DENTAL EXTRACTIONS AFTER RADIATION-THERAPY IN THE HEAD AND NECK AREA AND HARD-TISSUE REPLACEMENT (HTR) THERAPY - A PRELIMINARY-STUDY

Statement of problem. Dental extractions in patients who had radiation therapy for cancer in the head and neck region carry with them the ri sks of delayed healing, prolonged alveolar bone exposure, infection, a nd osteoradionecrosis. Among the precautions to minimize these risks a re antibiotic coverage, limited extractions at any one time, soft tiss ue closure, and hyperbaric oxygen treatment. Rapid epithelization and minimal bone exposure are essential after extractions in irradiated pa tients. Purpose. This study examined the effects of hard tissue replac ement on head and neck cancer patients who were treated with radiation therapy. Material and methods. In a series of eight patients who had radiation doses from 4000 cGy to 7440 cGy in the head and neck area an d who had 44 teeth extracted, hard tissue replacement material mixed w ith tetracycline powder was placed in the extraction sites. Results. O f the 44 teeth extracted, 19 mandibular molars and premolars were in t he direct field of radiation in seven patients. One patient also had 6 mandibular anterior teeth and 12 maxillary teeth extracted that recei ved minimal radiation exposure. One patient had 6 mandibular anterior teeth extracted that were not in the area of direct exposure. One pati ent had a mandibular first molar extracted in an area that received mi nimal radiation exposure. Clinically, complete epithelization occurred in all patients. No infections developed. Radiographically no bone di ssolution could be identified in the extraction area(s). The follow-up times ranged from 7 months to 18 months when the patients were seen l ast. Conclusion. The hard tissue replacement particles appears to prov ide a matrix for fibrous connective tissue formation.