Carcinoma primario intraóseo de mandíbula. Presentación de un caso clínico y revisión de la literatura / Intraosseous carcinoma of the mandible: a case report and review of the literature

El carcinoma primario intraóseo se describe como una neoplasia maligna que aparece únicamente en los huesos maxilares, pues deriva de los remanentes epiteliales odontogénicos. Es un tumor de muy baja incidencia que requiere el cumplimiento de unos criterios clínicos, radiológicos y anatomopatológicos para su diagnóstico. Las manifestaciones clínicas son inespecíficas, predominantemente dolor y tumefacción, por lo que suele diagnosticarse en estadio avanzado, y requiere un tratamiento radical, incluyendo cirugía y radioterapia. Presentamos el caso de un varón de 66 años con diagnóstico de carcinoma primario intraóseo de cuarto cuadrante, atendido en el Hospital Universitario Ramón y Cajal, las pruebas complementarias realizadas y el tratamiento recibido incluyendo la reconstrucción primaria con un colgajo osteomiocutáneo libre microvascularizado de peroné. (AU)

Primary intraosseous carcinoma is described as a malignant neoplasm that appears only in the maxillary bones, since it derives from odontogenic epitelial remnants. It is rare, and requires compliance with clinical, radiological and pathological criteria for its diagnosis. The clinical manifestations are non-specific, predominantly pain and swelling, which is why it is usually diagnosed in an advanced stage, and requires radical treatment including surgery and radiotherapy. A case of a 66 year old man diagnosed and treated of a primary intraosseous carcinoma of lower right quadrant at Ramon y Cajal Univeristy Hospital is reported. The complementary test performed and the treatment received, including inmediate reconstruction with a free osteocutaneous fibula flap are presented. (AU)

Granuloma central a células gigantes agresivo, de presentación atípica: reporte de un caso / Aggressive central giant cell granuloma: report of an atypical case

El granuloma central a células gigantes (GCCG) es una lesión osteólitica poco frecuente, no odontogénica, benigna, localizada y potencialmente agresiva, caracterizada por la presencia de células gigantes en un estroma vascular. Se presenta mayoritariamente en mujeres, más frecuentemente en las dos primeras décadas de vida. Radiográficamente el GCCG se puede observar desde una imagen radiolúcida de aspecto quístico, a una imagen multilocular extensa de límites pocos definidos. De acuerdo a la presentación clínica, radiográfica e histológica del GCCG, se ha propuesto un tipo agresivo caracterizado por crecimiento rápido, dolor, parestesia, expansión y perforación de corticales, rizalisis y alta tasa de recidiva. Existe controversia respecto a la etiología. Si bien está descrito como una lesión de carácter reparativo asociada a trauma, se observan características potencialmente destructivas, expansivas e infiltrativas. Se presenta un caso de GCCG agresivo, de presentación atípica en relación con la edad, sexo del paciente y ubicación de la lesión. (AU)

Central giant cell granuloma (CGCG) is an infrequent benign, localized, potentially aggressive, non-odontogenic osteolytic lesion, characterized by the presence of giant cells in a vascular stroma. CGCG is seen mainly in women, more frequently in the first two decades of life. Radiographically, CGCG can be seen from a cystic-like radiolucent image, to an extensive multilocular image, with less defined margins. According to clinical, radiographic and histological aspects of CGCG, an aggressive type has been proposed, which is characterized by rapid growing, pain, paresthesia, expansion/perforation of cortical bone, rizalisis, and high rates of recurrence. Of controversial etiology, CGCG has been described as a reparative lesion, associated to trauma. However, potentially destructive, expansive and infiltrative characteristics have been observed in CGCG. An atypical case of an aggressive CGCG is presented. (AU)

Effect of undersized drilling on the stability of immediate tapered implants in the anterior maxillary sector. A randomized clinical trial / Efecto de una perforación de tamaño insuficiente sobre la estabilidad de los implantes cónicos inmediatos en el sector anterior del maxilar. Un ensayo clínico aleatorizado

Background: To evaluate the effect of undersized drilling on the primary and secondary stability of immediateimplants placed in the anterior maxilla.Material and methods: A comparative randomized clinical trial was carried out in 30 healthy adults. Thirty ta-pered implants, 16 involving conventional drilling and 14 undersized drilling, were placed immediately afteranterior maxillary tooth removal. Insertion torque and implant stability assessed by resonance frequency analysis(RFA) were evaluated at three different timepoints: at implant placement and 6 and 12 weeks post-implantation.The results were compared using parametric statistical tests.Results: All implants showed adequate stability during follow-up. At implant placement, the undersized drillinggroup exhibited greater insertion torque values than the conventional drilling group, but stability assessed by RFAshowed greater mean values in the conventional group. After 6 and 12 weeks of follow-up, both groups showedimproved stability, though the RFA values remained comparatively higher in the conventional group. The differ-ences were not statistically significant.Conclusions: Based on the results obtained, undersized drilling does not appear to afford significantly improvedstability of immediate implants placed in the anterior zone of the maxilla during the osseointegration period.(AU)

Quiste óseo solitario / No disponible

INTRODUCCIÓN: El quiste óseo solitario representa el 1% de todos los quistes maxilares. Es una lesión ósea benigna que aparece de forma fortuita en una radiografía de control en la primera/segunda década de la vida, aunque la lesión carezca de trascendencia en la vida del paciente requiere de abordaje quirúrgico para confirmar el diagnóstico. CASO CLÍNICO: Se presenta un caso clínico de una paciente mujer de 11 años de edad y raza negra, remitida al Servicio de Cirugía Bucal del Hospital Virgen de la Paloma tras observarse imagen radiotransparente apical a nivel de 43 y 44. Una vez realizada la exploración clínica y radiológica se propone cirugía exploratoria ante diagnóstico de presunción de quiste óseo solitario. Bajo anestesia local se procedió al abordaje quirúrgico observándose cavidad vacía en maxilar inferior sin contenido alguno, legrándose profusamente las paredes de la cavidad e introduciendo plasma rico en plaquetas obtenido previamente de la paciente. CONCLUSIONES: La cirugía exploratoria confirma el diagnóstico de presunción de quiste óseo solitario vacío al no poderse mandar a analizar a anatomía patológica

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Carga inmediata de implantes monofásicos postextracción utilizando los expansores roscados atraumáticos: estudio retrospectivo 2001-2011 / Immediate loading of post-extraction one-piece implants using atraumatic threaded bone expanders: retrospective study 2001-2011

Objetivo. El objetivo del presente estudio era valorar la predictibilidad de la carga inmediata con implantes monofásicos postextracción en el maxilar inferior, utilizando los expansores roscados atraumáticos. Material y métodos. Se realizó un estudio retrospectivo en 56 pacientes rehabilitados con 448 implantes en el maxilar inferior: 8 implantes a cada paciente, 4 en la zona intermentoniana y 2 en la zona posterior en cada hemiarcada. Los expansores roscados atraumáticos fueron utilizados para preparar la osteotomía antes de la inserción de los implantes monofásicos postextracción, seguida por carga inmediata. Las prótesis definitivas se adaptaron a los 3-4 meses. Resultados. Se perdieron 9 implantes en 3 pacientes (2%) durante la fase de oseointegración, indicando una supervivencia y éxito del 98% en un periodo de estudio entre uno y 10 años. Ningún implante se ha perdido después, ni se evidenciaron complicaciones durante el resto del seguimiento clínico. Conclusiones. Tras haber analizado toda la secuencia referida a la carga inmediata, podemos concluir que los implantes monofásicos insertados con la aplicación de esta técnica son un procedimiento predecible: su éxito en el maxilar inferior en nuestro estudio de 10 años fue del 98%. Sin embargo, es necesario determinar los casos candidatos para dicho procedimiento, así como las características del implante que favorecen la implantación inmediata (AU)

Objective. The aim of this study was to evaluate the predictability of immediate loading in conjunction with one-piece post-extraction implants in the mandible using atraumatic threaded bone expanders. Material and methods. A total of 56 patients were enrolled in this retrospective study and received 448 implants in the mandible, each patient received 8 implants; 4 in the anterior mandible and 2 in each side in the posterior mandible. Atraumatic threaded bone expanders were used to prepare the osteotomy site before the insertion of one-piece post-extraction implants, followed by immediate loading. The definitive prostheses were delivered to patients after 3-4 months. Results. A total of 9 implants were lost in 3 patients (2%) during the period of osseointegration indicating a survival and success rate of 98% in a study period of 1-10 years. No other implant failed after that nor have been any complication during the rest of the follow up period. Conclusions. One-piece implants submitted to this technique have converted to a predictable procedure, it's success in the mandible in this study of 10 years was 98%. However, it is necessary to determine the cases that are indicated for this procedure, as well as the characteristics of the implant, which favor immediate implantation (AU)

Consideraciones anatómicas durante la cirugía periodontal / Anatomic considerations during periodontal surgery

En el presente trabajo hemos realizado una revisión bibliográfica de la literatura con el objetivo de esclarecer las consideraciones anatómicas que deben tenerse en cuenta a la hora de realizar cirugía periodontal, que posibles estructuras anatómicas podemos encontrarnos al elevar un colgajo y cómo podemos evitar la lesión de las mismas. También aportamos un breve repaso sobre conceptos y referencias anatómicas que los especialistas debemos tener presentes durante el manejo de los tejidos blandos y duros

For the present work, we have made a revision through the literature with the objective to clarify the anatomic considerations that should be considered during periodontal surgery, which anatomic structures we could find when raising a flap and how could we avoid injury. Also we have made a short review of the concepts and anatomic references that the specialists should take into consideration during the management of soft and hard tissues

Cross-sectional study of correlation between mandibular incisor crowding and third molars in young Brazilians

Objectives: The aim of this study was to evaluate transversally the clinical correlation between lower incisor crowding and mandible third molar. Study Design: Three hundred healthy volunteers (134 male and 16666 female), aged 20.4 (±2.4) years-old were submitted to a complete clinical examination and filled up a questionnaire about gender, age, total teeth number and presence or absence of superior and inferior third molar. After a recent panoramic radiography were evaluated. The multiple logistic regression showed that none of the studied factors influenced the mandibular incisor crowding. Results: The proportion of both molars present or both absent was higher than the other conditions (Chi-square, p<.0001). The multiple logistic regression showed that any of the studied factors, influenced (p>.05) the mandibular incisor crowding. Despite the statistical significance, wear orthodontics appliances showed a little correlation(odds ratios < 1.0) in the mandibular incisor crowding. Conclusion: Presence of maxillary and/or mandibular third molars has no relation with the lower incisor crowding (AU)

Cranial base and maxillary changes in patients treated with Frankel’s functional regulator (1b)

Objectives: The purpose of this study was to assess cranial base and maxillary growth in patients with Class IItype I malocclusions when treated with Frankel’s functional regulator (FR-1b). Study Design: The treatment group was made up of 43 patients that were divided into two groups: prepubescent (n: 28), and pubescent (n: 15). The control group included 40 patients who did not receive any kind of treatment and were likewise divided into a prepubescent group (n: 19), and a pubescent group (n: 21). A computerized cephalometric study was carried out and superimpositions were done in order to assess the antero-posterior, vertical and rotational movement of the maxilla. Results: The results indicate that anterior cranial length is not affected by the regulator but the cranial deflection of the treatment group was diminished. Although a slight counterclockwise rotation effect on the upper jaw was observed due to treatment, no growth restriction of the maxilla in a vertical or antero-posterior direction was observed compared to other non-treated Class II-type I malocclusion patients. Conclusion: The functional regulator does not have any effect on anterior cranial length, but it does affect the angulation of the cranial base. According to our results, the appliance has demonstrated a flattening effect of the cranial base (p<0.05) in the treated sample. The functional regulator induces counterclockwise rotation rather than vertical or sagittal changes in the maxilla (AU)

Relation between bone density and primary implant stability

Aims: This study aims to relate bone density in Hounsfield units (Hu) with the primary implant stability measured by insertion torque (Ncm) and resonance frequency analysis (ISQ).Materials and Methods: Ten patients were included in this study. A total of 54 implant sites were provided from 10 computerized tomography scans. The computerized tomography scan was used for the preoperative evaluation of bone density for each patient. The bone mean density around planned implants was determined with Physioplanet TM software. Bone quality according resistance to drilling, insertion torque and resonance frequency measurements were recorded. Results: A statistically significant relationship was observed between bone quality density and location with ISQvalues. Conclusions: This research demonstrates a strong relationship between the bone density values from computerized tomography and the location in the maxillaries. A correlation exists between bone quality, according to the Lekholm & Zarb classification, and Hu computerized tomography values. The primary implant stability measuredwith resonance frequency analysis depends on bone density values, bone quality and implant location (AU)

Alternativas de tratamiento para la osteonecrosis de los maxilares asociada a bisfosfonatos / Treatment alternatives for bisphosphonate associated osteonecrosis of the jaw

Se ha notificado recientemente un incremento de la osteonecrosis en los pacientes que reciben bisfosfonatos que contienen nitrógeno. Clínicamente, la necrosis ósea maxilar o mandibular puede ocurrir de forma espontánea o aparecer secundariamente a una exodoncia o trauma que afecte los maxilares. La necrosis se manifiesta por exposición del hueso en el sitio afectado, inflamación de los tejidos blandos adyacentes, halitosis, dolor y fiebre; puede producir fístula mucosa o cutánea. También se observa que los pacientes tratados con administración intravenosa de bisfosfonatos se encuentran en alto riesgo de desarrollar focos osteonecróticos únicos o múltiples, situación advertida esporádicamente en los sujetos tratados con administración oral. Se han indicado diferentes recomendaciones con el fin de establecer los procedimientos efectivos para tratar la osteonecrosis asociada a bisfosfonatos. Los tratamientos comprenden alternativas no quirúrgicas, antibióticos, terapia hiperbárica, cirugía convencional o mediante láser. Adicionalmente, las medidas preventivas son un aspecto importante que debe tenerse en cuenta (AU)

A relative increase in osteonecrosis has been reported in recent years particularly among patients receiving nitrogen-containing bisphosphonates. Clinically, mandibular or maxillary necrosis may occur spontaneously orbe secondary to tooth extraction or trauma affecting the jaws. Necrosis typically manifests itself with exposure of the bone at the site involved and swelling of the adjacent soft tissues, halitosis, pain and fever, and may produce cutaneous or mucosal fistulae. It has also been observed that patients who have taken bisphosphonates by intravenous administration appear to be at a higher risk of developing single or multiple osteonecrotic foci of the jaw bones, whereas this has only been reported sporadically in patients with oral administration Several recommendations have been made to establish effective procedures to treat biphosphonate-associated osteonecrosis. The treatment ranges from nonsurgical approach to conventional surgery through medical treatment, antibiotic regimen, hyperbaric therapy and laser surgery. Beside, the importance of preventive measures is thus highlighted (AU)

Quiste óseo simple atípico. Presentación de un caso clínico / Atypical simple bone cyst. A case report

El quiste óseo simple (sinonimia quiste óseo traumático, quisteóseo solitario, quiste óseo hemorrágico) es un pseudoquiste intraóseo desprovistode recubrimiento epitelial con un contenido seroso y/o hemáticoque en ocasiones puede estar ausente.Es una patología poco frecuente que afecta a los huesos maxilares con predilecciónpor el maxilar inferior.El objetivo del presente trabajo es presentar un caso de quiste óseo simpleen maxilar inferior que difiere de los habitualmente encontrados en los huesosmaxilares en cuanto a su presentación clínica, radiográfica e histopatológica(AU)

The simple bone cyst (reported in the literature as traumaticbone cyst, solitary bone cyst, hemorrhagic bone cyst) is anintraosseous pseudocyst devoid of epithelial lining and filled withserous and/or hematic fluid that may also be lacking.Is a an uncommon condition that usually affects the jaws, withpredilection for the lower jaw.The aim of the present work was to report a case of traumatic bonecyst of the jaw that differs from other maxillary bone cysts in itsclinical, radiologic, and histologic presentation(AU)

Mecanobiología de los huesos maxilares. I. Conceptos generales / Mechanobiology of maxillary bones. I. Geneal concepts

La mecanobiología ósea se encarga de la interacción entre las señales mecánicas y los mecanismos moleculares en las células y el tejido óseo. El estudio actual de esta disciplina engloba los modelos informáticos, la biología molecular y las técnicas de imagen en alta resolución. En este artículo se revisan los conceptos generales que se estudian en la mecanobiología y biomecánica de los hueso maxilares. Se establecen las principales propiedades biomecánicas del hueso en las diferentes escalas de medición y determinados factores que influyen en la reacción del hueso perimplantario ante las cargas biomecánicas (AU)

Bone mechanobiology deals with connection between mechanical signals and molecular events in cells and bone tissue. The current study on this subject involves computer models, molecular biology and high resolution imaging of bone. This paper reviews general concepts which take place on mechanobiology and biomechanics of maxillary bones. Mechanical features in several dimensional levels are studied and some factors with influence on perimplantary bone are also evaluated (AU)

Osteonecrosis de los maxilares asociada al empleo de bifosfonatos / Bisphosphonate-associated osteonecrosis of the jaw

Los bifosfonatos constituyen un grupo de fármacos inhibidoresde la resorción ósea, utilizados en el tratamiento de numerosas patologíascomo la osteoporosis, la enfermedad de Paget, el mieloma múltiple,la hipercalcemia maligna y las metástasis óseas asociadas al cáncer de mamao de próstata. El principal efecto farmacológico de los bifosfonatos es lainhibición de la resorción ósea, mediante una disminución de la actividadde los osteoclastos, sin intervenir en la formación y mineralización del hueso.Son fármacos utilizados a nivel mundial con unos claros beneficios contrastadosclínicamente. Numerosas publicaciones durante los últimos tresaños, y debido a su utilización masiva, consideran que la osteonecrosisde los maxilares está asociada al tratamiento con bifosfonatos.Es importante que los pacientes sean informados del riesgo de presentarseesta complicación, para tener la oportunidad de someterse a procedimientosdentales previos al inicio del tratamiento. Las medidas preventivasdeben realizarse antes, durante y después del tratamiento con bifosfonatos.El tratamiento quirúrgico debe reservarse para aquellos pacientesque presenten síntomas. Son necesarias nuevas investigaciones que clarifiquenesta complicación(AU)

Bisphosphonates constitute a group of inhibitors of boneresorption that are used for treating many disor-ders such asosteoporosis, Paget’s disease, multiple myeloma, malignanthypercalcemia and bone metas-tases associated with breast andprostate cancer. The main pharmacological effect of bisphosphonatesis the inhibition of bone resorption, mediated by a decreased functionof osteoclasts without interfering in bone formation andmineralization.These drugs are used worldwide, with clear and clinically provenbenefits. Several publications within the last three years considerosteonecrosis of the jaw to be associated with bisphosphonatetherapy as a result of their extensive use.It is important for patients to be informed of the risk of thiscomplication, so that they have the oppor-tunity to assess the needfor dental treatment before starting therapy. Preventive measuresmust be taken before, during, and after treatment withbisphosphonates. Surgical treatment should be reserved for thosepatients who are symptomatic. Further investigation is needed tocompletely elucidate this complication(AU)

Osteonecrosis de los maxilares inducida por bifosfonatos: prevención y actitud terapéutica / Bisphosphonate induced osteonecrosis of the jaws: prevention and therapeutic approach

Introducción. La osteonecrosis maxilar o mandibular por bifosfonatospuede convertirse en una epidemia debido a la amplia difusión deestos fármacos entre la población.Material y método. Se muestra un protocolo para la prevención y el tratamientode esta enfermedad. Se presentan tres casos de osteonecrosismaxilar/mandibular.Resultados. Es difícil lograr una curación completa; sin embargo es posibledetener la progresión de la enfermedad.Discusión. La cirugía y la suspensión de la terapia con bifosfonatos handemostrado poca utilidad. Los antibióticos y los enjuagues con clorhexidinason las únicas medidas eficaces.Conclusiones. Es imprescindible una planificación adecuada previa a la instauracióndel tratamiento con bifosfonatos. Ante una osteonecrosis establecida,la actitud debe ser conservadora (AU)

Introduction. Bisphosphonate-induced osteonecrosis of the jaws might reach epidemic proportions due tothe widespread use of this therapy.Materials and methods. A protocol for prevention and treatmentof this pathology is shown. Three clinical cases arereported.Results. It is quite difficult to reach restitutio ad integrum,but stopping the progress of the disease is possible.Discussion. Surgical treatment and cessation of bisphosphonatetherapy are of no use. Only antibiotics and oral chlorhexidinehave shown some benefits.Conclusions. An accurate preventive attitude is mandatoryprior to undergoing bisphosphonate therapy. If osteonecrosisof the jaws is present, management should be conservative (AU)

Maxillary lesion presenting as a first sign of multiple myeloma: case report

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Plasma cell neoplasia is a lymphoid neoplastic proliferation of B cells. This denomination encloses multiple myeloma(MM), solitary bone plasmacytoma and extramedullary plasmacytoma. MM consists of a clonal proliferation of plasmacells based in the bone marrow, with various degrees of differentiation. Neoplastic cells usually produce great amountsof monoclonal light or heavy chains of immunoglobulin that can be detected in serum or urine. The disease is morefrequently in men and the average age at diagnosis is about 60 years. The diagnosis is established by blood and urineexams and medullary biopsy. Patients may present renal failure, bone pain, fatigue, recurrent infections and nervoussystem dysfunction. Oral manifestations may be the first sign of MM, highlighting the importance of the dentist in theearly diagnosis of the disease. Treatment involves mainly irradiation and chemotherapy and the prognosis is generallypoor. This paper reports a case of a 65 years old black female who had a complaint of a painful mass in the maxillathat prompted a MM diagnosis

Maxillary necrosis by mucormycosis. A case report and literature review

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The maxilla rarely undergoes necrosis due to its rich vascularity. Maxillary necrosis can occur due to bacterial infections such as osteomyelitis, viral infections such as herpes zoster or fungal infections such as mucormycosis, aspergillosis etc. Mucormycosis is an opportunistic fulminant fungal infection, which mainly infects immunocompromised patients. The infection begins in the nose and paranasal sinuses due to inhalation of fungal spores. The infection can spread to orbital and intracranial structures either by direct invasion or through the blood vessels. The fungus invades the arteries leading to thrombosis that subsequently causes necrosis of hard and soft tissues. We report a case of maxillary necrosis by mucormycosis in an uncontrolled diabetic patient to emphasize early diagnosis of this potentially fatal fungal infection. We briefly discuss different diseases which can lead to maxillary necrosis and review the current concepts in management of mucormycosis. Early diagnosis and prompt treatment can reduce the mortality and morbidity of this lethal fungal infection

Osteonecrosis of the jaws and bisphosphonates. Report of fifteen cases. Therapeutic recommendations

Recientemente se han descrito casos de osteonecrosis mandibular y maxilar (ONM) en pacientes sometidos a tratamiento crónico con bisfosfonatos (BF). Hasta el momento tres han sido los fármacos implicados: Pamidronato de disodio, Ácido Zoledrónico y Alendronato de sodio. Se trata de un efecto secundario muy poco frecuente, no detectado en ensayos clínicos precomercialización, que repercute de forma significativa en la calidad de vida de estos pacientes.La mayoría de los casos se dan en pacientes oncológicos que reciben tratamiento antineoplásico concomitante a largo plazo y muchos de ellos estaban sometidos a tratamiento intermitente con esteroides a corto plazo, junto a los bisfosfonatos vía endovenosa, para el tratamiento del cáncer y de los síntomas. Entre estos casos se encuentran los publicados por R.E. Marx (1), S.L. Ruggiero (2) y J. V. Bagán (3).Este artículo presenta quince casos clínicos diagnosticados, tratados y seguidos por nuestro servicio y da una serie de recomendaciones para reducir su incidencia en pacientes con cáncer que van a recibir BF, así como en pacientes con ONM establecida en tratamiento con dichos fármacos y que puedan necesitar un tratamiento quirúrgico

Recently there have been reports of osteonecrosis of the jaw (ONJ) in patients with chronic therapy with bisphosphonates (Bps). So far three drugs have been linked: Pamidronate of disodium, Zoledronic acid and Alendronate of sodium. It is due to a non detected side effect in clinical trials before commercialization, and reverberates significantly in the quality of life of these patients.Most of the cases are seen in oncology patients that have received long term concurrent antineoplasic therapy and were treated sporadically with steroids, together with Bps endovenous, for treatment of cancer and its symptoms. Among these cases we find the reported by R.E. Marx (1), S.L. Ruggiero (2) and J. V. Bagán (3).In this report fifteen cases diagnosed, treated and followed up at the author´s surgery department are presented and some suggestions are given in order to reduce the incidence in patients with cancer who are going to receive Bps, as well as in patients with established ONJ being treated with these drugs who may need a surgical intervention

Recommendations for the prevention, diagnosis, and treatment of osteonecrosis of the jaw (ONJ) in cancer patients treated with bisphosphonates

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Osteonecrosis de los maxilares asociada a bifosfonatos: revisión sistemática / Osteonecrosis of the jaws associated to biphosphonates: systematical review

En los últimos años se ha descrito una nueva complicación en la terapia con bifosfonatos: la osteonecrosis de los maxilares. Esta complicación no había sido detectada en los ensayos clínicos previos. En esta revisión sistemática de 340 casos, los pacientes afectados presentan como diagnóstico primario principalmente: mieloma múltiple (51,2%), cáncer de mama (31,4%), cáncer de próstata (7,1%) y osteoporosis (4,1%). La mandíbula resulta más afectada que el maxilar, con el 59,1%. La relación entre género femenino y masculino es de 2:2,6. El pamidronato es el bifosfonato más asociado a los casos de osteonecrosis (35,3%). Los factores de riesgos desencadenantes incluyen: exposición a bifosfonatos, infecciones orales, traumas, procedimientos quirúrgicos orales previos y terapias contra el cáncer (quimioterapia, corticoides y otros agentes citostáticos). La alteración en el equilibrio óseo, factores antiangiogénicos, inhibición en el ciclo celular de los queratinocitos y mecanismos osteolíticos generados en la infección podrían explicar la etiopatogenia en el desarrollo de esta complicación (AU)

In the last years a new complication has been described in the therapy with biphosphonates: biphosphonateassociated osteonecrosis of the jaws. This complication had not been detected in previous clinical tests. In this systematic review of 340 cases, the patients had as primary diagnosis principally: multiple myeloma (51.2%), breast cancer (31.4%), prostate cancer (7.1%) and osteoporosis (4.1%). The mandible is more affected than the maxilla, with 59.1%. The relationship between femenine and masculine gender was 2:2.6. The pamidronate was the biphosphonate more associated to the cases of osteonecrosis (35.3%). The risk factors associated include: use of biphosphonates, presence of oral infections, trauma, oral surgical procedures and therapies against cancer (chemoterapy, corticosteroids and other cytostatics agents). Effects on bone turnover, antiangiogenic property of biphosphonates, inhibitory effect of biphosphonates on the keratinocyte cell cycle and osteolysis mechanisms induced in the bacterial infection could explain the etiological mechanisms in the development of this complication (AU)