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Purpose: The purpose of this meta‐analysis was to compare implant survival in irradiated and non‐irradiated bone and to investigate potential risk factors for implant therapy in oral cancer patients. Material and methods: An extensive search in the electronic databases of the National Library of Medicine was performed. Systematic review and meta‐analysis were conducted according to PRISMA statement. The meta‐analysis was performed for studies with a mean follow‐up of at least three and five years, respectively. Results: The systematic review resulted in a mean overall implant survival of 87.8% (34%–100%). The meta‐analysis revealed a significantly higher rate of implant failure in irradiated bone compared to non‐irradiated bone (p <.00001, OR 1.97, CI [1.63, 2.37]). The studies also showed that implants placed into irradiated grafted bone were more likely to fail than those in irradiated native bone (p <.0001, OR 2.26, CI [1.50, 3.40]). Conclusion: Even though overall implant survival was high, radiotherapy proves to be a significant risk factor for implant loss. Augmentation procedures may also increase the risk of an adverse outcome, especially in combination with radiotherapy. Clinical relevance: The treatment of patients receiving radiotherapy of any form requires precise individual planning and a close aftercare. Implants should be placed in local bone rather than in bone grafts, if possible. [ABSTRACT FROM AUTHOR]

Abstract: Background: In addition to other treatments, patients with prostate cancer (pCA) and bone metastasis receive bisphosphonates. Since 2003, a previously unknown side-effect of bisphosphonates—bisphosphonate-associated osteonecrosis of the jaws (BP-ONJ)—has been described, and frequency has since increased. An exact incidence is still unknown. Objectives: The aim of this study was to assess the incidence and additional factors in the development of BP-ONJ. Design, setting, and participants: From July 2006 to October 2007, patients with advanced pCA and osseous metastasis receiving bisphosphonate therapy in the Department of Urology or Haematology and Oncology at the Johannes-Gutenberg-University Mainz, Germany, received a dental examination. In all, 43 patients were included. Measurements: Patients were checked for exposed bone, osteonecrosis, mucosal defects, inflammation, and oral hygiene. Further points were the applied bisphosphonate, co-medication, the duration of application, and possible trigger factors for BP-ONJ. Results and limitations: Eight of 43 patients developed BP-ONJ (18.6%). All patients had received zoledronate at least 14 times. Two patients had received bondronate, and one patient had received pamidronate before switching to zoledronate. All patients had had a previous tooth extraction or a denture pressure sore, and all patients had received additional chemotherapy and corticosteroids. Conclusions: The reason for this relatively high incidence compared to other studies might be the prospective study design and thorough dental examination. In studies with such small numbers as have been published to date, nondetection or nonreported cases of BP-ONJ have an influence on the outcome. The incidence of BP-ONJ in patients with pCA might be an underestimated problem. [Copyright &y& Elsevier]

Background: To assess the influence of ridge preservation procedures on the healing of extraction sockets under antiresorptive therapy. Material and Methods: A total of 10 Dutch Belted rabbits were randomly allocated to either the intravenous administration of amino‐bisphosphonate (zoledronic acid) (Za) (n = 5) or a negative control group (no Za [nZa]) (n = 5). At 6 months, the mandibular and maxillary molars were extracted and the four experimental sites randomly allocated to the following subgroups: (a) socket grafting using a collagen‐coated natural bone mineral (BOC) + primary wound closure, (b) coronectomy (CO), or (c) spontaneous healing + primary wound closure (SP). Za medication was continued for another 4 months. Histomorphometrical analyses considered, for example, crestal hard tissue closure of the extraction site (C) and mineralized tissue (MT) formation. Results: Za‐SP was associated with an incomplete median C (31.76% vs 100% in nZa‐SP) and signs of bone arrosion along the confines of the socket. BOC had no major effects on increases in C and MT values in the Za group. CO commonly resulted in an encapsulation and partial replacement resorption of residual roots by MT without any histological signs of osteonecrosis. Conclusions: (a) Za‐SP was commonly associated with a compromised socket healing and signs of osteonecrosis, (b) BOC had no major effect on socket healing in the Za group, and (c) CO at noninfected teeth might be a feasible measure for the prevention of a Za‐related osteonecrosis of the jaw. [ABSTRACT FROM AUTHOR]

Background: Bisphosphonate-associated osteonecrosis of the jaws (BP-ONJ) is an adverse effect of bisphosphonate treatment with varying reported incidence rates. Methods: In two neighboring German cities, prevalence and additional factors of the development of BP-ONJ in multiple myeloma patients with bisphosphonates therapy were recorded using a retrospective (RS) and cross-sectional study (CSS) design. For the RS, all patients treated from Jan. 2000 - Feb. 2006 were contacted by letter. In the CSS, all patients treated from Oct. 2006 - Mar. 2008 had a physical and dental examination. Additionally, a literature review was conducted to evaluate all articles reporting on BP-ONJ prevalence. PubMed search terms were: bisphosphonat, diphosphonate, osteonecrosis, prevalence and incidence. Results: In the RS, data from 81 of 161 patients could be obtained; four patients (4.9%) developed BP-ONJ. In the CSS, 16 of 78 patients (20.5%) developed BP-ONJ. All patients with BP-ONJ had received zoledronate; 12 of these had had additional bisphosphonates. All except one had an additional trigger factor (tooth extraction [n = 14], dental surgical procedure [n = 2], sharp mylohyoid ridge [n = 3]). Conclusion: The prevalence of BP-ONJ may have been underestimated to date. The oral examination of all patients in this CSS might explain the higher prevalence, since even early asymptomatic stages of BP-ONJ and previously unnoticed symptomatic BP-ONJ were recorded. Since nearly all patients with BP-ONJ had an additional trigger factor, oral hygiene and dental care might help to reduce BP-ONJ incidence. [ABSTRACT FROM AUTHOR]

The article cites a study assessing the bisphosphonate-associated osteonecrosis of the jaws (BP-ONJ) preponderance in patients with breast cancer. A retrospective study was carried on and a structured interviews were conducted to all patients. Results from the study show that 5.3% of the observed patients show prevalence of BP-ONJ.

Abstract: Purpose: In this retrospective study, two approaches to preserve the parotid function after radiotherapy (RT) were compared: application of the radioprotective agent amifostine during RT and parotid-sparing intensity-modulated radiotherapy (IMRT). Patients and methods: Patients were qualified for this analysis if (1) both parotid glands received a radiation dose of ⩾50Gy using conventional radiotherapy techniques (cRT) or if they received a parotid-sparing IMRT as alternative, if (2) salivary gland scintigraphies before and after RT were performed, and if (3) a normal parotid function was present before RT. Quantitative salivary gland scintigraphy was used to assess the parotid gland function. Results: Altogether 275 salivary gland scintigraphies of 100 patients were analyzed. The mean relative tracer uptake (ΔU) of patients treated with cRT, cRT with amifostine and IMRT 1–12 months after RT was 0.59 (95%CI 0.54–0.65), 0.67 (95%CI 0.59–0.76), and 0.93 (95%CI 0.78–1.07), respectively. The mean relative ΔU 13–47 months after RT was 0.40 (95%CI 0.32–0.49), 0.60 (95%CI 0.48–0.71), and 0.92 (95%CI 0.56–1.28). At 1–12 months after RT, ANOVA testing with post-hoc comparison using the Bonferroni correction showed a significant difference between IMRT and cRT (p <0.001) or IMRT and amifostine (p <0.01). The difference between amifostine and cRT was not significant during the first year. At 13–47 months after RT, the difference between cRT and amifostine was significant (p =0.02). Conclusion: Our data suggest that both amifostine and IMRT are able to partially preserve the parotid function after radiotherapy. The effect of IMRT appeared to be much greater. [Copyright &y& Elsevier]