Post-radiotherapy Restorative and Endodontic Challenges in Head and Neck Cancer Survivors: A Narrative Review
Priya Pal, Rhythm Bains, Promila VermaBackground
Radiotherapy is a cornerstone in the management of head and neck cancer but frequently results in acute and chronic oral complications that adversely affect dental hard tissues, salivary gland function, pulpal vitality, and oral rehabilitation. These changes increase the risk of radiation caries, restorative failure, pulpal pathology, and osteoradionecrosis, posing significant challenges to restorative and endodontic management. This narrative review aimed to provide an overview of the biological effects of radiotherapy on oral tissues and to discuss current preventive, restorative, and endodontic strategies for managing patients with irradiated tissues.
Methodology
A literature search was conducted in PubMed/MEDLINE, Scopus, and Google Scholar till July 2026. Relevant literature was critically interpreted and narratively synthesized.
Results
Current literature supports comprehensive pre-radiotherapy dental assessment, meticulous oral hygiene, lifelong fluoride therapy, regular follow-up, and conservative management to preserve natural dentition whenever feasible. Nonsurgical endodontic treatment is generally preferred over extraction in appropriately selected cases to reduce the risk of osteoradionecrosis. Contemporary advances, including bioactive restorative materials, photobiomodulation, digital workflows, and regenerative endodontics, show promise; however, evidence supporting their routine clinical use in irradiated patients remains limited and largely experimental.
Conclusion
Successful dental rehabilitation following head and neck radiotherapy requires a multidisciplinary, prevention-oriented approach supported by individualized treatment planning and long-term maintenance. Although emerging technologies may improve future patient care, further high-quality clinical studies are required before widespread clinical implementation can be recommended.