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1.
J Clin Oncol ; 37(25): 2270-2290, 2019 Sep 01.
Artigo em Inglês | MEDLINE | ID: mdl-31329513

RESUMO

PURPOSE: To provide guidance regarding best practices in the prevention and management of medication-related osteonecrosis of the jaw (MRONJ) in patients with cancer. METHODS: Multinational Association of Supportive Care in Cancer/International Society of Oral Oncology (MASCC/ISOO) and ASCO convened a multidisciplinary Expert Panel to evaluate the evidence and formulate recommendations. Guideline development involved a systematic review of the literature and a formal consensus process. PubMed and EMBASE were searched for studies of the prevention and management of MRONJ related to bone-modifying agents (BMAs) for oncologic indications published between January 2009 and December 2017. Results from an earlier systematic review (2003 to 2008) were also included. RESULTS: The systematic review identified 132 publications, only 10 of which were randomized controlled trials. Recommendations underwent two rounds of consensus voting. RECOMMENDATIONS: Currently, MRONJ is defined by (1) current or previous treatment with a BMA or angiogenic inhibitor, (2) exposed bone or bone that can be probed through an intraoral or extraoral fistula in the maxillofacial region and that has persisted for longer than 8 weeks, and (3) no history of radiation therapy to the jaws or metastatic disease to the jaws. In patients who initiate a BMA, preventive care includes comprehensive dental assessments, discussion of modifiable risk factors, and avoidance of elective dentoalveolar surgery (ie, surgery that involves the teeth or contiguous alveolar bone) during BMA treatment. It remains uncertain whether BMAs should be discontinued before dentoalveolar surgery. Staging of MRONJ should be performed by a clinician with experience in the management of MRONJ. Conservative measures comprise the initial approach to MRONJ treatment. Ongoing collaboration among the dentist, dental specialist, and oncologist is essential to optimal patient care.

2.
J Clin Densitom ; 20(1): 8-24, 2017 Jan - Mar.
Artigo em Inglês | MEDLINE | ID: mdl-27956123

RESUMO

Osteonecrosis of the jaw (ONJ) has been associated with antiresorptive therapy in both oncology and osteoporosis patients. This debilitating condition is very rare and advances in diagnosis and management may now effectively reduce the risk of its development and offer valuable treatment options for affected patients. This paper provides a case-based review of ONJ and application of the International Task Force on ONJ (referred to as the "Task Force") recommendations for the diagnosis and management of ONJ. The Task Force was supported by 14 international societies and achieved consensus from representatives of these multidisciplinary societies on key issues pertaining to the diagnosis and management of ONJ. The frequency of ONJ in oncology patients receiving oncology doses of bisphosphonate (BP) or denosumab is estimated at 1%-15%, and the frequency in the osteoporosis patient population receiving much lower doses of BP or denosumab is estimated at 0.001%-0.01%. Although the diagnosis of ONJ is primarily clinical, imaging may be helpful in confirming the diagnosis and staging. In those with multiple risk factors for ONJ for whom major invasive oral surgery is being planned, interruption of BP or denosumab therapy (in cancer patients) is advised, if possible, before surgery, until the surgical site heals. Major oral surgery in this context could include multiple extractions if surgical extractions are required, not simple forceps extractions. ONJ development may be reduced by optimizing oral hygiene and postoperatively using topical and systemic antibiotics as appropriate. Periodontal disease should be managed before starting oncology doses of BP or denosumab. Local debridement may be successful in disease unresponsive to conservative therapy. Successful surgical intervention has been reported in those with stage 3 disease; less severe disease is best managed conservatively. Teriparatide may be helpful in healing ONJ lesions and may be considered in osteoporosis patients at a high fracture risk in the absence of contraindications. Resumption of BP or denosumab therapy following healing of ONJ lesions is recommended, and there have not been reports of subsequent local recurrence.


Assuntos
Osteonecrose da Arcada Osseodentária Associada a Difosfonatos/epidemiologia , Conservadores da Densidade Óssea/efeitos adversos , Neoplasias Ósseas/tratamento farmacológico , Denosumab/efeitos adversos , Difosfonatos/efeitos adversos , Osteoporose/tratamento farmacológico , Fraturas por Osteoporose/prevenção & controle , Doenças Periodontais/epidemiologia , Comitês Consultivos , Antibacterianos/uso terapêutico , Osteonecrose da Arcada Osseodentária Associada a Difosfonatos/etiologia , Osteonecrose da Arcada Osseodentária Associada a Difosfonatos/terapia , Conservadores da Densidade Óssea/administração & dosagem , Desbridamento , Denosumab/administração & dosagem , Difosfonatos/administração & dosagem , Relação Dose-Resposta a Droga , Fraturas Ósseas/prevenção & controle , Humanos , Higiene Bucal/métodos , Doenças Periodontais/terapia , Guias de Prática Clínica como Assunto , Fatores de Risco , Teriparatida/uso terapêutico
3.
JBMR Plus ; 1(2): 101-106, 2017 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-30283883

RESUMO

Giant cell tumors (GCTs) and central giant cell granulomas (CGCGs) are aggressive lesions that appear in the jaw. These lesions occur in the second and third decades of life and often arise in the mandible. Clinical manifestations of these lesions vary from asymptomatic to symptomatic tooth displacement with cortical perforation. GCTs, which are characterized by multinucleated osteoclast-type giant cells that express receptor activator of nuclear factor-κB (RANK) ligand, rarely present in the jaw and have overlapping histopathologic features with CGCGs, which are composed of fibroblastic stromal cell lesions. GCTs and CGCGs have overlying histopathologic features that make distinction between the two challenging. There is a real controversy as to whether giant cell tumors and central giant cell granulomas are in fact, one and the same lesion. The majority of GCTs occur in the long bone, with surgery being the typical therapeutic option. Denosumab as a treatment modality is a fairly new concept that has been used effectively in GCTs affecting long bones. There is less experience, however, with its use for jaw lesions. This seven-case series describes the effective use of both low-dose and high-dose denosumab in the treatment of GCTs and CGCGs affecting the jaw and special dosing considerations for younger patients who present with disease. © 2017 The Authors. JBMR Plus Published by Wiley Periodicals, Inc. on behalf of the American Society for Bone and Mineral Research.

4.
J Oral Maxillofac Surg ; 73(12 Suppl): S94-S100, 2015 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-26608159

RESUMO

PURPOSE: The treatment of patients with medication-related osteonecrosis of the jaw (MRONJ) is challenging. The purpose of the present study was to estimate the frequency and identify the factors associated with clinical improvement during treatment. PATIENTS AND METHODS: We designed and implemented a retrospective cohort study and enrolled a sample of subjects diagnosed with MRONJ between 2004 and 2015. The primary predictor variables were a set of heterogeneous variables grouped into the following categories: demographic (age and gender) and clinical (location of necrosis, therapy duration, medication type, disease stage, and treatment type). The primary outcome variable was the treatment outcome, defined as stable or worse and improved or healed. The descriptive, bivariate, and multiple logistic statistics were computed, and statistical significance was defined as P < .05. RESULTS: The sample included 337 subjects with a mean age of 68.9 years. Of the 337 subjects, 256 were women (76%). A total of 143 patients (42.2%) experienced spontaneous necrosis. Twenty-four (7.1%) had had exposure to targeted antiangiogenic agents. Those with stage 1 or 2 disease were more likely to have better outcomes than those with stage 3 disease (stage 1, adjusted odds ratio [OR] 3.4, P = .005; stage 2, adjusted OR 2.2, P = .03). Treatment type was a significant variable. Subjects undergoing surgery were 28 times more likely to have a positive outcome than those receiving nonoperative therapy (adjusted OR 28.7, P < .0001). CONCLUSIONS: Subjects with MRONJ who presented with less severe disease or who underwent operative treatment were most likely to have improvement or complete healing of their MRONJ-related lesions.


Assuntos
Osteonecrose da Arcada Osseodentária Associada a Difosfonatos/classificação , Idoso , Alveolectomia/métodos , Inibidores da Angiogênese/uso terapêutico , Antibacterianos/uso terapêutico , Anti-Infecciosos/uso terapêutico , Osteonecrose da Arcada Osseodentária Associada a Difosfonatos/tratamento farmacológico , Osteonecrose da Arcada Osseodentária Associada a Difosfonatos/cirurgia , Conservadores da Densidade Óssea/efeitos adversos , Estudos de Coortes , Feminino , Seguimentos , Humanos , Masculino , Doenças Mandibulares/classificação , Doenças Mandibulares/tratamento farmacológico , Doenças Mandibulares/cirurgia , Doenças Maxilares/classificação , Doenças Maxilares/tratamento farmacológico , Doenças Maxilares/cirurgia , Pessoa de Meia-Idade , Antissépticos Bucais/uso terapêutico , Neoplasias/tratamento farmacológico , Osteoporose/tratamento farmacológico , Osteotomia/métodos , Ligante RANK/antagonistas & inibidores , Estudos Retrospectivos , Fatores de Tempo , Resultado do Tratamento , Cicatrização/fisiologia
6.
Oral Maxillofac Surg Clin North Am ; 27(4): 479-87, 2015 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-26293329

RESUMO

The relationship between osteonecrosis of the jaw and bisphosphonate therapy was initially established more than 10 years ago. Since that time our understanding of this disease process has evolved as the direct result of clinical, basic science, and animal research initiatives. Medication-related osteonecrosis of the jaw (MRONJ) is a well-known entity now known to be associated with various antiresorptive therapies and recently with antiangiogenic medications. This article reviews the recently modified diagnostic criteria for MRONJ with a focus on the clinical, histopathologic, and imaging characteristics of this disease process.


Assuntos
Inibidores da Angiogênese/efeitos adversos , Conservadores da Densidade Óssea/efeitos adversos , Difosfonatos/efeitos adversos , Doenças Maxilomandibulares/induzido quimicamente , Doenças Maxilomandibulares/diagnóstico , Osteonecrose/induzido quimicamente , Osteonecrose/diagnóstico , Osteonecrose da Arcada Osseodentária Associada a Difosfonatos/diagnóstico , Diagnóstico por Imagem , Humanos , Doenças Maxilomandibulares/patologia , Osteonecrose/patologia , Terminologia como Assunto
9.
J Bone Miner Res ; 30(1): 3-23, 2015 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-25414052

RESUMO

This work provides a systematic review of the literature from January 2003 to April 2014 pertaining to the incidence, pathophysiology, diagnosis, and treatment of osteonecrosis of the jaw (ONJ), and offers recommendations for its management based on multidisciplinary international consensus. ONJ is associated with oncology-dose parenteral antiresorptive therapy of bisphosphonates (BP) and denosumab (Dmab). The incidence of ONJ is greatest in the oncology patient population (1% to 15%), where high doses of these medications are used at frequent intervals. In the osteoporosis patient population, the incidence of ONJ is estimated at 0.001% to 0.01%, marginally higher than the incidence in the general population (<0.001%). New insights into the pathophysiology of ONJ include antiresorptive effects of BPs and Dmab, effects of BPs on gamma delta T-cells and on monocyte and macrophage function, as well as the role of local bacterial infection, inflammation, and necrosis. Advances in imaging include the use of cone beam computerized tomography assessing cortical and cancellous architecture with lower radiation exposure, magnetic resonance imaging, bone scanning, and positron emission tomography, although plain films often suffice. Other risk factors for ONJ include glucocorticoid use, maxillary or mandibular bone surgery, poor oral hygiene, chronic inflammation, diabetes mellitus, ill-fitting dentures, as well as other drugs, including antiangiogenic agents. Prevention strategies for ONJ include elimination or stabilization of oral disease prior to initiation of antiresorptive agents, as well as maintenance of good oral hygiene. In those patients at high risk for the development of ONJ, including cancer patients receiving high-dose BP or Dmab therapy, consideration should be given to withholding antiresorptive therapy following extensive oral surgery until the surgical site heals with mature mucosal coverage. Management of ONJ is based on the stage of the disease, size of the lesions, and the presence of contributing drug therapy and comorbidity. Conservative therapy includes topical antibiotic oral rinses and systemic antibiotic therapy. Localized surgical debridement is indicated in advanced nonresponsive disease and has been successful. Early data have suggested enhanced osseous wound healing with teriparatide in those without contraindications for its use. Experimental therapy includes bone marrow stem cell intralesional transplantation, low-level laser therapy, local platelet-derived growth factor application, hyperbaric oxygen, and tissue grafting.


Assuntos
Mandíbula , Anticorpos Monoclonais Humanizados/efeitos adversos , Anticorpos Monoclonais Humanizados/uso terapêutico , Infecções Bacterianas/imunologia , Osteonecrose da Arcada Osseodentária Associada a Difosfonatos/diagnóstico , Osteonecrose da Arcada Osseodentária Associada a Difosfonatos/diagnóstico por imagem , Osteonecrose da Arcada Osseodentária Associada a Difosfonatos/etiologia , Osteonecrose da Arcada Osseodentária Associada a Difosfonatos/imunologia , Osteonecrose da Arcada Osseodentária Associada a Difosfonatos/terapia , Tomografia Computadorizada de Feixe Cônico , Consenso , Denosumab , Difosfonatos/efeitos adversos , Difosfonatos/uso terapêutico , Humanos , Macrófagos/imunologia , Macrófagos/patologia , Mandíbula/diagnóstico por imagem , Mandíbula/imunologia , Monócitos/imunologia , Monócitos/patologia , Osteoporose/diagnóstico , Osteoporose/diagnóstico por imagem , Osteoporose/tratamento farmacológico , Osteoporose/imunologia , Receptores de Antígenos de Linfócitos T gama-delta/imunologia , Fatores de Risco , Linfócitos T/imunologia , Linfócitos T/patologia
11.
J Oral Maxillofac Surg ; 72(10): 1938-56, 2014 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-25234529

RESUMO

Strategies for management of patients with, or at risk for, medication-related osteonecrosis of the jaw (MRONJ) were set forth in the American Association of Oral and Maxillofacial Surgeons (AAOMS) position papers in 2007 and 2009. The position papers were developed by a special committee appointed by the board and composed of clinicians with extensive experience in caring for these patients and basic science researchers. The knowledge base and experience in addressing MRONJ has expanded, necessitating modifications and refinements to the previous position paper. This special committee met in September 2013 to appraise the current literature and revise the guidelines as indicated to reflect current knowledge in this field. This update contains revisions to diagnosis, staging, and management strategies and highlights current research status. The AAOMS considers it vitally important that this information be disseminated to other relevant health care professionals and organizations.


Assuntos
Inibidores da Angiogênese/efeitos adversos , Osteonecrose da Arcada Osseodentária Associada a Difosfonatos/etiologia , Conservadores da Densidade Óssea/efeitos adversos , Doenças Maxilomandibulares/induzido quimicamente , Osteonecrose/induzido quimicamente , Antineoplásicos/efeitos adversos , Osteonecrose da Arcada Osseodentária Associada a Difosfonatos/diagnóstico , Osteonecrose da Arcada Osseodentária Associada a Difosfonatos/terapia , Remodelação Óssea/efeitos dos fármacos , Reabsorção Óssea/prevenção & controle , Diagnóstico Diferencial , Humanos , Doenças Maxilomandibulares/diagnóstico , Doenças Maxilomandibulares/terapia , Neoplasias/tratamento farmacológico , Neovascularização Fisiológica/efeitos dos fármacos , Procedimentos Cirúrgicos Bucais/efeitos adversos , Osteonecrose/diagnóstico , Osteonecrose/terapia , Osteoporose/tratamento farmacológico , Planejamento de Assistência ao Paciente , Medição de Risco , Fatores de Risco , Terminologia como Assunto , Fatores de Tempo
12.
Int J Oral Maxillofac Implants ; 29(1): e45-57, 2014 Jan-Feb.
Artigo em Inglês | MEDLINE | ID: mdl-24451887

RESUMO

Just a decade ago, the outlook appeared limitless for the use of bisphosphonates for the treatment of a large number of metabolic bone diseases ranging from osteoporosis to cancer-related bone alterations to oral bone loss. Soon thereafter, however, osteonecrosis of the jaw (ONJ) emerged as a rare but significant condition associated with bisphosphonate treatment. Although many questions remain concerning ONJ, some significant knowledge has been gained over the past decade. Ideas have emerged regarding how to stage and treat the condition, and a number of preclinical models have been developed that will soon begin to speed progress toward understanding the pathophysiology of this condition. Researchers have also discovered that ONJ is not specific to bisphosphonates, as other potent antiremodeling agents have now been associated with the condition. While antiremodeling agents remain essential tools in medicine, ONJ has somewhat slowed the momentum for this drug class, especially as it relates to new and emerging applications. Until more effective prevention or treatment regimens for ONJ are developed, this side effect of remodeling suppression will continue-for better or worse-to have a significant impact on the field. One potential treatment option may be in the form of osteoanabolics. Exciting new data have emerged demonstrating the efficacy of teriparatide (parathyroid hormone) in reversing oral cavity bone loss and even as a potential therapy for ONJ.


Assuntos
Osteonecrose da Arcada Osseodentária Associada a Difosfonatos , Conservadores da Densidade Óssea/efeitos adversos , Difosfonatos/efeitos adversos , Anabolizantes/uso terapêutico , Osteonecrose da Arcada Osseodentária Associada a Difosfonatos/diagnóstico , Osteonecrose da Arcada Osseodentária Associada a Difosfonatos/prevenção & controle , Remodelação Óssea/efeitos dos fármacos , Remodelação Óssea/fisiologia , Osso e Ossos/efeitos dos fármacos , Osso e Ossos/fisiologia , Humanos , Osteoporose/tratamento farmacológico , Osteoporose/prevenção & controle
13.
Gen Dent ; 61(7): 24-9, 2013 Nov-Dec.
Artigo em Inglês | MEDLINE | ID: mdl-24192731

RESUMO

Antiresorptive medications have proven to be extremely efficacious in the treatment of disorders of bone remodeling and metabolism. However, the benefits of these agents have been offset to some degree by the occurrence of jaw necrosis in a subset of patients receiving these medications. This complication was first reported in 2004; since then there have been multiple retrospective, prospective, and case-controlled studies that have defined the diagnosis, associated risk factors, and treatment outcomes for this unique complication. The risk of developing this complication appears to be related to the potency of the antiresorptive, the duration of exposure, and dentoalveolar trauma. Stage-specific management strategies have been developed, as well as guidelines for evaluating the potential risks associated with this complication. Recent clinical, in vivo, and in vitro studies have made significant progress toward understanding anti-resorptive osteonecrosis of the jaw.


Assuntos
Osteonecrose da Arcada Osseodentária Associada a Difosfonatos/diagnóstico , Osteonecrose da Arcada Osseodentária Associada a Difosfonatos/cirurgia , Osteonecrose da Arcada Osseodentária Associada a Difosfonatos/diagnóstico por imagem , Humanos , Radiografia Panorâmica
15.
J Oral Maxillofac Surg ; 71(12): 2077-86, 2013 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-23945512

RESUMO

PURPOSE: The aim of the present study was to investigate the microscopic presence of metastatic cancer in jaw specimens clinically and histologically diagnosed as having osteonecrosis in patients receiving intravenous bisphosphonate medications. PATIENTS AND METHODS: A retrospective cohort multicenter study was designed. Patients from the University of Tennessee Medical Center, New York University Medical Center, and New York Center for Orthognathic and Maxillofacial Surgery were enrolled who had been treated with intravenous bisphosphonate medications for an underlying diagnosis of cancer and who had been clinically diagnosed with bisphosphonate-related osteonecrosis of the jaws (BRONJ). The institutional review boards approved the present study. The primary predictor variable was the clinical presence of BRONJ. The primary outcome variable was the microscopic presence of metastatic cancer in the osteonecrotic jaw specimens. RESULTS: A total of 744 sites of BRONJ were clinically diagnosed. Of these sites, 552 (74%) were diagnosed in patients who had received intravenous bisphosphonate medications. Of these 552 sites, 357 (65%) underwent microscopic evaluation through biopsy, sequestrectomy, or resection with curative intent. Of the 357 sites of BRONJ subjected to microscopic analysis, 19 (5.3%) sites were diagnosed with 20 cancers in 16 patients. CONCLUSIONS: Albeit rare, the presence of cancer in a BRONJ specimen represents 1 explanation for the development of osteonecrosis in patients exposed to intravenous bisphosphonate medications in whom a clinical diagnosis of BRONJ has been applied. Additional molecular information is needed to provide an explanation for this observation.


Assuntos
Osteonecrose da Arcada Osseodentária Associada a Difosfonatos/complicações , Neoplasias Maxilomandibulares/complicações , Neoplasias Maxilomandibulares/secundário , Adulto , Idoso , Idoso de 80 Anos ou mais , Neoplasias da Mama/complicações , Estudos de Coortes , Diagnóstico Diferencial , Feminino , Humanos , Neoplasias Maxilomandibulares/diagnóstico , Neoplasias Maxilomandibulares/tratamento farmacológico , Masculino , Pessoa de Meia-Idade , Mieloma Múltiplo/complicações , Estudos Retrospectivos
17.
J Oral Maxillofac Surg ; 71(6): 1017-26, 2013 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-23375897

RESUMO

PURPOSE: Factors contributing to osteonecrosis of the jaw with anti-remodeling drug treatment are unclear. Epidemiologic and experimental studies have suggested the combination of bisphosphonates and dexamethasone results in osteonecrosis of the jaw more often than either agent alone. The goal of this study was to assess the combination of these 2 drugs in a large animal model previously shown to be susceptible to exposed bone in the oral cavity when treated with bisphosphonates. MATERIALS AND METHODS: Skeletally mature beagle dogs were untreated controls or treated with zoledronic acid (ZOL), dexamethasone (DEX), or ZOL plus DEX. ZOL and DEX were given at doses based on those used in humans. All animals underwent single molar extraction at 7 and 8 months after the start of the study. Extraction sites were obtained at month 9 for assessment of osseous healing using micro-computed tomography and histology. RESULTS: No animals were observed to have exposed bone after dental extraction, yet 1 animal treated with ZOL and 1 treated with ZOL plus DEX had severely disrupted extraction sites as viewed by computed tomography and histology. These 2 animals had an intense periosteal reaction that was less obvious but still present in all ZOL-treated animals and absent from untreated animals. There was no significant difference in bone volume within the socket among groups at 4 or 8 weeks after healing, yet the ratio of surface to volume was significantly higher in animals treated with ZOL plus DEX at 8 weeks compared with control animals. CONCLUSIONS: These findings suggest a more complex pathophysiology to osteonecrosis of the jaw than is implied by previous epidemiologic studies and those in rodents and raise questions about the potential role of DEX in its etiology.


Assuntos
Osteonecrose da Arcada Osseodentária Associada a Difosfonatos/etiologia , Conservadores da Densidade Óssea/efeitos adversos , Difosfonatos/efeitos adversos , Imidazóis/efeitos adversos , Extração Dentária/efeitos adversos , Alvéolo Dental/efeitos dos fármacos , Análise de Variância , Animais , Osteonecrose da Arcada Osseodentária Associada a Difosfonatos/fisiopatologia , Conservadores da Densidade Óssea/administração & dosagem , Dexametasona/administração & dosagem , Dexametasona/efeitos adversos , Difosfonatos/administração & dosagem , Cães , Combinação de Medicamentos , Feminino , Imidazóis/administração & dosagem , Mandíbula/efeitos dos fármacos , Modelos Animais , Periósteo/efeitos dos fármacos , Microtomografia por Raio-X , Ácido Zoledrônico
18.
Oral Maxillofac Surg Clin North Am ; 25(1): 11-20, v, 2013 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-23159218

RESUMO

Since the first description of bone necrosis in patients receiving bisphosphonate therapy in 2004, there have been multiple retrospective, prospective, and case-control studies that have served to characterize the diagnosis, associated risk factors, and treatment of this new complication. Bisphosphonate-related osteonecrosis of the jaw is at present associated with several risk factors that are identified across several disciplines in medicine and dentistry. With this level of broad-based recognition, new clinical and basic science research initiatives have begun and are likely to elucidate the etiopathogenesis of this disease process, significantly improving the level of disease management and prevention.


Assuntos
Osteonecrose da Arcada Osseodentária Associada a Difosfonatos/terapia , Osteonecrose da Arcada Osseodentária Associada a Difosfonatos/etiologia , Osteonecrose da Arcada Osseodentária Associada a Difosfonatos/prevenção & controle , Conservadores da Densidade Óssea/efeitos adversos , Difosfonatos/efeitos adversos , Humanos , Fatores de Risco
20.
Surgeon ; 10(1): 36-42, 2012 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-22233554

RESUMO

The use of bisphosphonate drugs has been popularised in the late 20th century for the management of many conditions associated with abnormalities of bone turnover, particularly metastatic and haematogenous malignancy and osteopenia. The increase in indications for the use of bisphosphonates was supported by what was thought to be a very good safety profile. However in 2003 cases of osteonecrosis related to the use of bisphosphonates were first described. The pathogenesis, and with this the explanation of why it only appears to affect the maxillofacial skeleton, and the best way of managing this problem remains unknown. In this review we examine the process of identification of this pathology and the development of guidelines from medical societies and professional bodies on the management of patients before commencing bisphosphonate therapy, requiring dental treatment whilst on therapy, or with a diagnosis of bisphosphonate associated osteonecrosis of the jaws.


Assuntos
Osteonecrose da Arcada Osseodentária Associada a Difosfonatos , Osteonecrose da Arcada Osseodentária Associada a Difosfonatos/diagnóstico , Osteonecrose da Arcada Osseodentária Associada a Difosfonatos/epidemiologia , Osteonecrose da Arcada Osseodentária Associada a Difosfonatos/história , Osteonecrose da Arcada Osseodentária Associada a Difosfonatos/terapia , Difosfonatos/efeitos adversos , História do Século XXI , Humanos , Guias de Prática Clínica como Assunto , Reino Unido
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