20 November 2019

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Osteointegration of titanium implant in patients treated with antiangiogenic targeted chemotherapy

Lara Figini

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Recent advances in dental implants have led to an increase in the number of patients treated, with survival rates of more than 95% in a healthy population. More and more frequently dental implant are performed in elderly subjects or in people who have undergone chemotherapy treatments for cancer. Traditional chemotherapy is characterized by a lack of selectivity for tumor cells, that can may lead to drug resistance or result in systemic toxicity. Recently, better targeted treatments, which depend on monoclonal antibodies (mAb) that bind to specific targets on the surface of tumour cells, have been introduced. These differ from traditional treatments as they target cancer cell apoptosis by blocking oncogenic pathways and restricting angiogenesis.
These new chemotherapy drugs, thanks to their selectivity, guarantee fewer side effects, however, require longer treatment times than the traditional ones. But the antiangiogenic targeted chemotherapy can affect the osseointegration of dental implant?

Materials and Methods
In an in vitro animal study, published on British Journal of Oral and Maxillofacial Surgery  February 2019, the authors examined the effect of targeted anti-angiogenetic chemotherapy on the osseointegration of titanium implants. Fourteen white rabbits were allocated randomly into two groups of seven: the placebo control group and the Avastin® group. Animals in the Avastin® group had five doses of bevacizumab intraperitoneally (3 mg/kg/week). The first was given two days before the implant was inserted and the remaining four were given weekly for four weeks. One titanium implant was inserted in the right distal femoral condyle of each rabbit. Osseointegration of the implants was measured using microcomputed tomography (CT) and histomorphometric evaluation.

Results
Both microcomputed tomography and histomorphometric evaluation showed less osseointegration in the Avastin® group than in the controls.

Conclusions
From the data of this study, which must be confirmed with other similar studies and in clinical trials in humans, it can be concluded that the pharmacological inhibition of angiogenesis by bevacizumab can negatively influence the osseointegration of titanium implants on animals.

Clinical implications
The dentist have to  take into consideration that in cases of implantology in patients in therapy or recent undergoned  with chemotherapy-targeted antiangiogenic drugs, the osseointegration can be negatively affected by the intake of bevacizumab specifically.

For additional informations:  Effect of antiangiogenic targeted chemotherapy on the osseointegration of titanium implants in rabbits.

Italian version: http://www.odontoiatria33.it/implantologia/17721/osteointegrazione-di-impianti-dentali-in-pazienti-in-cura-con-i-recenti-chemioterapici.html