli\u003eFive articles described implants installed before and after radiotherapy\u003c\/li\u003e\n\u003cli\u003eFour reported implants installed after radiotherapy\u003c\/li\u003e\n\u003cli\u003eOne study evaluated implant installation during panendoscopy or ablative surgery, which is before radiotherapy\u003c\/li\u003e\n\u003c\/ul\u003e\n\n\u003cp\u003eAll selected studies evaluated the survival of implants installed in the upper jaw (maxilla) and the lower jaw (mandible). Seven studies investigated implants installed in both native bone and grafted bone. Two studies analyzed implants installed only in native bone. One study did not mention the bone type.\u003c\/p\u003e\n\n\u003cp\u003eOnly one study investigated the time interval between radiotherapy and implantation. The follow-up time among the studies varied from one month to 23 years. One study did not mention the follow-up period.\u003c\/p\u003e\n\n\u003ch2 id=\"survival\"\u003eKey Finding: Implant Survival in Irradiated vs. Non-Irradiated Patients\u003c\/h2\u003e\n\u003cp\u003eThe survival rate of implants was higher among non-irradiated patients, according to data from 11 meta-analyses. In contrast, three meta-analyses showed no significant difference between the irradiated and non-irradiated groups. Data were reported across four time periods (1990–2021, 1990–2006, 2007–2013, and 2013–2021) and two follow-up periods (at least 3 years of follow-up and at least 5 years of follow-up).\u003c\/p\u003e\n\n\u003cp\u003eOverall, the analysis evaluated 48,563 implants:\u003c\/p\u003e\n\u003cul\u003e\n\u003cli\u003e\n\u003cstrong\u003eIrradiated group:\u003c\/strong\u003e 14,471 implants, with 2,674 failures, giving a survival rate of \u003cstrong\u003e81.52%\u003c\/strong\u003e\n\u003c\/li\u003e\n\u003cli\u003e\n\u003cstrong\u003eNon-irradiated group:\u003c\/strong\u003e 34,092 implants, with 1,825 failures, giving a survival rate of \u003cstrong\u003e94.64%\u003c\/strong\u003e\n\u003c\/li\u003e\n\u003c\/ul\u003e\n\n\u003cp\u003eIndividual meta-analyses reported the following results:\u003c\/p\u003e\n\u003cul\u003e\n\u003cli\u003e\n\u003cstrong\u003eCamolesi et al. (2023), 5 years of follow-up:\u003c\/strong\u003e weighted proportion in the irradiated group was 93.13% (95% confidence interval [CI]: 87.20–99.6; p\u0026lt;0.001; I²=85%); weighted proportion in the control group was 98.52% (95% CI: 97.56–99.48; p\u0026lt;0.001; I²=0%). Survival rate: 93.13% irradiated vs. 98.56% non-irradiated.\u003c\/li\u003e\n\u003cli\u003e\n\u003cstrong\u003eShahi et al. (2023), follow-up not mentioned:\u003c\/strong\u003e 136 failures out of 1,226 implants in the irradiated group and 41 failures out of 932 in the control group. Odds ratio (OR): 1.79; 95% CI: 1.35–2.23; p\u0026lt;0.01; I²=62.89%. Survival rate: 81.35% irradiated vs. 87.45% non-irradiated.\u003c\/li\u003e\n\u003cli\u003e\n\u003cstrong\u003eKende et al. (2022), mean 52.5 months of follow-up:\u003c\/strong\u003e 364 failures out of 2,186 implants in the irradiated group and 179 failures out of 1,685 in the control group. OR: 0.24; 95% CI: 0.14–0.40; p\u0026lt;0.01; I²=73%. Survival rate: 82.47% irradiated vs. 89.37% non-irradiated.\u003c\/li\u003e\n\u003cli\u003e\n\u003cstrong\u003eSchiegnitz et al. (2022), 2013–2021, at least 3 years of follow-up:\u003c\/strong\u003e OR: 2.07; 95% CI: 1.54–2.97; p\u0026lt;0.00001.\u003c\/li\u003e\n\u003cli\u003e\n\u003cstrong\u003eSchiegnitz et al. (2022), 2013–2021, at least 5 years of follow-up:\u003c\/strong\u003e OR: 1.8; 95% CI: 1.21–2.67; p=0.003.\u003c\/li\u003e\n\u003cli\u003e\n\u003cstrong\u003eSchiegnitz et al. (2022), 1990–2021, 3 years of follow-up:\u003c\/strong\u003e 500 failures out of 3,269 implants in the irradiated group and 339 failures out of 3,348 in the control group. OR: 2.06; 95% CI: 1.75–2.42; p\u0026lt;0.00001; I²=33%. Survival rate: 79.56% irradiated vs. 86.61% non-irradiated.\u003c\/li\u003e\n\u003cli\u003e\n\u003cstrong\u003eSchiegnitz et al. (2022), 1990–2021, 5 years of follow-up:\u003c\/strong\u003e 373 failures out of 1,825 implants in the irradiated group and 278 failures out of 2,077 in the control group. OR: 1.97; 95% CI: 1.63–2.37; p\u0026lt;0.00001; I²=47%. Survival rate: 84.70% irradiated vs. 89.87% non-irradiated.\u003c\/li\u003e\n\u003cli\u003e\n\u003cstrong\u003eShokouhi and Cerajewska (2022), 1–3.8 years of follow-up:\u003c\/strong\u003e 62 failures out of 508 implants in the irradiated group and 13 failures out of 452 in the control group. OR: 4.77; 95% CI: 2.57–8.89; p\u0026lt;0.00001; I²=0%. Survival rate: 87.79% irradiated vs. 97.12% non-irradiated.\u003c\/li\u003e\n\u003cli\u003e\n\u003cstrong\u003eGupta et al. (2021), 6–12 months of follow-up:\u003c\/strong\u003e 323 failures out of 2,203 implants in the irradiated group and 141 failures out of 2,349 in the control group. OR: 2.95; 95% CI: 1.93–4.50; p\u0026lt;0.00001; I²=50%. Survival rate: 85.80% irradiated vs. 93.90% non-irradiated.\u003c\/li\u003e\n\u003cli\u003e\n\u003cstrong\u003eIn't Veld et al. (2021), follow-up not mentioned:\u003c\/strong\u003e 37 failures out of 473 implants in the irradiated group and 5 failures out of 372 in the control group. Risk ratio (RR): 5.02; 95% CI: 0.92–27.38; p=0.06; I²=56%. Survival rate: 92.17% irradiated vs. 98.65% non-irradiated.\u003c\/li\u003e\n\u003cli\u003e\n\u003cstrong\u003eSmith Nobrega et al. (2016), 16 years of follow-up:\u003c\/strong\u003e 629 failures out of 3,773 implants in the irradiated group and 191 failures out of 3,328 in the control group. RR: 2.63; 95% CI: 1.93–3.58; p\u0026lt;0.001; I²=56%. Survival rate: 84.30% irradiated vs. 94.26% non-irradiated.\u003c\/li\u003e\n\u003cli\u003e\n\u003cstrong\u003eChrcanovic et al. (2016), follow-up not mentioned:\u003c\/strong\u003e 640 failures out of 3,914 implants in the irradiated group and 684 failures out of 14,514 in the control group. RR: 2.18; 95% CI: 1.71–2.79; p\u0026lt;0.00001; I²=52%. Survival rate: 83.64% non-irradiated vs. 95.29% irradiated (as reported in the source table).\u003c\/li\u003e\n\u003cli\u003e\n\u003cstrong\u003eSchiegnitz et al. (2014), 2007–2013, at least 5 years of follow-up:\u003c\/strong\u003e 19 failures out of 263 implants in the irradiated group and 13 failures out of 241 in the control group. OR: 1.44; 95% CI: 0.67–3.10; p=0.35; I²=75%. Survival rate: 92.77% irradiated vs. 94.60% non-irradiated.\u003c\/li\u003e\n\u003cli\u003e\n\u003cstrong\u003eSchiegnitz et al. (2014), 1990–2006, at least 5 years of follow-up:\u003c\/strong\u003e 281 failures out of 983 implants in the irradiated group and 203 failures out of 1,040 in the control group. OR: 2.11; 95% CI: 1.69–2.65; p\u0026lt;0.00001; I²=72%. Survival rate: 71.41% irradiated vs. 80.48% non-irradiated.\u003c\/li\u003e\n\u003cli\u003e\n\u003cstrong\u003eChambrone et al. (2013), follow-up not mentioned:\u003c\/strong\u003e 110 failures out of 549 implants in the irradiated group and 293 failures out of 8,383 in the control group. RR: 2.74; 95% CI: 1.86–4.05; p\u0026lt;0.00001; I²=0%. Survival rate: 83.30% irradiated vs. 93.81% non-irradiated.\u003c\/li\u003e\n\u003c\/ul\u003e\n\n\u003ch2 id=\"jaw\"\u003eKey Finding: Upper Jaw vs. Lower Jaw in Irradiated Patients\u003c\/h2\u003e\n\u003cp\u003eTwo meta-analyses showed higher implant survival when implants were installed in the irradiated lower jaw (mandible) compared with the irradiated upper jaw (maxilla).\u003c\/p\u003e\n\n\u003cp\u003eThe first meta-analysis reported a risk ratio (RR) of 3.16 (95% CI: 1.76–5.68; p=0.0001; I²=70%). The second meta-analysis reported an RR of 5.96 (95% CI: 2.71–13.12; p\u0026lt;0.00001; I²=33%).\u003c\/p\u003e\n\n\u003cp\u003eA total of 3,378 implants were evaluated:\u003c\/p\u003e\n\u003cul\u003e\n\u003cli\u003e\n\u003cstrong\u003eIrradiated maxilla group:\u003c\/strong\u003e 897 implants, with 188 failures, giving a survival rate of \u003cstrong\u003e79.04%\u003c\/strong\u003e\n\u003c\/li\u003e\n\u003cli\u003e\n\u003cstrong\u003eIrradiated mandible group:\u003c\/strong\u003e 2,481 implants, with 160 failures, giving a survival rate of \u003cstrong\u003e93.55%\u003c\/strong\u003e\n\u003c\/li\u003e\n\u003c\/ul\u003e\n\n\u003cp\u003eIn the study by Shokouhi and Cerajewska (2022), implants installed in the maxilla were significantly more likely to fail than those installed in the mandible. The odds ratio was 5.03 (95% CI: 1.07–23.58; p=0.04; I²=87%).\u003c\/p\u003e\n\n\u003ch2 id=\"bone\"\u003eKey Finding: Grafted Bone vs. Native Bone, Radiation Dose, and Timing\u003c\/h2\u003e\n\u003cp\u003eTwo meta-analyses covering literature from 1990 to 2021 showed higher implant survival in irradiated native bone compared with irradiated grafted bone.\u003c\/p\u003e\n\n\u003cul\u003e\n\u003cli\u003eFor follow-up of at least 36 months: OR 2.06; 95% CI: 1.44–2.94; p\u0026lt;0.0001; I²=0%\u003c\/li\u003e\n\u003cli\u003eFor follow-up of at least 60 months: OR 2.26; 95% CI: 1.50–3.40; p\u0026lt;0.0001; I²=12%\u003c\/li\u003e\n\u003c\/ul\u003e\n\n\u003cp\u003eIn contrast, one meta-analysis showed no significant difference between irradiated grafted bone and irradiated native bone (RR: 1.35; 95% CI: 0.93–1.94; p=0.11; I²=48%).\u003c\/p\u003e\n\n\u003cp\u003eA total of 1,740 implants were evaluated:\u003c\/p\u003e\n\u003cul\u003e\n\u003cli\u003e\n\u003cstrong\u003eIrradiated grafted bone group:\u003c\/strong\u003e 596 implants, with 106 failures, giving a survival rate of \u003cstrong\u003e82.21%\u003c\/strong\u003e\n\u003c\/li\u003e\n\u003cli\u003e\n\u003cstrong\u003eIrradiated native bone group:\u003c\/strong\u003e 1,144 implants, with 148 failures, giving a survival rate of \u003cstrong\u003e87.06%\u003c\/strong\u003e\n\u003c\/li\u003e\n\u003c\/ul\u003e\n\n\u003cp\u003eOne meta-analysis examined radiation dose. It showed a tendency for implants exposed to lower doses of radiotherapy to have higher implant survival (RR: 1.59; 95% CI: 0.98–2.59; p=0.06; I²=47%). However, no statistically significant difference was observed between the groups evaluated.\u003c\/p\u003e\n\n\u003cp\u003eA total of 1,057 implants were evaluated in this dose analysis:\u003c\/p\u003e\n\u003cul\u003e\n\u003cli\u003e\n\u003cstrong\u003eHigher dose group:\u003c\/strong\u003e 546 implants, with 98 failures, giving a survival rate of \u003cstrong\u003e82.05%\u003c\/strong\u003e\n\u003c\/li\u003e\n\u003cli\u003e\n\u003cstrong\u003eLower dose group:\u003c\/strong\u003e 511 implants, with 51 failures, giving a survival rate of \u003cstrong\u003e90.01%\u003c\/strong\u003e\n\u003c\/li\u003e\n\u003c\/ul\u003e\n\n\u003cp\u003eAnother meta-analysis found no statistically significant difference when implants were installed before or after 12 months following radiotherapy (RR: 1.37; 95% CI: 0.76–2.45; p=0.29; I²=64%).\u003c\/p\u003e\n\n\u003cp\u003eFor the 445 implants installed up to 12 months after radiotherapy, 79 failures occurred, giving a survival rate of \u003cstrong\u003e84.26%\u003c\/strong\u003e. In the group of implants installed more than 12 months after radiotherapy, 58 failures occurred among 505 implants, giving a survival rate of \u003cstrong\u003e88.51%\u003c\/strong\u003e.\u003c\/p\u003e\n\n\u003ch2 id=\"quality\"\u003eMethodological Quality of the Included Reviews\u003c\/h2\u003e\n\u003cp\u003eOverall, the eligible reviews showed critically low quality according to the AMSTAR 2 tool domains. This means the included systematic reviews had more than one critical flaw, with or without non-critical weaknesses. The authors detail the reasons for downgrading these studies in the supporting information of the original article.\u003c\/p\u003e\n\n\u003ch2 id=\"implications\"\u003eClinical Implications: What This Means for Patients\u003c\/h2\u003e\n\u003cp\u003eThis umbrella review included 11 systematic reviews published between 2013 and 2023. The reviews assessed the survival of 14,471 dental implants installed before and\/or after radiotherapy in head and neck cancer patients. These were compared with 34,092 implants in non-irradiated patients.\u003c\/p\u003e\n\n\u003cp\u003eOverall, the survival rate of implants installed in irradiated patients was lower than that of implants installed in non-irradiated patients. This finding matters for patients who are considering dental implants after radiation treatment for head and neck cancer.\u003c\/p\u003e\n\n\u003cp\u003eThe location of the implant appears to matter. Implants placed in the irradiated upper jaw (maxilla) failed more often than implants placed in the irradiated lower jaw (mandible). The survival rate was 79.04% in the irradiated maxilla compared with 93.55% in the irradiated mandible.\u003c\/p\u003e\n\n\u003cp\u003eThe type of bone also appears to matter. Implants placed in irradiated native bone survived better than implants placed in irradiated grafted bone. The survival rate was 87.06% in irradiated native bone compared with 82.21% in irradiated grafted bone.\u003c\/p\u003e\n\n\u003cp\u003eRadiation dose may also play a role. Implants exposed to lower doses of radiotherapy showed a tendency toward higher survival (90.01%) compared with implants exposed to higher doses (82.05%). However, this difference did not reach statistical significance.\u003c\/p\u003e\n\n\u003cp\u003eThe timing of implant placement after radiotherapy did not show a statistically significant effect. Implants placed up to 12 months after radiotherapy had a survival rate of 84.26%, and implants placed more than 12 months after radiotherapy had a survival rate of 88.51%.\u003c\/p\u003e\n\n\u003ch2 id=\"limitations\"\u003eLimitations: What the Study Could Not Prove\u003c\/h2\u003e\n\u003cp\u003eThe authors identified several important limitations. The most significant limitation is the quality of the evidence. All included systematic reviews had critically low methodological quality according to the AMSTAR 2 tool.\u003c\/p\u003e\n\n\u003cp\u003eThe included studies also differed from one another (heterogeneity). Most included reports lacked a comparison group. For these reasons, the authors recommend interpreting the presented results with caution.\u003c\/p\u003e\n\n\u003cp\u003eThree meta-analyses showed no significant difference between the irradiated and non-irradiated groups. This means the evidence is not entirely consistent, even though most meta-analyses favored non-irradiated bone.\u003c\/p\u003e\n\n\u003cp\u003eTwo studies did not mention the radiation dose. One study did not report the sample age. One study did not mention the follow-up period. Only one study investigated the time interval between radiotherapy and implantation. These gaps limit how completely the authors could analyze all relevant factors.\u003c\/p\u003e\n\n\u003cp\u003eThe authors conclude that further well-designed clinical studies are warranted.\u003c\/p\u003e\n\n\u003ch2 id=\"recommendations\"\u003eRecommendations\u003c\/h2\u003e\n\u003cp\u003eBased on this umbrella review, the authors make the following points for patients and clinicians to consider:\u003c\/p\u003e\n\n\u003col\u003e\n\u003cli\u003eDiscuss the lower implant survival rate in irradiated bone with your dental and cancer care team. The review found a survival rate of 81.52% in irradiated bone compared with 94.64% in non-irradiated bone.\u003c\/li\u003e\n\u003cli\u003eAsk about the planned implant location. Implants in the irradiated upper jaw (maxilla) had a lower survival rate (79.04%) than implants in the irradiated lower jaw (mandible, 93.55%).\u003c\/li\u003e\n\u003cli\u003eAsk whether the implant will be placed in native bone or grafted bone. Irradiated native bone showed a higher survival rate (87.06%) than irradiated grafted bone (82.21%).\u003c\/li\u003e\n\u003cli\u003eUnderstand that the quality of the available evidence is critically low. The authors state that further well-designed clinical studies are needed before firm conclusions can be drawn.\u003c\/li\u003e\n\u003cli\u003eInterpret all results with caution, because the included studies differed from one another and most lacked a comparison group.\u003c\/li\u003e\n\u003c\/ol\u003e\n\n\u003c!-- ddn:faq:start --\u003e\n\u003ch2 id=\"ddn-faq\"\u003eFrequently Asked Questions\u003c\/h2\u003e\n\u003ch3\u003eIf I had radiation for head and neck cancer, how well do dental implants survive?\u003c\/h3\u003e\n\u003cp\u003eAn umbrella review of 11 systematic reviews found that across 48,563 implants, those in irradiated bone had a survival rate of 81.52%, compared with 94.64% in non-irradiated bone. Most meta-analyses favored non-irradiated bone, but three showed no significant difference, and all included reviews had critically low methodological quality.\u003c\/p\u003e\n\u003ch3\u003eDoes it matter whether the implant goes in my upper or lower jaw after radiation?\u003c\/h3\u003e\n\u003cp\u003eYes. In irradiated patients, implants in the upper jaw (maxilla) had a survival rate of 79.04%, while implants in the lower jaw (mandible) had a survival rate of 93.55%. Two meta-analyses showed higher survival in the irradiated lower jaw, and one study found upper-jaw implants were significantly more likely to fail.\u003c\/p\u003e\n\u003ch3\u003eIs an implant in grafted bone riskier than one in my own bone after radiation?\u003c\/h3\u003e\n\u003cp\u003eIn irradiated patients, implants placed in native bone had a survival rate of 87.06%, compared with 82.21% in grafted bone. Two meta-analyses found higher survival in irradiated native bone, though one meta-analysis found no significant difference. Ask your clinician whether your implant will be placed in native or grafted bone.\u003c\/p\u003e\n\u003ch3\u003eShould I wait a certain amount of time after radiation before getting implants?\u003c\/h3\u003e\n\u003cp\u003eOne meta-analysis compared implants placed up to 12 months after radiotherapy with those placed more than 12 months after. Survival was 84.26% and 88.51% respectively, with no statistically significant difference. Only one included study investigated this time interval, so the evidence on timing is limited.\u003c\/p\u003e\n\u003ch3\u003eHow reliable is this information about implant survival after radiation?\u003c\/h3\u003e\n\u003cp\u003eAll 11 included systematic reviews had critically low methodological quality according to the AMSTAR 2 tool, meaning more than one critical flaw. The studies also differed from one another, and most lacked a comparison group. The authors recommend interpreting the results with caution and say further well-designed clinical studies are needed.\u003c\/p\u003e\n\u003ch3\u003eWhat should I discuss with my dental and cancer care team about implants after radiation?\u003c\/h3\u003e\n\u003cp\u003eThe authors recommend discussing the lower survival rate in irradiated bone (81.52% versus 94.64% in non-irradiated bone), asking about the planned implant location because the irradiated upper jaw had lower survival (79.04%) than the lower jaw (93.55%), and asking whether native or grafted bone will be used.\u003c\/p\u003e\n\u003ch3\u003eI had radiation for head and neck cancer and my dentist is recommending dental implants — when should I get a second opinion?\u003c\/h3\u003e\n\u003cp\u003eA second opinion is worth considering before implants are placed in irradiated bone, because survival is lower there (81.52%) than in non-irradiated bone (94.64%). Ask about the planned location: implants in the irradiated upper jaw survived less often (79.04%) than in the lower jaw (93.55%). Ask whether native or grafted bone is planned, since irradiated native bone survived better (87.06%) than grafted bone (82.21%). The available evidence is of critically low quality, so an independent review of your records can help. Diagnostic Detectives Network provides independent expert second opinions.\u003c\/p\u003e\n\u003c!-- ddn:faq:end --\u003e\n\n\u003ch2 id=\"source\"\u003eSource Information\u003c\/h2\u003e\n\u003cp\u003e\u003cstrong\u003eOriginal article title:\u003c\/strong\u003e Survival of dental implants in irradiated head and neck cancer patients compared to non-irradiated patients: An umbrella review.\u003c\/p\u003e\n\n\u003cp\u003e\u003cstrong\u003eAuthors:\u003c\/strong\u003e Maria Cândida Dourado Pacheco, Alexandre Henrique dos Reis Prado, Danilo Viegas da Costa, Lara Cancella de Arantes, Caio Fernando Teixeira Portela, Tarcísio Passos Ribeiro Campos, and Arno Heeren de Oliveira.\u003c\/p\u003e\n\n\u003cp\u003e\u003cstrong\u003eAuthor affiliations:\u003c\/strong\u003e Department of Nuclear Engineering, Federal University of Minas Gerais, School of Engineering, Belo Horizonte, Minas Gerais, Brazil; Restorative Dentistry, Federal University of Minas Gerais, School of Dentistry, Belo Horizonte, Minas Gerais, Brazil; Dental Clinics with an Emphasis on Periodontics at the Pontifical Catholic University of Minas Gerais, Belo Horizonte, Minas Gerais, Brazil.\u003c\/p\u003e\n\n\u003cp\u003e\u003cstrong\u003ePublication details:\u003c\/strong\u003e PLOS ONE, 20(9): e0324388. Published September 3, 2025. DOI: https:\/\/doi.org\/10.1371\/journal.pone.0324388\u003c\/p\u003e\n\n\u003cp\u003e\u003cstrong\u003eReview registration:\u003c\/strong\u003e PROSPERO number CRD42023406059.\u003c\/p\u003e\n\n\u003cp\u003e\u003cstrong\u003eFunding:\u003c\/strong\u003e The authors received no specific funding for this work.\u003c\/p\u003e\n\n\u003cp\u003e\u003cstrong\u003eCompeting interests:\u003c\/strong\u003e The authors declared that no competing interests exist.\u003c\/p\u003e\n\n\u003cp\u003e\u003cem\u003eThis patient-friendly article is based on peer-reviewed research.\u003c\/em\u003e\u003c\/p\u003e","brand":"DiagnosticDetectives.Com","offers":[{"title":"Default Title","offer_id":47807312429212,"sku":null,"price":0.0,"currency_code":"USD","in_stock":true}],"thumbnail_url":"\/\/cdn.shopify.com\/s\/files\/1\/0599\/5449\/5644\/files\/ddn-medical-article-dental-implant-survival-in-head-and-neck-cancer-patients-who-received-radiation-therapy-compared-with-patients-who-did-n-hero.png?v=1792732913","url":"https:\/\/diagnosticdetectives.com\/da\/products\/dental-implant-survival-in-head-and-neck-cancer-patients-who-received-radiation-therapy-compared-with-patients-who-did-not","provider":"DiagnosticDetectives.Com","version":"1.0","type":"link"}