Baş-Boyun Bölgesine Uygulanan Radyoterapi ve Endodonti
Özet
Baş-boyun bölgesi kanserlerinde kullanılan tedavi modalitelerinden birisi radyoterapidir. Baş-boyun bölgesine uygulanan radyoterapi pek çok komplikasyona yol açabilmektedir. Radyoterapiye sekonder olarak mine ve dentin yapısında değişimler meydana gelir. Baş-boyun bölgesine radyoterapi alan hastalarda diş çürüğü, eksik diş ve dolgulu diş oranı daha yüksektir. Radyoterapinin önemli komplikasyonlarından birisi olan osteoradyonekroz riski nedeniyle bu hastalarda diş çekimi önerilmemektedir. Bu nedenle kök kanal tedavisi önemli bir alternatif haline gelmektedir. Bu hastaların kök kanal tedavisi açısından değerlendirilmesi özellikli bir durumdur. Dental açıdan değerlendirmenin radyoterapi uygulanmadan önce yapılması gerekmektedir. Bu bölümde güncel literatür eşliğinde, baş-boyun bölgesine uygulanan radyoterapinin endodonti açısından etkileri ele alınmıştır.
Radiotherapy is one of the primary treatment modalities used in the management of head and neck cancers. However, radiotherapy applied to the head and neck region can lead to various complications. Secondary to radiotherapy, structural changes occur in enamel and dentin. Patients receiving radiotherapy in this region exhibit higher rates of dental caries, missing teeth, and restored teeth. One of the significant complications of radiotherapy is osteoradionecrosis, which necessitates avoiding tooth extractions in these patients. Consequently, root canal treatment emerges as a crucial alternative. The endodontic evaluation of these patients presents unique challenges, requiring careful consideration. Ideally, a dental assessment should be conducted before the initiation of radiotherapy to optimize oral health outcomes. This chapter reviews the impact of head and neck radiotherapy on endodontic treatment based on current literature.
Referanslar
Abed H, Mannocci F, Bakhsh A. The impact of radiotherapy on pulp vitality in patients with head and neck cancer: a systematic review. Saudi Endodontic Journal. 2021;11(2):123-128. doi: 10.4103/sej.sej_136_20
Weissheimer T, Só BB, Pradebon MC, et al. Head and neck radiotherapy effects on the dental pulp vitality and response to sensitivity tests: A systematic review with meta-analysis. International Endodontic Journal. 2022;55(6):563–578. doi: 10.1111/iej.13726
Wali R, Sacco R, Singh G, et al. The clinical effect of radiotherapy on pulpal microvasculature: a systematic review. British Dental Journal. 2022;10.1038/s41415-022-5301-8. Advance online publication. doi: 10.1038/s41415-022-5301-8
Kataoka SHH, Setzer FC, Gondim-Junior E, et al. Late effects of head and neck radiotherapy on pulp vitality assessed by pulse oximetry. Journal of Endodontics. 2016;42:886–889. doi: 10.1016/j.joen.2016.02.016
Yaduka P, Kataki R, Roy D, et al. Effects of radiation therapy on the dislocation resistance of root canal sealers applied to dentin and the sealer-dentin interface: a pilot study. Restorative Dentistry & Endodontics. 2021;46(2):e22. doi: 10.5395/rde.2021.46.e22
Hong CHL, Napeñas JJ, Hodgson BD, et al. A systematic review of dental disease in patients undergoing cancer therapy. Supportive Care in Cancer. 2010;18, 1007–1021. doi: 10.1007/s00520-010-0873-2
Tavangar MS, Shafiei F, Eslami Pirharati S, et al. Effect of crosslinking/antioxidant agents as final irrigant on the fracture resistance of endodontically treated root after radiotherapy. PloS One. 2024;19(10):e0311132. doi: 10.1371/journal.pone.0311132
Silva AR, Alves FA, Antunes A, et al. Patterns of demineralization and dentin reactions in radiation-related caries. Caries Resarch. 2009; 43(1):43–9. Epub 20090119. doi: 10.1159/000192799 PMID: 19151554.
Faria KM, Brandão TB, Ribeiro ACP, et al. Micromorphology of the dental pulp is highly preserved in cancer patients who underwent head and neck radiotherapy. Journal of Endodontics. 2014;40:1553–1559. doi: 10.1016/j.joen.2014.07.006
Madani Z, Azarakhsh S, Shakib P, et al. Histopathological changes in dental pulp of rats following radiotherapy. Dental Research Journal. 2017;14:19–24. doi: 10.4103/1735-3327.201139
Garg H, Grewal MS, Rawat S, et al. Dental pulp status of posterior teeth in patients with oral and oropharyngeal cancer treated with concurrent chemoradiotherapy. Journal of Endodontics. 2015;41:1830–1833. doi: 10.1016/j.joen.2015.08.006
Gupta N, Grewal MS, Gairola M, et al. Dental pulp status of posterior teeth in patients with oral and oropharyngeal cancer treated with radiotherapy: 1-year follow-up. Journal of Endodontics. 2018;44:549–554.
Daveshwar SR, Kapoor SV, Daveshwar MR. A clinical study determining pulp vitality in oropharyngeal cancer patients undergoing radiotherapy using diagnostic tool-pulse oximetry. Current Health Sciences Journal. 2021;47:5–9. doi: 10.12865/CHSJ.47.01.01
Kataoka SHH, Setzer FC, Gondim-Junior E, et al. Pulp vitality in patients with intraoral and oropharyngeal malignant tumors undergoing radiation therapy assessed by pulse oximetry. Journal of Endodontics. 2011;37:1197–1200. doi: 10.1016/j.joen.2011.05.038
Setzer FC, Kataoka SHH, Natrielli F, et al. Clinical diagnosis of pulp inflammation based on pulp oxygenation rates measured by pulse oximetry. Journal of Endodontics. 2012;38:880–883. doi: 10.1016/j.joen.2012.03.027
Hommez GMG, De Meerleer GO, De Neve WJ, et al. Effect of radiation dose on the prevalence of apical periodontitis—a dosimetric analysis. Clinical Oral Investigations. 2012;16:1543–1547. doi: 10.1007/s00784-011-0665-1
Walker MP, Wichman B, Cheng AL, et al. Impact of Radiotherapy Dose on Dentition Breakdown in Head and Neck Cancer patients. Practical Radiation Oncology. 2011;1(3):142–148. doi: 10.1016/j.prro.2011.03.003.
Patel V, Di Silvio L, Kwok J, et al. The impact of intensity modulated radiation treatment on dento alveolar microvasculature in pharyngeal cancer implant patients. Journal of Oral Rehabilitation. 2020;47:1411–1421. doi: 10.1111/joor.13084
Bastos P, Patel V, Festy F, et al. In vivo imaging of the microvasculature of the soft tissue margins of osteonecrotic jaw lesions. British Dental Journal. 2017; 223: 699–705. doi: 10.1038/sj.bdj.2017.888
Gulderen O, Saricam E, Gökhan Açikgöz S, et al. Effects of radiotherapy dose and application time on the load-to-failure values of teeth filled with different sealers. BMC Oral Health. 2024;24(1):1260. doi: 10.1186/s12903-024-05029-4
Martins CV, Leoni GB, Oliveira HF, et al. Influence of therapeutic cancer radiation on the bond strength of an epoxy- or an MTA-based sealer to root dentine. International Endodontic Journal. 2016;49:1065-1072. doi: 10.1111/iej.12556
Yamin PA, Pereira RD, Lopes FC, et al. Longevity of bond strength of resin cements to root dentine after radiation therapy. International Endodontic Journal. 2018;51:1301-1312. doi: 10.1111/iej.12945
Bodrumlu E, Avsar A, Meydan AD, et al. Can radiotherapy affect the apical sealing ability of resin-based root canal sealers?. Journal of the American Dental Association (1939). 2009;140(3):326–330. doi: 10.14219/jada.archive.2009.0162
Zach GA. X-ray diffraction and calcium-phosphorous analysis of irradiated human teeth. Journal of Dental Research. 1976;55:907-909. doi: 10.1177/00220345760550053301
Soares CJ, Roscoe MG, Castro CG, et al. Effect of gamma irradiation and restorative material on the biomechanical behaviour of root filled premolars. International Endodontic Journal. 2011;44(11):1047–1054. doi: 10.1111/j.1365-2591.2011.01920.x.
Aktemur Türker S, Kaşıkçı S, Uzunoğlu Özyürek E, et al. The effect of radiotherapy delivery time and obturation materials on the fracture resistance of mandibular premolars. Clinical Oral Investigations. 2021;25(3), 901–905. https://doi.org/10.1007/s00784-020-03378-2
Madrid CC, de Pauli PM, Line SR, et al. Structural analysis of enamel in teeth from head-and-neck cancer patients who underwent radiotherapy. Caries Research. 2017;51:119–128. doi: 10.1159/000452866
Velo MMAC, Farha ALH, da Silva Santos PS, et al. Radiotherapy alters the composition, structural and mechanical properties of root dentin in vitro. Clinical Oral Investigations. 2018;22:2871–2878. doi: 10.1007/s00784-018-2373-6
Hürmüzlü F, Kiremitçi A, Serper A, et al. Fracture resistance of endodontically treated premolars restored with ormocer and packable composite. Journal of Endodontics. 2003;29:838–840. doi: 10.1097/00004770-200312000-00014
Paiola FG, Lopes FC, Mazzi-Chaves JF, et al. How to improve root canal filling in teeth subjected to radiation therapy for cancer. Brazilian Oral Research. 2018;32:e121. doi: 10.1590/1807-3107bor-2018.vol32.0121
Novais VR, Soares PB, Guimarães CM, et al. Effect of Gamma Radiation and Endodontic Treatment on Mechanical Properties of Human and Bovine Root Dentin. Brazilian Dental Journal. 2016;27(6):670–674. doi: 10.1590/0103-6440201601267
