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Osseointegration of implants in irradiated bone with and without hyperbaric oxygen treatment: an experimental study in rat tibiae
Örebro University, School of Health and Medical Sciences, Örebro University, Sweden. Örebro University hospital, Örebro, Sweden.
Sahlgrenska University Hospital, Gothenburg, Sweden.
Örebro University Hospital, Örebro, Sweden.
Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
2013 (English)In: International Journal of Oral & Maxillofacial Implants, ISSN 0882-2786, E-ISSN 1942-4434, Vol. 28, no 3, p. 739-746Article in journal (Refereed) Published
Abstract [en]

Purpose: Hyperbaric oxygen (HBO) has been recommended to enhance implant osseointegration in irradiated bone. The aim of this study was to further investigate the effects of HBO on implant integration in irradiated bone tissue.

Materials and Methods: The present study was an experimental intraindividual study in 16 rats. A single fraction of 20 Gy external irradiation was applied to one rat hind leg, while the other served as a nonirradiated control. Three days after radiation, two implants were inserted in each tibial tuberosity. The rats were divided into two groups: non-HBO treated (group 1) and HBO treated (group 2). Five weeks after radiation, removal torque tests were performed. Implants with surrounding tissue were processed to undecalcified cut and ground sections for histomorphometric evaluations of bone-to-implant contact and bone area. Retrieved bones were also investigated with dual-energy x-ray absorptiometry.

Results: The non-HBO treated rats (group 1) demonstrated higher, but not statistically significantly higher, values in the nonirradiated leg for all investigated parameters compared to the HBO-treated rats (group 2). However, the mean value for bone area was significantly higher in the irradiated sides compared to the nonirradiated control sides.

Conclusions: In the present study, HBO treatment did not have a significant impact on osseointegration of implants in irradiated bone.

Place, publisher, year, edition, pages
Quintessence Publishing Co., Inc. , 2013. Vol. 28, no 3, p. 739-746
Keywords [en]
bone, dental implant, hyperbaric oxygen therapy, osseointegration, radiation therapy
National Category
Dentistry
Research subject
Medicine
Identifiers
URN: urn:nbn:se:oru:diva-30313DOI: 10.11607/jomi.3083ISI: 000322078500018PubMedID: 23748304Scopus ID: 2-s2.0-84898313432OAI: oai:DiVA.org:oru-30313DiVA, id: diva2:642749
Note

Funding agency: Särfonderna, Örebro University Hospital, Örebro, Sweden;  Hjalmar Svenssons Research Fund, Goteborg, Sweden 

Available from: 2013-08-23 Created: 2013-08-23 Last updated: 2018-04-16Bibliographically approved
In thesis
1. On implant integration in irradiated bone: clinical and experimental studies
Open this publication in new window or tab >>On implant integration in irradiated bone: clinical and experimental studies
2015 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Radiation has an impact on the processes involved in bone- healing, regeneration and remodeling. The mechanisms that cause impaired bone healing of dental implants are not fully understood. Adjunctive treatments to revers radiation effects are limited. Dental implant surgery can be a risk in irradiated jaws and the risk for osteoradionecrosis is of concern. There is no consensus when to install implant after completed radiation therapy or what radiation dosage might cause impaired bone healing. The overall aim of the studies was to investigate bone tissue reactions adjacent to implants after irradiation.

I. A clinically long-term follow-up study was performed to assess the outcome of 18 dental implants inserted in five patients with and without irradiated fibula-reconstructed mandibles. Bone tissue reactions adjacent to 14 micro-implants were histologically evaluated. In the clinical follow-up, 15 implants were in function, with an overall success rate of 83%. The histomorphometric analyses demonstrated an impaired osseointegration with reduced bone-to-implant contact (BIC) and bone area (BA), in irradiated sides.

II. In an experimental animal study the aim was to find a critical level for a given single external radiation dosages causing impaired implant osseointegration. 9 rats received a single radiation dose of 2, 5, 10, 20 and 30 Gy, respectively to one hind-leg while the other served as a control. Three days post radiation two implants were inserted in each hind-leg and after a period of 5 weeks the implants (n=36) were harvested for histological examination. BIC and BA were lower for irradiated samples for dosages of 20 Gy and higher.

III. The aim was to investigate the effects of HBO on osseointegration of titanium implants in irradiated bone. 15 rats received an external single radiation dose of 20 Gy to one hind-leg. 3-days post-irradiation 2 implants were inserted in each hind-leg (n=60). The rats were divided in to 2 groups and one group received hyperbaric oxygen treatment (HBOT) 3 days post-implant insertion (n=8). After 5 weeks the distal implants were harvested for histological examination (n=30) and the proximal implants were used for removal torque tests (n=30). BIC obtained significant higher values for non-irradiated side, independent of HBO or not. BA obtained significant higher values for irradiated sides in the non-HBO group.

IV. The aim was to investigate gene expression in irradiate bone after implant insertion for bone formation, resorption and remodelling. 8 rats, received a single radiation dose of 20 Gy to one hind-leg and two implants inserted in each hind-leg 8 weeks after completed radiation therapy. After 5 weeks bone samples with implants were collected for gene expression analysis. ALP, OC (formation) and RANKL/OPG (remodelling) were down regulated in irradiated samples.

Conclusion: Bone-anchored dental bridges can be used in selected oro-mandibular reconstructed patients. Bone quality disturbances with impaired osseointegration for dosages of 20 Gy and more were demonstrated in an animal study model. HBO did not enhance osseointegration of implants placed in rat bone during a five-week follow-up period. Irradiation significant reduces bone formation and remodeling under influence of pro-inflammatory and growth factor cytokines

Place, publisher, year, edition, pages
Örebro: Örebro university, 2015. p. 75
Series
Örebro Studies in Medicine, ISSN 1652-4063 ; 128
Keywords
dental implant, osseointegration, radiation therapy, bone remodeling, histomorphometry, hyperbaric oxygen therapy, gene expression and in vivo
National Category
Surgery Dentistry
Research subject
Surgery
Identifiers
urn:nbn:se:oru:diva-45834 (URN)978-91-7529-096-6 (ISBN)
Public defence
2015-11-20, Universitetssjukhuset, Bomanssonsalen, Södra Grev Rosengatan, Örebro, 09:00 (Swedish)
Opponent
Supervisors
Available from: 2015-09-18 Created: 2015-09-18 Last updated: 2017-10-17Bibliographically approved

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Nyberg, JanJohansson, Carina B.

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