Effect of dental restorations and prostheses on radiotherapy dose distribution: a Monte Carlo study

Dental restorations, fixed prosthodontics, and implants affect dose distribution in head and neck radiation therapy due to the high atomic number of the materials utilized. The backscatter of electrons from metallic materials due to the impinging treatment x-ray results in localized dose enhancements. These dose enhancements cause localized mucositis in patients who have dental work, a significant clinical complication. We investigated the backscatter effect of 23 configurations of dental work using the EGS4nrc Monte Carlo (MC) simulation system. We found that all-metal fixed partial dentures caused the highest amount of dose enhancement-up to 33%-while amalgam restorations did not cause a significant amount. Restorations with a ceramic veneer caused up to 8% enhancement. Between 3 mm and 5 mm of water-equivalent material almost completely absorbed the backscatter. MC simulations provide an accurate estimate of backscatter dose, and may provide patient-specific estimates in future.