A fundamental improvement of restorative dentistry is the compensation of missing teeth by insertion of artificial dental roots allowing retention of dental prosthesis. The function of dental implants conserves a permanent perforation of the mucosa and upholds a non-physiological contact of bone with foreign material and oral micro-organisms. Occasionally head and neck cancer patients are scheduled to receive radiotherapy but are wearing dental implants. An earlier study had shown that the distribution of x-rays is noteworthily changed when dental implants are present in the irradiation field. New implants of smaller size are currently being designed that allow sufficient retention for dental prosthesis. The aim of this consecutive study was to calculate alterations in the irradiated bone caused by a foreign body, representing an implant of reduced size and physical qualities equivalent to titanium, using a stochastic (Monte Carlo) simulation. A clinical linear accelerator was simulated using BEAM/EGS4. The calculations showed that the presence of a dimension-reduced implant results in remarkable differences of the dose distribution all around the implant. Titanium dental implants of reduced size located in the field of irradiation were capable of causing significant radiation scattering. Similar to standard implants, the risk for dose enhancement was notably important for the bone in direct contact with the implant. All therapists involved in the therapy of cancer patients undergoing head and neck radiotherapy should consider the impact of dental implants on the radiation beam as a catalyst of osteoradionecrosis.
