Evaluation of Mandibular Bone After Dental Extraction in Rats Treated With Antiresorptive Drugs.

PURPOSE: Zoledronic acid (ZOL) and denosumab (Dmab) are commonly used to treat bone pathologies. Because these drugs suppress bone metabolism, this study sought to compare their effect on bone repair after tooth extraction. MATERIALS AND METHODS: Four-week-old male Wistar rats were randomly assigned to 1 of 3 groups: ZOL 0.125 mg/kg, Dmab 0.25 mg/kg, or saline solution 10 mL/kg (control). After 1 week of treatment, the first left molar was extracted; the rats were euthanized at 28 days. The jaws were removed and photographed for macroscopic analysis of wound healing and then subjected to tomographic and histologic analyses. Immunohistochemistry was carried out against the receptor activator of nuclear factor-κB ligand (RANKL) and osteoprotegerin (OPG). RESULTS: No difference in wound healing, presence of inflammatory infiltrate and bone sequestration, or osteocyte expression of RANKL and OPG was found among groups. Tomographic analysis showed that the ZOL group had less alveolar resorption and more complete alveolar repair compared with the other groups. There was a statistically significant difference in the OPG marker in the control (P = .008) and ZOL (P = .05) groups when comparing the extracted and non-extracted sides. CONCLUSION: Systemic use of ZOL can improve alveolar bone healing; however, the potential risk for the development of osteonecrosis should be considered. Higher expression of OPG seems to be associated with the control of osteoclastogenesis during bone repair.

The risk of osteonecrosis on alveolar healing after tooth extraction and systemic administration of antiresorptive drugs in rodents: a systematic review.

PURPOSE: There is much concern about the increasing number of patients with medication-related osteonecrosis of the jaw (MRONJ), and many studies have been published in an attempt to understand the pathophysiology of this condition. This study aimed to systematically review the literature on MRONJ arising in rodents under antiresorptive drug therapy after tooth extraction. METHODS: A search of electronic databases, including LILACS, PROQUEST, PubMed, SCOPUS, and the Web of Science. RESULTS: The search resulted in 2319 titles after removing the duplicates, and one paper was identified using the reference list. Ninety-eight full-text papers were then screened for eligibility, resulting in 20 for inclusion in the final qualitative synthesis. The quality of the articles was assessed using the 'ARRIVE' tool. CONCLUSION: Despite the wide heterogeneity of the methodologies used by the authors, the current available evidence suggests that the combination of bisphosphonate and/or denosumab therapy and tooth extraction is associated with osteonecrosis of the jaw in rodents.

Cisto de retenção mucoso em mucosa sinusal e levantamento de seio maxilar / Mucosal retention cyst and maxillary sinus lifting: a case report

A técnica de levantamento de seio maxilar é a opção mais utilizada para tratamento das deficiências em altura na região posterior da maxila. Algumas patologias apresentam aumento na dificuldade de execução da técnica, podendo contraindicar temporariamente o procedimento. Uma das alterações mais frequentes na região é a presença de cistos de retenção mucosos (mucoceles de seio maxilar). Apesar de normalmente serem de fácil diagnóstico em imagens, seu comportamento clínico de diminuição ou regressão espontânea pode mascará-los, levando a diagnósticos incorretos. Os autores relataram um caso em que as imagens tomográficas demonstravam pequena imagem hiperdensa na cavidade sinusal, porém, sem evidências de mucocele sinusal. Apresentam também a condução do caso após o diagnóstico transcirúrgico.

The technique of sinus lifting is one of the most indicated to treat height defIciencies in posterior maxilla. Some pathologies can counterindicate temporarily the procedure. Mucous retention cyst (MRC) are frequent inside the maxillary sinus. Although easy to detect on images, its clinical bahavior can lead to an incorrect diagnosis. The present paper aims to report a case which images were showing a small hyperdense image in the right maxillary antrum, but without evidences of MRC. The solution after transurgical diagnosis is also presented.

Osteonecrose maxilo-mandibular induzida por bisfosfonato: revisão bibliográfica / Maxillomandibular osteonecrosis induced by bisphosphonate: a literature review

Diante da necessidade de novas tecnologias farmacêuticas para o tratamento de diversos tipos de lesões malignas, surgiram os bisfosfonatos, medicamentos amplamente administrados a pacientes portadores de câncer de mama e próstata com metástases ósseas, mieloma múltiplo, osteoporose, doença de Paget, hipercalcemia maligna e outras lesões ósseas metastáticas. Várias reações adversas oriundas do uso desse medicamento têm surgido, destacando-se a osteonecrose dos maxilares (ONM). Mediante de uma revisão bibliográfica, o objetivo deste trabalho é o de realizar uma abordagem objetiva acerca das principais características desse fármaco, suas complicações, prevenção e terapêutica da ONM. Diante da ausência de um protocolo de tratamento efetivo para a ONM, a prevenção apresenta-se como melhor opção. Faz-se pertinente frisar que os pacientes submetidos à quimioterapia com os bisfosfonatos devem ser encaminhados ao serviço odontológico para criteriosa avaliação de possíveis fatores predisponentes ao aparecimento da ONM. O tratamento de pacientes com osteonecrose maxilo-mandibular bisfosfonatoassociado, além da natural dificuldade, apresenta resultados imprevisíveis.

The need for new pharmaceutical technologies in the treatment of several types of malignant lesions led to the emergence of the bisphosphonates, a drug widely administered to patients with breast and prostate cancer with bone metastases, multiple myeloma, osteoporosis, Paget's disease, hypercalcemia and other malignant metastatic bone lesions. Several adverse reactions have emerged, in particular osteonecrosis of the jaw (ONJ). This paper sets out to objectively address some of the main characteristics of this drug, its complications and role in the prevention and treatment of ONJ. Given the absence of a protocol for the effective treatment of ONJ, prevention is seen to be the best option. It is important to note that patients undergoing chemotherapy with bisphosphonates should be referred to a dental unit for careful evaluation of possible predisposing factors. Apart from the inherent difficulty of the treatment of patients with biphosphonate-associated maxillomandibular osteonecrosis, its results are unpredictable.