Diagnóstico, tratamento e prevenção da osteonecrose maxilar relacionada a medicamentos
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Abstract
Medication-related osteonecrosis of the jaws (MRONJ) is a rare and serious adverse effect of anti-resorptive and/or antiangiogenic therapy that can cause necrotic bone exposure in the oral cavity, which affects patients’ quality of life. The present study aimed to review literature regarding MRONJ with special focus on diagnostic and treatment. The databases PubMed, Scielo and Google Scholar were searched for reports regarding diagnostic and treatment of MRONJ. Even though this disorder shows poor response to treatment, there is an increase in cure rates when early diagnosed and treated. In this way, systematic dental follow-up of patients under anti-resorptive and/or antiangiogenic therapy is essential for the identification of signs and symptoms suggestive of MRONJ like pain, swelling or dental mobility. Radiographic and tomographic features like increase of bone density, bone sclerosis or osteolysis, persisting alveolar socket, periosteal neoformation, lamina dura widening and mandibular canal widening may indicate bone necrosis. Since there is no universally accepted treatment to cure MRONJ, the management involves symptom palliation and control of associated infection, and surgical excision of necrotic bone is recommended for more severe cases. Each case must be individually evaluated by a multidisciplinary team, allowing dental and medical discussion. The prevention of MRONJ by patients education, elimination of risk factors and oral health maintenance is still the most important measure in the management of these patients.
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References
AAOMS. American Association of Oral and Maxillofacial Surgeons Position Paper on Bisphosphonate-Related Osteonecrosis of the Jaws. Journal of Oral and Maxillofacial Surgery, v. 65, n. 3, p. 369–376, 2007.
ALJOHANI, S. et al. What is the effect of anti-resorptive drugs (ARDs) on the development of medication-related osteonecrosis of the jaw (MRONJ) in osteoporosis patients: A systematic review. Journal of Cranio-Maxillofacial Surgery, v. 45, n. 9, p. 1493–1502, 2017.
ANESI, A. et al. From osteoclast differentiation to osteonecrosis of the jaw: Molecular and clinical insights. International Journal of Molecular Sciences, v. 20, n. 19, 2019.
BAGAN, J. V. et al. Bisphosphonate-related osteonecrosis of the jaws: Study of the staging system in a series of clinical cases. Oral Oncology, v. 48, n. 8, p. 753–757, 2012.
EPSTEIN, M. S. et al. Management of bisphosphonate-associated osteonecrosis: Pentoxifylline and tocopherol in addition to antimicrobial therapy. An initial case series. Oral Surgery, Oral Medicine, Oral Pathology, Oral Radiology and Endodontology, v. 110, n. 5, p. 593–596, 2010.
FAVIA, G.; PILOLLI, G. P.; MAIORANO, E. Histologic and histomorphometric features of bisphosphonate-related osteonecrosis of the jaws: An analysis of 31 cases with confocal laser scanning microscopy. Bone, v. 45, n. 3, p. 406–413, 2009.
FEDELE, S. et al. Up to a quarter of patients with osteonecrosis of the jaw associated with antiresorptive agents remain undiagnosed. British Journal of Oral and Maxillofacial Surgery, v. 53, n. 1, p. 13–17, 2015.
FLEISHER, K. E. et al. Predicting risk for bisphosphonate-related osteonecrosis of the jaws: CTX versus radiographic markers. Oral Surgery, Oral Medicine, Oral Pathology, Oral Radiology and Endodontology, v. 110, n. 4, p. 509–516, 2010.
GIOVANNACCI, I. et al. Clinical Differences in Autofluorescence Between Viable and Nonvital Bone: A Case Report With Histopathologic Evaluation Performed on Medication-Related Osteonecrosis of the Jaws. Journal of Oral and Maxillofacial Surgery, v. 75, n. 6, p. 1216–1222, 2017.
KHAN, A. A. et al. Diagnosis and management of osteonecrosis of the jaw: A systematic review and international consensus. Journal of Bone and Mineral Research, v. 30, n. 1, p. 3–23, 2015.
KHOSLA, S. Oral Bisphosphonate–Induced Osteonecrosis: Risk Factors, Prediction of Risk Using Serum CTX Testing, Prevention, and Treatment. Journal of Oral and Maxillofacial Surgery, v. 66, n. 6, p. 1320–1321, jun. 2008.
KOTH, V. et al. Interrelationship of clinical, radiographic and haematological features in patients under bisphosphonate therapy. Dentomaxillofacial Radiology, v. 46, n. 4, 2017.
KOTH, V. et al. Bisphosphonate-related osteonecrosis of the jaw: From the sine qua non condition of bone exposure to a non-exposed BRONJ entity. Dentomaxillofacial Radiology, v. 45, n. 7, 2016.
LÓPEZ-JORNET, P. et al. Bisphosphonate-associated osteonecrosis of the jaw. Knowledge and attitudes of dentists and dental students: A preliminary study. Journal of Evaluation in Clinical Practice, v. 16, n. 5, p. 878–882, 2010.
MARLIÉRE, D. A. A. et al. Knowledge and clinical behavior on antiresorptive medications and osteonecrosis of the jaws: a cross-sectional study. RGO - Revista Gaúcha de Odontologia, v. 67, p. 1–13, 2019.
MARTOS-FERNÁNDEZ, M. et al. Pentoxifylline, tocopherol, and clodronate for the treatment of mandibular osteoradionecrosis: a systematic review. Oral Surgery, Oral Medicine, Oral Pathology and Oral Radiology, v. 125, n. 5, p. 431–439, 2018. Disponível em: <https://doi.org/10.1016/j.oooo.2018.02.004>.
MARX, R. E. Pamidronate (Aredia) and zoledronate (Zometa) induced avascular necrosis of the jaws: a growing epidemic. Journal of Oral and Maxillofacial Surgery, v. 61, n. 9, p. 1115–1117, set. 2003.
MARX, R. E.; CILLO, J. E.; ULLOA, J. J. Oral Bisphosphonate-Induced Osteonecrosis: Risk Factors, Prediction of Risk Using Serum CTX Testing, Prevention, and Treatment. Journal of Oral and Maxillofacial Surgery, v. 65, n. 12, p. 2397–2410, 2007.
MCGOWAN, K.; MCGOWAN, T.; IVANOVSKI, S. Risk factors for medication-related osteonecrosis of the jaws: A systematic review. Oral Diseases, v. 24, n. 4, p. 527–536, 2018.
MIGLIORATI, C. A.; MATTOS, K.; PALAZZOLO, M. J. How patients’ lack of knowledge about oral bisphosphonates can interfere with medical and dental care. Journal of the American Dental Association, v. 141, n. 5, p. 562–566, 2010.
MORAES, S. L. C. DE et al. Riscos e complicações para os ossos da face decorrentes do uso de bisfosfonatos. Rev. bras. odontol., v. 70, n. 2, p. 114–119, 2013.
MORRIS, P. G. et al. Serum N-telopeptide and bone-specific alkaline phosphatase levels in patients with osteonecrosis of the jaw receiving Bisphosphonates for bone metastases. Journal of Oral and Maxillofacial Surgery, v. 70, n. 12, p. 2768–2775, 2012.
OLIVEIRA, A. B. DE. Eficácia do CTX em predizer o risco de desenvolver Osteonecrose dos maxilares associada ao uso dos bisfosfonatos. 2016. 52 f. Departamento de Odontologia da Faculdade de Ciências da Saúde - Universidade de Brasília, Brasília, 2016.
OTTO, S. et al. Medication-related osteonecrosis of the jaw: Prevention, diagnosis and management in patients with cancer and bone metastases. Cancer Treatment Reviews, v. 69, p. 177–187, 2018.
PAN, W. L. et al. Strontium ranelate treatment in a postmenopausal woman with osteonecrosis of the jaw after long-term oral bisphosphonate administration: A case report. Clinical Interventions in Aging, v. 12, p. 1089–1093, 2017.
POGREL, M. A. Bisphosphonates and bone necrosis. Journal of Oral and Maxillofacial Surgery, v. 62, n. 3, p. 391–392, 2004.
RISTOW, O. et al. Is the conservative non-surgical management of medication-related osteonecrosis of the jaw an appropriate treatment option for early stages? A long-term single-center cohort study. Journal of Cranio-Maxillofacial Surgery, v. 47, n. 3, p. 491–499, 2019.
ROLLASON, V. et al. Interventions for treating bisphosphonate-related osteonecrosis of the jaw (BRONJ). Cochrane Database of Systematic Reviews, v. 2016, n. 2, 2016.
RUGGIERO, S. L. et al. American Association of Oral and Maxillofacial Surgeons Position Paper on Bisphosphonate-Related Osteonecrosis of the Jaws-2009 Update. Journal of Oral and Maxillofacial Surgery, v. 67, n. 5 SUPPL., p. 2–12, 2009.
RUGGIERO, S. L. et al. American association of oral and maxillofacial surgeons position paper on medication-related osteonecrosis of the jaw - 2014 update. Journal of Oral and Maxillofacial Surgery, v. 72, n. 10, p. 1938–1956, 2014.
RUGGIERO, S. L. Guidelines for the diagnosis of bisphosphonate-related osteonecrosis of the jaw (BRONJ). Clinical Cases in Mineral and Bone Metabolism, v. 4, n. 1, p. 37–42, 2007.
SANTOS, M. et al. Extensive osteonecrosis of the maxilla caused by bisphosphonates: Report of a rare case. Journal of Clinical and Experimental Dentistry, v. 11, n. 2, p. e203–e207, 2019.
TREISTER, N. S.; FRIEDLAND, B.; WOO, S. BIN. Use of cone-beam computerized tomography for evaluation of bisphosphonate-associated osteonecrosis of the jaws. Oral Surgery, Oral Medicine, Oral Pathology, Oral Radiology and Endodontology, v. 109, n. 5, p. 753–764, 2010.
WATTS, N. B. et al. Invasive oral procedures and events in postmenopausal women with osteoporosis treated with denosumab for up to 10 years. Journal of Clinical Endocrinology and Metabolism, v. 104, n. 6, p. 2443–2452, 2019.
WHITEFIELD, S. et al. Changing face of medication-related osteonecrosis of the jaw: Sheba Medical Center experience-fifteen years. Journal of Bone and Mineral Metabolism, n. 0123456789, 2020.
YAROM, N. et al. Medication-related osteonecrosis of the jaw: MASCC/ISOO/ASCO clinical practice guideline. Journal of Clinical Oncology, v. 37, n. 25, p. 2270–2290, 2019.
ZHANG, X. et al. Osteonecrosis of the Jaw in the United States Food and Drug Administration’s Adverse Event Reporting System (FAERS). Journal of Bone and Mineral Research, v. 31, n. 2, p. 336–340, 2016.