Implant osseointegration in the irradiated mandible. A comparative study in dogs with a microradiographic and histologic assessment.

This research focuses on the effects of radiotherapy on the osseointegration of dental implants placed before or after radiotherapy in 11 male beagles. After the extraction of all mandibular premolars 1st and 2nd molars, three dogs were implanted without radiotherapy (Control group), four dogs were irradiated 4 weeks after implantation (IrA group) and four dogs were irradiated 8 weeks before implantation (IrB group). Eight implants were placed in each dog, in an alternating pattern: four nonsubmerged ITI Bonefit titanium plasma spray-coated and four submerged Steri-Oss hydroxyapatite-coated. The irradiated dogs received 4.3 Gy daily for 10 days. Two different fluorescent markers were administered at the time of implantation and of irradiation. The dogs were sacrificed 6 months after implantation, i.e. 5 months after radiotherapy for the IrA group and 8 months for the IrB group. Each mandible was submitted to histological and microradiographic analysis. Bone formation occurred around 85 of the 88 implants and consisted mostly of the successive deposit of woven and lamellar bone. Both irradiated groups showed obvious bone remodeling in alveolar bone as well as in the basilar part of the mandible. Nevertheless, in the IrA group, the resorption phenomena predominated over osteogenesis. The balance between these two opposite processes seemed to be restored 8 months after the end of radiotherapy (IrB group). In spite of focal lesions of radiation-specific bone destruction emphasized in some irradiated dogs, we conclude from our results that osseointegration of dental implants is possible in irradiated bone tissue.