I came across this thread and hopefully I can help to shread some lights on this topic. Barb, I am very saddened to hear that 3 months post radiation treatments some teeth have to be removed due to periodontal disease. Usually this complication can be prevented with a proper dental consultation before a person undergoes oral cancer therapy. Anytime a patient undergoes oral cancer treatment, a dental consult must be initiated. The dentist would look at the condition of the teeth in terms of caries and bony support. If the teeth are questionable and MAY require extraction, then the teeth need to be removed BEFORE radiation rather than after. Dealing with ORN (osteoradionecrosis)after the fact is expensive and time consuming. Ofcourse this decision to remove the teeth depends on the patient's oral hygiene habit and the location of the radiation field as well as the amount of radiation recieved. It is very frustrating for me to see patients who had undergone radiation without any kind of pre-op dental evaluations. Managing patients with oral cancer is a two way street that requires the dentists as well as the surgeons to be collectively working together.

Regarding the need for implants retained versus conventional dentures (resting on tissue) depends on many factors:

1. Can the prosthesis be adequately retained in the mouth without the use of implants? If there are still adequate numbers of teeth left or if the ridge is "tall and big" enough, then you would not need implants. Experiences tell me that rarely the upper denture requires implants because the dentures can be succesfully retained from the peripheral seal of the upper denture borders. For lower denture with advanced resorbed ridge, implants do play a role.

2. How dry is the mouth? If the oral cavity is extremely dry, denture wearing can be difficult as saliva is needed to aid retention. Think of two wet glass pieces pressed together and try to seperate them. You need some saliva for retention as well as a lubricant to prevent sore spots. In severe condition like this, implant prosthesis that hold the prosthesis away from the gingiva will help.

3. Patient's ability to practice adequate proper oral hygeine. If a person lost the teeth because of poor OH, I would not put implants in because the implants will fail just like the teeth. You will not get cavities on the implants but will have periodontal problems if you do not brush them well. The plaque accumulation between the gum and the implant will cause bone loss and that means the implants will loose their anchor.

4. Is there adequate bone to put implants in? If not, you would need a bone graft and this is not easy especially after you had recieved radiation to the area. Radiation affects blood supply and if you don't have enough, the body can't repair the wound.

So by now, you are pretty confused. My suggestion is this. Choose the most simple approach that can give you the esthetics and function that you need. Implants sound really good but do you really need them? Try the conventional approach first then see if you are willing to consider implants. If you do then consider this. Where are the locations of the implants and where is the field of radiation and the dosage? If the implants are in the field and the dosage recieved is high enough to put you at risk for ORN, then I would a) reconsider the implant option or b) stick with the non-implant retained approach or c) get HBO treatment. I hope this makes some sense in your dilema. DP