Preradiation dental extractions and the incidence of bone necrosis

TLDR

The risk of bone necrosis in patients undergoing head‑and‑neck radiation depends on the size of the radiation field, the dose to mandibular bone, and the healing time of extraction wounds. Mandibular molars with advanced chronic periodontal bone loss within the planned radiation field should be removed before radiation commences. A prospective study of 120 patients who underwent pre‑radiation dental extractions within the treatment volume was conducted. In this cohort 14.1% developed bone necrosis at extraction sites, most of which responded to conservative management, indicating that selective tooth removal before radiation reduces osteoradionecrosis risk.

Abstract

Abstract Studies were done with 120 patients submitting to preradiation dental extraction within the radiation treatment volume. Bone necroses developed at the extraction sites in 17 patients (14.1%). The risk of bone necrosis in these patients is primarily dependent upon the size of the radiation treatment volume, radiation dose to mandibular bone, and healing time for the extraction wounds. Of the 13 mandibular bone necroses occurring at preradiation extraction sites, only two have not responded favorably to conservative management. Our data indicates that a policy of selected tooth removal, before radiation treatment, will minimize the risk of osteoradionecrosis. Mandibular molars with advanced chronic periodontal bone loss, residing within the proposed radiation field should be considered for removal before commencement of radiation treatment.