Дентальная имплантация у онкологических пациентов после резекции и реконструкции челюстей: оценка сроков установки и факторов приживления имплантатов. Систематический обзор

Цель исследования – оценить оптимальные сроки установки дентальных имплантатов у онкологических пациентов после резекции и реконструкции челюстей, а также определить факторы, влияющие на их приживление.

Материал и методы. Систематический поиск литературы проведен в базах данных MEDLINE (PubMed), Scopus и Web of Science с включением оригинальных статей, вышедших с 2000 г. и посвященных дентальной имплантации у пациентов с опухолями головы и шеи, в рамках которого выполнялась реконструкция челюстей с использованием свободных реваскуляризированных костных лоскутов. Первичной конечной точкой настоящего систематического обзора являлся показатель приживления дентальных имплантатов (успешной остеоинтеграции) у онкологических пациентов. Вторичной конечной точкой оценивалась эффективность ортопедической реабилитации, в том числе возможность и успех функционального протезирования. Первичный поиск в базах данных выявил 554 научных исследования, из которых в окончательный анализ включено 23 публикации.

Результаты. Приживаемость дентальных имплантатов у онкологических пациентов, перенесших реконструкцию челюсти с использованием костных аутотрансплантатов, варьировала в широком диапазоне – от 44 до 100 %. При этом практически все исследования демонстрируют снижение приживаемости дентальных имплантатов у пациентов, перенесших лучевую терапию, по сравнению с теми, кто не подвергался облучению.

Заключение. Анализ литературы показал, что дентальная имплантация у онкологических пациентов, перенесших резекцию и реконструкцию челюстей, является клинически оправданным и потенциально успешным методом реабилитации. Приживляемость имплантатов может варьировать в широких пределах, наибольшее влияние оказывает предшествующая лучевая терапия.

1. Sung H., Ferlay J., Siegel R.L., Laversanne M., Soerjomataram I., Jemal A., Bray F. Global Cancer Statistics 2020: GLOBOCAN Estimates of Incidence and Mortality Worldwide for 36 Cancers in 185 Countries. CA Cancer J Clin. 2021; 71(3): 209–49. doi: 10.3322/caac.21660.

2. Bosetti C., Carioli G., Santucci C., Bertuccio P., Gallus S., Garavello W., Negri E., La Vecchia C. Global trends in oral and pharyngeal cancer incidence and mortality. Int J Cancer. 2020; 147(4): 1040–49. doi: 10.1002/ijc.32871.

3. Шахзадова А.О., Старинский В.В., Лисичникова И.В. Состояние онкологической помощи населению России в 2022 году. Сибирский онкологический журнал. 2023; 22(5): 5–13. doi: 10.21294/1814-4861-2023-22-5-5-13. EDN: PESHHL.

4. Pamias-Romero J., Saez-Barba M., de-Pablo-García-Cuenca A., Vaquero-Martínez P., Masnou-Pratdesaba J., Bescós-Atín C. Quality of Life after Mandibular Reconstruction Using Free Fibula Flap and Customized Plates: A Case Series and Comparison with the Literature. Cancers (Basel). 2023; 15(9): 2582. doi: 10.3390/cancers15092582.

5. Azher S., McGrath R., Kamalabadi Y.M., Tsakos G., Sim F., Singh A. Impact of rehabilitation with dental implants on the quality of life of patients undergoing maxillofacial reconstruction: a systematic review. Qual Life Res. 2025; 34(1): 113–30. doi: 10.1007/s11136-024-03795-w.

6. Chim H., Salgado C.J., Mardini S., Chen H.C. Reconstruction of mandibular defects. Semin Plast Surg. 2010; 24(2): 188–97. doi: 10.1055/s0030-1255336.

7. Hidalgo D.A. Fibula free flap: a new method of mandible reconstruction. Plast Reconstruct Surg. 1989; 84(1): 71–79.

8. Kokosis G., Schmitz R., Powers D.B., Erdmann D. Mandibular Reconstruction Using the Free Vascularized Fibula Graft: An Overview of Different Modifications. Arch Plast Surg. 2016; 43(1): 3–9. doi: 10.5999/aps.2016.43.1.3.

9. Mancha de la Plata M., Gías L.N., Díez P.M., Muñoz-Guerra M., González-García R., Lee G.Y., Castrejón-Castrejón S., Rodríguez-Campo F.J. Osseointegrated implant rehabilitation of irradiated oral cancer patients. J Oral Maxillofac Surg. 2012; 70(5): 1052–63. doi: 10.1016/j.joms.2011.03.032.

10. Jackson R.S., Price D.L., Arce K., Moore E.J. Evaluation of clinical outcomes of osseointegrated dental implantation of fibula free flaps for mandibular reconstruction. JAMA Facial Plast Surg. 2016; 18(3): 201–206. doi: 10.1001/jamafacial.2015.2271.

11. Cotic J., Jamsek J., Kuhar M., Ihan Hren N., Kansky A., Özcan M., Jevnikar P. Implant-prosthetic rehabilitation after radiation treatment in head and neck cancer patients: a case-series report of outcome. Radiol Oncol. 2016; 51(1): 94–100. doi: 10.1515/raon-2016-0005.

12. Meloni S.M., Tallarico M., De Riu G., Pisano M., Deledda A., Lolli F.M., Massarelli O., Tullio A. Guided implant surgery after free-flap reconstruction: Four-year results from a prospective clinical trial. J Craniomaxillofac Surg. 2015; 43(8): 1348–55. doi: 10.1016/j.jcms.2015.06.046.

13. Nack C., Raguse J.D., Stricker A., Nelson K., Nahles S. Rehabilitation of irradiated patients with chemically modified and conventional SLA implants: five-year follow-up. J Oral Rehabil. 2015; 42(1): 57–64. doi: 10.1111/joor.12231.

14. Tumuluri V., Leinkram D., Froggatt C., Dunn M., Wykes J., Singh J., Low T.H., Palme C.E., Howes D., Clark J.R. Outcomes of immediate dental implants in vascularised bone flaps for mandibular reconstruction. ANZ J Surg. 2023; 93(6): 1682–87. doi: 10.1111/ans.18427.

15. Ko H.H., Chou C.H., Cheng S.J. The dental implant survival rate in 18 patients with post-operation revolutionary jaw reconstruction using free fibular flap, dental implants, and overdentures. J Dent Sci. 2024; 19(3): 1819–26. doi: 10.1016/j.jds.2024.05.021.

16. Salinas T.J., Desa V.P., Katsnelson A., Miloro M. Clinical evaluation of implants in radiated fibula flaps. J Oral Maxillofac Surg. 2010; 68(3): 524–29. doi: 10.1016/j.joms.2009.09.104.

17. Wu Y., Huang W., Zhang Z., Zhang Z., Zou D. Long-term success of dental implant-supported dentures in postirradiated patients treated for neoplasms of the maxillofacial skeleton: a retrospective study. Clin Oral Investig. 2016; 20(9): 2457–65. doi: 10.1007/s00784-016-1753-z.

18. Sandoval M.L., Rosen E.B., Robert A.J., Nelson J.A., Matros E., Gelblum D.Y. Immediate dental implants in fibula free flaps to reconstruct the mandible: A pilot study of the short-term effects on radiotherapy for patients with head and neck cancer. Clin Implant Dent Relat Res. 2020; 22(1): 91–95. doi: 10.1111/cid.12870.

19. Fenlon M.R., Lyons A., Farrell S., Bavisha K., Banerjee A., Palmer R.M. Factors affecting survival and usefulness of implants placed in vascularized free composite grafts used in post-head and neck cancer reconstruction. Clin Implant Dent Relat Res. 2012; 14(2): 266–72. doi: 10.1111/j.1708-8208.2009.00250.x.

20. Teoh K.H., Huryn J.M., Patel S., Halpern J., Tunick S., Wong H.B., Zlotolow I.M. Implant prosthodontic rehabilitation of fibula free-flap reconstructed mandibles: a Memorial Sloan-Kettering Cancer Center review of prognostic factors and implant outcomes. Int J Oral Maxillofac Implants. 2005; 20(5): 738–46.

21. Pellegrino G., Tarsitano A., Ferri A., Corinaldesi G., Bianchi A., Marchetti C. Long-term results of osseointegrated implant-based dental rehabilitation in oncology patients reconstructed with a fibula free flap. Clin Implant Dent Relat Res. 2018; 20(5): 852–59. doi: 10.1111/cid.12658.

22. Ch’ng S., Skoracki R.J., Selber J.C., Yu P., Martin J.W., Hofstede T.M., Chambers M.S., Liu J., Hanasono M.M. Osseointegrated implant-based dental rehabilitation in head and neck reconstruction patients. Head Neck. 2016; 38(s1): E321–27. doi: 10.1002/hed.23993.

23. Navarro Cuéllar C., Martínez E.B., Navarro Cuéllar I., López A.M., Rial M.T., Pérez A.S., Salmerón Escobar J.I. Primary Maxillary Reconstruction With Fibula Flap and Dental Implants: A Comparative Study Between Virtual Surgical Planning and Standard Surgery in Class IIC Defects. J Oral Maxillofac Surg. 2021; 79(1): 237–48. doi: 10.1016/j.joms.2020.08.003.

24. Kim H., Roh T., Banegas D.W., Cha I.H., Kim H.J., Nam W., Cho S., Oh K.C., Kim D. Is immediate dental implant in fibula free flap beneficial for implant survival and osteoradionecrosis in jaw reconstruction? Oral Oncol. 2024; 156: 106945. doi: 10.1016/j.oraloncology.2024.106945.

25. Khadembaschi D., Borgna S.C., Beech N., Batstone M.D. Outcomes of osseointegrated implants in patients with benign and malignant pathologies of the head and neck: a 10-year single-centre study. Int J Oral Maxillofac Surg. 2021; 50(10): 1375–82. doi: 10.1016/j.ijom.2021.02.019.

26. Jelmini J., Williams F.C., Winstead M., Hammer D.A., Kim R.Y. Immediate dental rehabilitation in fibula free flaps for malignancy: Is it feasible? Head Neck. 2024; 46(11): 2737–43. doi: 10.1002/hed.27800.

27. Diab J., Leinkram D., Wykes J., Cheng K., Wallace C., Howes D., Singh J., Palme C., Clark J. Maxillofacial reconstruction with prefabricated prelaminated osseous free flaps. ANZ J Surg. 2021; 91(3): 430–38. doi: 10.1111/ans.16541.

28. Oldén A., Wamalwa A.O., Jonsson E.L., Thor A., Lorenzo A.R. Factors Affecting Complete Oral Rehabilitation in Patients With Vascularized Free Fibula Flap Mandibular Reconstruction: A 10-Year Retrospective Study. J Craniofac Surg. 2023; 34(6): 1635–39. doi: 10.1097/sCS.0000000000009543.

29. Attia S., Wiltfang J., Pons-Kühnemann J., Wilbrand J.F., Streckbein P., Kähling C., Howaldt H.P., Schaaf H. Survival of dental implants placed in vascularised fibula free flaps after jaw reconstruction. J Craniomaxillofac Surg. 2018; 46(8): 1205–10. doi: 10.1016/j.jcms.2018.05.008.

30. Bastien A.J., Lee J., Kupferman S., Donitza A., Davodi A., Amin L., Vasquez M., Musavi L., Patel H., Chen M., Walgama E., Zumsteg Z.S., Ho A.S., Mallen-St Clair J. Dental Prosthetic Rehabilitation in Mandibular Reconstruction: Optimizing Timing and Patient Selection. Laryngoscope. 2025; 135(8): 2801–809. doi: 10.1002/lary.32084.

31. Fierz J., Hallermann W., Mericske-Stern R. Patients with oral tumors. Part 1: Prosthetic rehabilitation following tumor resection. Schweiz Monatsschr Zahnmed. 2013; 123(2): 91–105. English, German.

32. Albrektsson T., Zarb G., Worthington P., Eriksson A.R. The long-term efficacy of currently used dental implants: a review and proposed criteria of success. Int J Oral Maxillofac Implants. 1986 Summer; 1(1): 11–25.

33. Chrcanovic B.R., Reher P., Sousa A.A., Harris M. Osteoradionecrosis of the jaws--a current overview--part 1: Physiopathology and risk and predisposing factors. Oral Maxillofac Surg. 2010; 14(1): 3–16. doi: 10.1007/s10006-009-0198-9.

34. Chrcanovic B.R., Reher P., Sousa A.A., Harris M. Osteoradionecrosis of the jaws-a current overview-part 2: Dental management and therapeutic options for treatment. Oral Maxillofac Surg. 2010; 14(2): 81–95. doi: 10.1007/s10006-010-0205-1.

35. Júnior L.H.F., Limirio P.H.J.O., Soares P.B.F., Dechichi P., de Souza Castro Filice L., Quagliatto P.S., Rocha F.S. The effect of hyperbaric oxygen therapy on bone macroscopy, composition and biomechanical properties after ionizing radiation injury. Radiat Oncol. 2020; 15(1): 95. doi: 10.1186/s13014-020-01542-2.

36. Sakyi M.Y., Miller B.J., Coleman M.C., Rodman S.N., Brouillette M.J., Johnson J.E., Fredericks D.C., Goetz J.E. Effects of Radiotherapy Upon Bone Structure-Strength Relationships Vary With Sex and Fractionation of Dosing. Iowa Orthop J. 2023; 43(1): 77–86.

37. Berk L. The effects of high-dose radiation therapy on bone: a scoping review. Radiat Oncol J. 2024; 42(2): 95–103. doi: 10.3857/roj.2023.00969.

38. Sun R., Zhu G., Wang J., Tong L., Zhai J. Indirect effects of X-irradiation on proliferation and osteogenic potential of bone marrow mesenchymal stem cells in a local irradiated rat model. Mol Med Rep. 2017; 15(6): 3706–14. doi: 10.3892/mmr.2017.6464.

39. Doğan G.E., Halici Z., Karakus E., Erdemci B., Alsaran A., Cinar I. Dose-dependent effect of radiation on resorbable blast material titanium implants: an experimental study in rabbits. Acta Odontol Scand. 2018; 76(2): 130–34. doi: 10.1080/00016357.2017.1392601.

40. Alberga J.M., Vosselman N., Korfage A., Delli K., Witjes M.J.H., Raghoebar G.M., Vissink A. What is the optimal timing for implant placement in oral cancer patients? A scoping literature review. Oral Dis. 2021; 27(1): 94–110. doi: 10.1111/odi.13312.

41. Granström G. Placement of dental implants in irradiated bone: the case for using hyperbaric oxygen. J Oral Maxillofac Surg. 2006; 64(5): 812-18. doi: 10.1016/j.joms.2006.01.012.

42. Chrcanovic B.R., Albrektsson T., Wennerberg A. Dental implants in irradiated versus nonirradiated patients: A meta-analysis. Head Neck. 2016; 38(3): 448–81. doi: 10.1002/hed.23875.

43. Esposito M., Worthington H.V. Interventions for replacing missing teeth: hyperbaric oxygen therapy for irradiated patients who require dental implants. Cochrane Database Syst Rev. 2013; 2013(9): CD003603. doi: 10.1002/14651858.CD003603.pub3.

44. Stoll P., Wächter R., Hodapp N., Schilli W. Radiation and osteosynthesis. Dosimetry on an irradiation phantom. J Craniomaxillofac Surg. 1990; 18(8): 361–66. doi: 10.1016/s1010-5182(05)80057-5.

45. Tavelli L., Barootchi S., Avila-Ortiz G., Urban I.A., Giannobile W.V., Wang H.L. Peri-implant soft tissue phenotype modification and its impact on peri-implant health: A systematic review and network meta-analysis. J Periodontol. 2021; 92(1): 21–44. doi: 10.1002/JPER.19-0716.

46. Galarraga-Vinueza M.E., Tavelli L. Soft tissue features of periimplant diseases and related treatment. Clin Implant Dent Relat Res. 2023; 25(4): 661–81. doi: 10.1111/cid.13156.

47. Sencimen M., Gulses A., Varol A., Ayna M., Ozen J., Dogan N., Açil Y. Vestibuloplasty with Retroauricular Skin Grafts for Dental Implant Rehabilitation in Vascularized Fibula Grafts: Two Case Reports. Int J Periodontics Restorative Dent. 2017; 37(4): 491–97. doi: 10.11607/prd.2238.

48. Meloni S.M., Tallarico M,. Canullo L., De Riu G., Massarelli O. Periimplant soft-tissue management in patients with a fibula free flap reconstruction: case series and description of a new technique. J Oral Science Rehabilitation. 2016; 2(4): 26–30.

49. Li R., Meng Z., Zhang Y., Shan X., Wang Y., He Y. Soft Tissue Management: A Critical Part of Implant Rehabilitation After Vascularized Free-Flap Reconstruction. J Oral Maxillofac Surg. 2021; 79(3): 560–74. doi: 10.1016/j.joms.2020.11.006.

50. Bouaoud J., Descols P., De Kerangal Q.L.G., Honart J.F., MoyaPlana A., Temam S., Brau J.J., D’andrea G., Benmoussa N. Vestibuloplasty for immediate dental implantation in fibular free flap for oral cancer patients undergoing mandibulectomy reconstruction: A technical note. J Stomatol Oral Maxillofac Surg. 2022; 123(5): 505–509. doi: 10.1016/j.jormas.2021.10.011.

51. Dodo C., Senna P.M., Del Bel Cury A.A., Meirelles L. Impact of High Insertion Torque on Implant Surface Integrity. Clin Implant Dent Relat Res. 2025; 27(2): e70030. doi: 10.1111/cid.70030.