Introduction

Rationale

The use of implants to retain prostheses as part of oral and dental rehabilitation of head and neck (H&N) cancer patients is becoming an increasingly common treatment approach. A number of benefits advocating implant anchorage over conventionally secured prostheses have been proposed but importantly include a significant improvement in the reported quality of life (QoL) of patients.

Patients with H&N cancer often undergo ablative surgery with or without surgical reconstruction, radiotherapy and chemotherapy. Both surgical and non-surgical interventions can lead to significant disability, including facial deformity, loss of hard and soft tissue, impaired speech, swallowing and mastication. Oral and dental rehabilitation has conventionally required the use of removable prostheses to obturate defects, to replace missing tissue structures and to restore function and aesthetics. In this patient group, removable prostheses are often poorly tolerated, are difficult for the patient to maintain and frequently fail to fully achieve the intended functional improvement. The use of dental implants has been proposed to enable secure anchorage for prostheses, reduced loading on vulnerable tissues and provide a better functional and cosmetic solution.

However, dental implants can only be placed if there is sufficient bone to encase the implant so that a direct interface between the implant surface and bone can be achieved. Frequently following resective surgery, insufficient bone volume remains and bony reconstruction of the surgical defect is required to enable successful dental implant placement. Patients are commonly reconstructed with either a non-vascularised bone graft or a composite free flap. A non-vascularised bone graft is a free piece of non-vascularised bone (or bone substitute) that is placed in the tissues. A free flap is a vascularised piece of bone (pedicled), which is being increasingly used to reconstruct tumour patients.

High ‘survival’ and ‘success’ rates have been reported in the literature for dental implants placed into autogenous bone grafts in healthy patients but notably the success rates remain lower for implants placed into healthy native bone. With the increasing use of complex reconstructive techniques in rehabilitation following H&N cancer and the placement of dental implants into transported bone, there is a need to appraise the highly varied evidence that is currently available in order to help inform clinical decision making.

Objectives

It is the aim of this systematic review to evaluate the survival of dental implants placed into autogenous bone grafts, in H&N oncology patients.