Three patients irradiated as a part of cancer treatment, both before and after placement of endosseous implants, were studied. Total irradiation doses varied from 80 to 195 Gy in the tumor/implant area. Implants failed at a rate of 64.2% during a 3-year follow-up period. All patients developed osteoradionecrosis in the tumor cavities adjacent to the implants. The combined effects of the pre- and postoperative irradiation, in conjunction with the placement of implants, appear to challenge the limits of osseointegration. Until further knowledge is obtained regarding how such highly radiated tissue should be handled, it is recommended that if anchorage of craniofacial prostheses is attempted according to osseointegration principles, it should be performed with the utmost care.