OSTEORADIONECROSIS FOLLOWING DENTAL EXTRACTIONS AND IMPLANTS IN NASOPHARYNGEAL CANCER PATIENTS TREATED WITH RADIOTHERAPY: A NARRATIVE REVIEW

Abstract

In patients with nasopharyngeal cancer (NPC), osteoradionecrosis (ORN) is a serious late side effect of radiation therapy, especially if implant placement or dental extractions are necessary. In addition to analyzing clinical factors related to dental extractions and implants in this population, this narrative review assesses the prevalence of ORN in NPC patients receiving radiotherapy. Mandibular involvement is most common, according to data from observational studies and retrospective cohorts, and radiation dose, tumor stage, and comorbidities all significantly affect the risk of ORN. Despite being widely used, pre-radiotherapy dental clearance has an inconsistent protective effect, and there is a much higher risk of ORN with extractions performed after radiation. Although the survival rate for dental implants placed in irradiated jaws is high, typically above 90%, the risk of ORN remains and seems to be higher in patients who receive cumulative doses greater than 60 Gy. Although they lack strong randomized evidence, preventive measures like hyperbaric oxygen therapy and pharmacologic regimens like pentoxifylline tocopherol have inconsistent results. All things considered, ORN in NPC patients remains a complex complication for which multidisciplinary management, optimal timing of dental procedures, and careful patient selection are essential. To lower ORN risk while maintaining long-term oral function and quality of life, more prospective research is needed to develop standardized preventive and treatment approaches.