{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,22]],"date-time":"2026-07-22T05:06:04Z","timestamp":1784696764743,"version":"3.55.0"},"reference-count":17,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,7,22]],"date-time":"2026-07-22T00:00:00Z","timestamp":1784678400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100004006","name":"Bilimsel Ara\u015ftirma Projeleri Birimi, Istanbul \u00dcniversitesi","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100004006","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Oncol."],"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>High-density dental implant materials may lead clinically relevant uncertainties in dose calculation and delivery during head and neck radiotherapy (RT). This study aimed to experimentally and computationally evaluate the dosimetric impact of titanium, zirconia, and customized subperiosteal implants.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Material and methods<\/jats:title>\n                    <jats:p>\n                      Three implant types were positioned within artificial bone phantoms (Sawbones\n                      <jats:sup>\u00ae<\/jats:sup>\n                      ) simulating a human mandible. For the subperiosteal group, a patient-specific framework was digitally designed and manufactured. Optically Stimulated Luminescence (OSL) dosimeters were placed at four anatomical locations (distal, buccal, mesial, and lingual) around each implant. Computed tomography (CT) scans (1-mm slice thickness) were obtained, and Intensity-Modulated Radiation Therapy (IMRT) plans were generated using a treatment planning system (TPS) equipped with the AcurosXB (AXB) algorithm with 6-MV photon energy and a target dose of 200 cGy. Statistical analysis was performed using the Wilcoxon Signed-Rank test on dependent groups to compare TPS-calculated and OSL-measured doses.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>A significant discrepancy was found between the overall measured and planned doses (p=0.003), with a median dose deviation of -7.8%. Backscatter-induced dose enhancement was systematically detected in the buccal region (up to +1.9%), whereas dose attenuation was predominant in the lingual and mesial regions (up to -14.5%). TPS-calculated maximum point doses revealed substantial hot spots, reaching 228 cGy for zirconia and 217 cGy for subperiosteal implants at the over-the-implant interface. While significant differences were confirmed for the endosseous group (p=0.021), the customized subperiosteal group demonstrated a trend toward a more predictable dosimetric profile (p=0.068) with a lower median deviation (-6.8%) compared to both titanium (-7.8%) and zirconia (-10.5%) endosseous implants.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Dental implant material and design influence dose distribution during RT, with high-density materials such as zirconia associated with greater discrepancies in dose estimation. Customized subperiosteal implants demonstrated a more predictable dosimetric profile in this experimental setting; however, the clinical significance of these findings remains to be established through larger studies incorporating clinical outcome data.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fonc.2026.1875805","type":"journal-article","created":{"date-parts":[[2026,7,22]],"date-time":"2026-07-22T04:42:19Z","timestamp":1784695339000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Dosimetric impact of titanium, zirconia, and customized subperiosteal dental implants in head and neck radiotherapy: an in vitro study"],"prefix":"10.3389","volume":"16","author":[{"given":"K\u00fcbra","family":"\u00d6zkaya Toraman","sequence":"first","affiliation":[{"name":"Department of Radiation Oncology, Oncology Institute, Istanbul University","place":["Istanbul, T\u00fcrkiye"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Serap","family":"\u00c7atl\u0131 Din\u00e7","sequence":"additional","affiliation":[{"name":"Department of Radiation Oncology, Faculty of Medicine, Gazi University","place":["Ankara, T\u00fcrkiye"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Can","family":"Ilg\u0131n","sequence":"additional","affiliation":[{"name":"Department of Radiation Oncology, Istanbul Faculty of Medicine, Istanbul University","place":["Istanbul, Istanbul, T\u00fcrkiye"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alp","family":"Saruhano\u011flu","sequence":"additional","affiliation":[{"name":"Department of Oral and Maxillofacial Surgery, Istanbul University Faculty of Dentistry","place":["Istanbul, T\u00fcrkiye"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"\u00d6zge","family":"Kuru Kavak","sequence":"additional","affiliation":[{"name":"Department of Radiation Oncology, Faculty of Medicine, Gazi University","place":["Ankara, T\u00fcrkiye"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Levent","family":"Demirkol","sequence":"additional","affiliation":[{"name":"Department of Medical Physics, Oncology Institute, Istanbul University","place":["Istanbul, T\u00fcrkiye"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"G\u00f6k\u00e7e","family":"U\u00e7ar Alvero\u011flu","sequence":"additional","affiliation":[{"name":"Department of Medical Physics, Oncology Institute, Istanbul University","place":["Istanbul, T\u00fcrkiye"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hatice","family":"Bilge Becerir","sequence":"additional","affiliation":[{"name":"Department of Medical Physics, Oncology Institute, Istanbul University","place":["Istanbul, T\u00fcrkiye"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,7,22]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","DOI":"10.3389\/fonc.2025.1665019","article-title":"Global burden of head and neck cancer: Epidemiological transitions, inequities, and projections to 2050","volume":"15","author":"Sun","year":"2025","journal-title":"Front Oncol"},{"key":"B2","doi-asserted-by":"publisher","DOI":"10.1111\/clr.12631","article-title":"The effect of zirconia or titanium as abutment material on soft peri-implant tissues: a systematic review and meta-analysis","volume":"26","author":"Linkevicius","year":"2015","journal-title":"Clin Oral Implants Res"},{"key":"B3","doi-asserted-by":"publisher","DOI":"10.1111\/cid.70025","article-title":"Subperiosteal implants: A lost art worth revisiting","volume":"27","author":"Goh","year":"2025","journal-title":"Clin Implant Dent Relat Res"},{"key":"B4","doi-asserted-by":"publisher","DOI":"10.1177\/0022034518792567","article-title":"Trends in dental implant use in the U.S. 1999-2016, and projections to 2026","volume":"97","author":"Elani","year":"2018","journal-title":"J Dent Res"},{"key":"B5","doi-asserted-by":"publisher","DOI":"10.1016\/j.bjoms.2021.09.006","article-title":"Radiotherapy and the survival of dental implants: a systematic review","volume":"60","author":"Shokouhi","year":"2022","journal-title":"Br J Oral Maxillofac Surg"},{"key":"B6","doi-asserted-by":"publisher","first-page":"198","DOI":"10.1002\/acm2.13255","article-title":"The application of metal artifact reduction methods on computed tomography scans for radiotherapy applications: A literature review","volume":"22","author":"Puvanasunthararajah","year":"2021","journal-title":"J Appl Clin Med Phys"},{"key":"B7","article-title":"Tissue inhomogeneity corrections for megavoltage photon beams, Report No. AAPM-85. 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