Tooth extraction significant risk factor for osteoradionecrosis, particularly when post-extraction sockets receive high RT dosage: Study

A study was done to evaluate osteoradionecrosis (ORN) incidence in a cohort of patients undergoing tooth extraction (TE) before radiotherapy (RT) for head and neck cancers. The Ethics Committee of Università Cattolica del Sacro Cuore (ID-2132) approved the study protocol and registered it at clinicaltrials.gov (ID: NCT04009161). TE was performed in case of signs of pericoronitis, periapical lesions, restorative impossibility, and severe periodontitis. ORN was defined as an exposed bone at an unhealed post-extraction socket in the absence of oncological recurrence. The RT plans were reviewed, and each post-extractive socket was contoured to calculate the received radiation dose. RESULTS

In total, 156 patients with 610 TE were enrolled. The mean follow-up was 567 days. ORN was diagnosed in four patients (2.6% of patients and 0.7% of TE). Need for osteotomy and radiation dose at the extraction site were associated with ORN (OR for osteotomy: 21.9, 95% CI: 2.17-222.2, p = 0.009; OR for RT dose: 1.1, 95% CI: 1-1.15, p = 0.05). TE appears to be a significant risk factor for ORN, particularly when osteotomy is required, and post-extraction sockets receive a high RT dosage. This study proposes a decision-making algorithm for TE and outlines a straightforward surgical protocol.

Reference:

Oral Dis 2024 Apr 09;[EPub Ahead of Print], C Rupe, G Gioco, M Massaccesi, L Tagliaferri, F Pastore, F Micciché, J Galli, D Mele, ML Specchia, A Cassano, M Cordaro, C Lajolo

Keywords:

Tooth extraction, significant, risk, factor, osteoradionecrosis, particularly, post-extraction, sockets, receive, high RT dosage, study, oral diseases