Periodontal therapy for patients before and after radiotherapy: A review of the literature and topics of interest for clinicians.

BACKGROUND: To review and discuss important topics regarding periodontal treatment pre- and post-radiotherapy for head and neck cancer in human patients; to discuss the references for adequate techniques, the appropriate moment for tooth extractions and periodontal management; and to discuss the prevention of osteoradionecrosis. MATERIAL AND METHODS: Thirty-nine studies including original studies, randomized clinical trials (RCTs) and reviews were searched in online databases MEDLINE (PubMed) and the Cochrane library. No year of publication restriction was applied. RESULTS: Language was restricted to English, and the following Medical Subject Heading terms were used: radiotherapy, radiation therapy and periodontal treatment. Studies regarding periodontal treatment and tooth extraction that involved clinical management of irradiated patients were selected. CONCLUSIONS: The treatment of periodontal diseases before radiotherapy is mainly required to avoid future dental extraction and to reduce the development of osteoradionecrosis. Periodontal treatment in irradiated patients mostly includes scaling and root planing, extraction of condemned teeth and topical and systemic antimicrobial therapy. Tooth removal should be planned at least 14 days before the first day of radiation treatment. Particular care and mouthwashes should be taken during and after radiation. CLINICAL SIGNIFICANCE: The management of irradiated patients represents a challenge for health professionals, including dentists. It is important to establish recommendations for clinicians concerning dental and periodontal management in irradiated patients before, during and after treatment.

Implant osseointegration in irradiated bone: an experimental study.

BACKGROUND AND OBJECTIVES: The aim of this study was to evaluate the effect of radiotherapy on the osseointegration of dental implants in the tibia and the action of platelet-rich plasma (PRP) as an adjuvant therapy. MATERIAL AND METHODS: A total of 18 rabbits received two implants in each tibial epiphysis, totalizing 72 implants. The control group (group I) was composed by six rabbits and did not receive radiotherapy. The test groups (II and III) received a single dose of 1727 cGy. Group II was composed by six irradiated animals and group III by six animals that received irradiation and PRP during implant placement. The implant success rate, the bone-implant contact (BIC), and the bone volume were analyzed. RESULTS: There was no osseointegration in four of the implants, three in group II and one in group III. Total BIC was significantly higher in group I, when compared to the other groups. There was a significant difference of osteoid BIC only between irradiated animals (group II, 8.5%; group III, 4.7%; p = 0.001). On the other hand, the mineralized BIC was significantly higher in group I. Furthermore, group II had a lower mineralized BIC than group III (p = 0.002). Bone volume was higher in the control group (41.3%), followed by group III (33.4%) and II (25.1%), with differences between groups I and II (p = 0.001) and groups II and III (p = 0.022). CONCLUSIONS: The present study showed that both the bone volume and BIC were higher in the control group. However, the failure rates of the implants were low in both irradiated groups. The PRP was a positive adjuvant in the osseointegration process.

Anastomose esplenorrenal seletiva profilatica na forma hepatosplenica da esquistossomose. Experiencia de 74 casos. / Prophylactic selective splenorenal anastomosis in the hepatosplenic form of schistosomiasis. Experience of 74 cases

Os autores apresentam os resultados de 74 pacientes portadores de hipertensao porta esquistossomotica sobmetidos a anastomose esplenorrenal seletiva com indicacao profilatica. Houve 2 0bitos (2,7%) e 3 casos de trombose da anastomose (4,05%). O controle endoscopico pos-operatorio das varizes em 40 casos mostrou ausencia em 14 (35%) e reducao em 23, ou seja 57,5%. Em face dos resultados, consideram valida a cirurgia profilatica na forma hepatosplenica da esquistossomose mansonica