Skip to main content

Implant survival or implant success? Evaluation of implant-based prosthetic rehabilitation in head and neck cancer patients—a prospective observational study

Clinical Oral Investigations volume 24, pages 3039–3047 (2020)Cite this article

Abstract

Objectives

Definition of implant success is unclear in prosthetic implant-based rehabilitation of head neck cancer patients.

Materials and methods

Fifty-two patients with 309 inserted implants were included in this prospective observational study. Implant survival (in situ and loaded) and implant success (modified Albrektsson criteria) at 2-year follow-up were evaluated under the influence of patient- and implant-specific variables.

Results

Thirty-nine patients with 234 implants finished the study. Overall implant survival after 2 years was 92.3% (216/234) with an osseointegration rate of 94% (220/234). Implant success was 78.6% (184/234). Main reasons for failure were “bone resorption > 1.7mm” (n = 27, 11.5%) and “implant not in situ or not loaded” (n = 18, 7.7%). Smoking (OR 3.1, p = 0.034), bone grafts (OR 2.4, p = 0.021) and radiation dose > 60 Gy (OR 3.8, p = 0.025) revealed as significant predictors for implant failure.

Conclusion

Implant survival differs significantly from implant success in head and neck cancer patients. Implant success is mainly determined by radiographic peri-implant bone resorption.

Clinical relevance

Dealing with head and neck cancer patients a higher amount of peri-implant bone resorption must be taken into account and warrants for intensified implant monitoring.

This is a preview of subscription content, access via your institution.

Access options

Buy single article

Instant access to the full article PDF.

43,34 €

Price includes VAT (Finland)
Tax calculation will be finalised during checkout.

Fig. 1

References

  1. Shaw RJ, Sutton AF, Cawood JI, Howell RA, Lowe D, Brown JS, Rogers SN, Vaughan ED (2005) Oral rehabilitation after treatment for head and neck malignancy. Head Neck 27:459–470. https://doi.org/10.1002/hed.20176

    Article  PubMed  Google Scholar 

  2. Yerit KC, Posch M, Seemann M, Hainich S, Dortbudak O, Turhani D, Ozyuvaci H, Watzinger F, Ewers R (2006) Implant survival in mandibles of irradiated oral cancer patients. Clin Oral Implants Res 17:337–344. https://doi.org/10.1111/j.1600-0501.2005.01160.x

    Article  PubMed  Google Scholar 

  3. Nelson K, Heberer S, Glatzer C (2007) Survival analysis and clinical evaluation of implant-retained prostheses in oral cancer resection patients over a mean follow-up period of 10 years. J Prosthet Dent 98:405–410. https://doi.org/10.1016/s0022-3913(07)60125-5

    Article  PubMed  Google Scholar 

  4. Schliephake H, Neukam FW, Schmelzeisen R, Wichmann M (1999) Long-term results of endosteal implants used for restoration of oral function after oncologic surgery. Int J Oral Maxillofac Surg 28:260–265

    Article  Google Scholar 

  5. Watzinger F, Ewers R, Henninger A, Sudasch G, Babka A, Woelfl G (1996) Endosteal implants in the irradiated lower jaw. J Craniomaxillofac Surg 24:237–244

    Article  Google Scholar 

  6. Albrektsson T, Zarb G, Worthington P, Eriksson AR (1986) The long-term efficacy of currently used dental implants: a review and proposed criteria of success. Int J Oral Maxillofac Implants 1:11–25

    PubMed  Google Scholar 

  7. Papaspyridakos P, Chen CJ, Singh M, Weber HP, Gallucci GO (2012) Success criteria in implant dentistry: a systematic review. J Dent Res 91:242–248. https://doi.org/10.1177/0022034511431252

    Article  PubMed  Google Scholar 

  8. Misch CE, Perel ML, Wang HL, Sammartino G, Galindo-Moreno P, Trisi P, Steigmann M, Rebaudi A, Palti A, Pikos MA, Schwartz-Arad D, Choukroun J, Gutierrez-Perez JL, Marenzi G, Valavanis DK (2008) Implant success, survival, and failure: the International Congress of Oral Implantologists (ICOI) Pisa Consensus Conference. Implant Dent 17:5–15. https://doi.org/10.1097/ID.0b013e3181676059

    Article  PubMed  Google Scholar 

  9. Lang NP, Berglundh T (2011) Periimplant diseases: where are we now?--consensus of the seventh European workshop on periodontology. J Clin Periodontol 38(Suppl 11):178–181. https://doi.org/10.1111/j.1600-051X.2010.01674.x

    Article  PubMed  Google Scholar 

  10. Ettl T, Weindler J, Gosau M, Muller S, Hautmann M, Zeman F, Koller M, Papavasileiou D, Burgers R, Driemel O, Schneider I, Klingelhoffer C, Meier J, Wahlmann U, Reichert TE (2016) 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 44:1453–1462. https://doi.org/10.1016/j.jcms.2016.07.016

    Article  PubMed  Google Scholar 

  11. Vandenbroucke JP, von Elm E, Altman DG, Gotzsche PC, Mulrow CD, Pocock SJ, Poole C, Schlesselman JJ, Egger M (2007) Strengthening the reporting of observational studies in epidemiology (STROBE): explanation and elaboration. PLoS Med 4:e297. https://doi.org/10.1371/journal.pmed.0040297

    Article  PubMed  PubMed Central  Google Scholar 

  12. Mombelli A, Lang NP (1994) Clinical parameters for the evaluation of dental implants. Periodontology 2000(4):81–86

    Article  Google Scholar 

  13. Adell R, Lekholm U, Rockler B, Branemark PI (1981) A 15-year study of osseointegrated implants in the treatment of the edentulous jaw. Int J Oral Surg 10:387–416

    Article  Google Scholar 

  14. Buser D, Weber HP, Lang NP (1990) Tissue integration of non-submerged implants. 1-year results of a prospective study with 100 ITI hollow-cylinder and hollow-screw implants. Clin Oral Implants Res 1:33–40

    Article  Google Scholar 

  15. Lekholm U, Zarb G-A (1985) Patient selection and preparation. In: Brånemark P-I ZG, Albrektsson T (eds) Book title. Quintessence, Chicago

    Google Scholar 

  16. Hopcraft MS, Tan C (2010) Xerostomia: an update for clinicians. Aust Dent J 55:238–244; quiz 353. https://doi.org/10.1111/j.1834-7819.2010.01229.x

    Article  PubMed  PubMed Central  Google Scholar 

  17. Firth D (1993) Bias reduction of maximum likelihood estimates. Biometrika 80:27–38

    Article  Google Scholar 

  18. Heinze GPM (2004) A SAS macro, S-PLUS library and R package to perform logistic regression without convergence problems. Technical Report 2/2004. Section for Clinical Biometrics, CeMSIIS, Medical University of Vienna

  19. Visch LL, van Waas MA, Schmitz PI, Levendag PC (2002) A clinical evaluation of implants in irradiated oral cancer patients. J Dent Res 81:856–859

    Article  Google Scholar 

  20. Korfage A, Schoen PJ, Raghoebar GM, Roodenburg JL, Vissink A, Reintsema H (2010) Benefits of dental implants installed during ablative tumour surgery in oral cancer patients: a prospective 5-year clinical trial. Clin Oral Implants Res 21:971–979. https://doi.org/10.1111/j.1600-0501.2010.01930.x

    Article  PubMed  Google Scholar 

  21. Heberer S, Kilic S, Hossamo J, Raguse JD, Nelson K (2011) Rehabilitation of irradiated patients with modified and conventional sandblasted acid-etched implants: preliminary results of a split-mouth study. Clin Oral Implants Res 22:546–551. https://doi.org/10.1111/j.1600-0501.2010.02050.x

    Article  PubMed  Google Scholar 

  22. Sammartino G, Marenzi G, Cioffi I, Tete S, Mortellaro C (2011) Implant therapy in irradiated patients. J Craniofac Surg 22:443–445. https://doi.org/10.1097/SCS.0b013e318207b59b

    Article  PubMed  Google Scholar 

  23. Weischer T, Mohr C (1999) Ten-year experience in oral implant rehabilitation of cancer patients: treatment concept and proposed criteria for success. Int J Oral Maxillofac Implants 14:521–528

    PubMed  Google Scholar 

  24. Hessling SA, Wehrhan F, Schmitt CM, Weber M, Schlittenbauer T, Scheer M (2015) Implant-based rehabilitation in oncology patients can be performed with high long-term success. J Oral Maxillofac Surg 73:889–896. https://doi.org/10.1016/j.joms.2014.11.009

    Article  PubMed  Google Scholar 

  25. Ernst N, Sachse C, Raguse JD, Stromberger C, Nelson K, Nahles S (2016) Changes in peri-implant bone level and effect of potential influential factors on dental implants in irradiated and nonirradiated patients following multimodal therapy due to head and neck cancer: a retrospective study. J Oral Maxillofac Surg 74:1965–1973. https://doi.org/10.1016/j.joms.2016.06.005

    Article  PubMed  Google Scholar 

  26. Buser D, Bragger U, Lang NP, Nyman S (1990) Regeneration and enlargement of jaw bone using guided tissue regeneration. Clin Oral Implants Res 1:22–32

    Article  Google Scholar 

  27. Weibrich G, Buch RS, Wegener J, Wagner W (2001) Five-year prospective follow-up report of the Astra tech standard dental implant in clinical treatment. Int J Oral Maxillofac Implants 16:557–562

    PubMed  Google Scholar 

  28. Karoussis IK, Bragger U, Salvi GE, Burgin W, Lang NP (2004) Effect of implant design on survival and success rates of titanium oral implants: a 10-year prospective cohort study of the ITI Dental Implant System. Clin Oral Implants Res 15:8–17

    Article  Google Scholar 

  29. Chrcanovic BR, Albrektsson T, Wennerberg A (2015) Smoking and dental implants: a systematic review and meta-analysis. J Dent 43:487–498. https://doi.org/10.1016/j.jdent.2015.03.003

    Article  PubMed  Google Scholar 

  30. Schiegnitz E, Al-Nawas B, Kammerer PW, Grotz KA (2014) Oral rehabilitation with dental implants in irradiated patients: a meta-analysis on implant survival. Clin Oral Investig 18:687–698. https://doi.org/10.1007/s00784-013-1134-9

    Article  PubMed  Google Scholar 

  31. Chiapasco M, Romeo E, Coggiola A, Brusati R (2011) Long-term outcome of dental implants placed in revascularized fibula free flaps used for the reconstruction of maxillo-mandibular defects due to extreme atrophy. Clin Oral Implants Res 22:83–91. https://doi.org/10.1111/j.1600-0501.2010.01999.x

    Article  PubMed  Google Scholar 

  32. Lizio G, Corinaldesi G, Pieri F, Marchetti C (2009) Problems with dental implants that were placed on vertically distracted fibular free flaps after resection: a report of six cases. Br J Oral Maxillofac Surg 47:455–460. https://doi.org/10.1016/j.bjoms.2009.06.002

    Article  PubMed  Google Scholar 

  33. Heberer S, Nelson K (2009) Clinical evaluation of a modified method of vestibuloplasty using an implant-retained splint. J Oral Maxillofac Surg 67:624–629. https://doi.org/10.1016/j.joms.2008.09.029

    Article  PubMed  Google Scholar 

  34. Poort LJ, Ludlage JHB, Lie N, Bockmann RA, Odekerken JCE, Hoebers FJ, Kessler P (2017) The histological and histomorphometric changes in the mandible after radiotherapy: an animal model. J Craniomaxillofac Surg 45:716–721. https://doi.org/10.1016/j.jcms.2017.02.014

    Article  PubMed  Google Scholar 

  35. Gallucci GO, Doughtie CB, Hwang JW, Fiorellini JP, Weber HP (2009) Five-year results of fixed implant-supported rehabilitations with distal cantilevers for the edentulous mandible. Clin Oral Implants Res 20:601–607. https://doi.org/10.1111/j.1600-0501.2008.01699.x

    Article  PubMed  Google Scholar 

Download references

Funding

This investigator-initiated study was financially supported by Dentsply Sirona (D-2008-44), Molndal, Sweden.

Author information

Affiliations

  1. Department of Oral and Maxillofacial Surgery, University Hospital of Regensburg, Franz-Josef-Strauß-Allee 11, 93053, Regensburg, Germany

    Tobias Ettl, Natalie Junold, Steffen Müller, Christoph Klingelhöffer, Torsten E. Reichert & Johannes K. Meier

  2. Centre for Clinical Studies, University Hospital of Regensburg, Franz-Josef-Strauß-Allee 11, 93053, Regensburg, Germany

    Florian Zeman

  3. Department of Radiotherapy, University Hospital of Regensburg, Franz-Josef-Strauß-Allee 11, 93053, Regensburg, Germany

    Matthias Hautmann

  4. Department of Prosthodontics, University Hospital of Leipzig, Liebigstraße 12, 04103, Leipzig, Germany

    Sebastian Hahnel

  5. Department of Prosthodontics, University Hospital of Regensburg, Franz-Josef-Strauß-Allee 11, 93053, Regensburg, Germany

    Carola Kolbeck

Authors
  1. Tobias Ettl
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Natalie Junold
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Florian Zeman
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Matthias Hautmann
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Sebastian Hahnel
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Carola Kolbeck
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Steffen Müller
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Christoph Klingelhöffer
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Torsten E. Reichert
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. Johannes K. Meier
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Tobias Ettl.

Ethics declarations

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed consent

Informed consent was obtained from all individual participants included in the study.

Additional information

Publisher’s note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Ettl, T., Junold, N., Zeman, F. et al. Implant survival or implant success? Evaluation of implant-based prosthetic rehabilitation in head and neck cancer patients—a prospective observational study. Clin Oral Invest 24, 3039–3047 (2020). https://doi.org/10.1007/s00784-019-03172-9

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00784-019-03172-9

Keywords

  • Head and neck cancer
  • Radiotherapy
  • Implants
  • Survival
  • Success
  • Bone resorption