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Osteonecrose como consequência da toma de bisfosfonatos em pacientes após a extração dentária: revisão narrativa
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Abstract(s)
Os bisfosfonatos são medicamentos inibidores da atividade osteoclástica, utilizados no tratamento de um leque abrangente de patologias, das oncológicas, às doenças ósseas degenerativas.
Para este trabalho de revisão narrativa foi realizada uma pesquisa bibliográfica na base de dados: Pubmed e B-on. Foram definidas as palavras-chave: “Bifosfonatos”; “Extrações dentárias”; “Osteonecrose”, articuladas entre si através do marcador booleano AND. Apos estipulados critérios de inclusão e exclusão para a elegibilidade dos artigos a incluir nesta revisão. Apenas 12 artigos foram incluídos. Para além destes, foram também utilizados 10 artigos encontrados através de pesquisa manual e Guidelines de sociedades internacionais de relevo para esta temática.
A toma de bifosfonatos, em determinadas circunstâncias pode levar ao aparecimento de osteonecrose após uma extração dentária, por uma combinação de vários fatores, entre os quais se destacam a diminuição da vascularização da região, alterações da remodelação óssea e dificuldade de cicatrização dos tecidos duros.
Após confirmação do diagnóstico de osteonecrose a actuação deve ser imediata. Numa primeira abordagem, instaurando medidas não cirúrgicas. Uma reavaliação da doença é feita após o término dos tratamentos (estabelecer se existe uma progressão ou estabilização da patologia). Posteriormente reavaliar a condição médica, os hábitos sociais e de higiene oral do paciente para que seja proposta uma terapia cirúrgica caso necessário.
Este trabalho tem como objetivo alertar e orientar os médicos dentistas para situações de osteonecrose, elucidando os seus fatores etiológicos, fatores de risco e fornecer uma orientação na terapêutica a adotar.
Bisphosphonates are medications that inhibit osteoclastic activity and are used in the treatment of a wide range of conditions, from oncological diseases to degenerative boné diseases. For this narrative review, a bibliographic search was conducted in the Pubmed and B-on databases. The keywords "Bisphosphonates," "Tooth extractions," and "Osteonecrosis" were defined and combined using the boolean operator "AND." Inclusion and exclusion criteria were established to determine the eligibility of articles to be included in this review. Only 12 articles were included. In addition to these, 10 articles found through manual search and guidelines from relevant international societies on this topic were also used. The use of bisphosphonates, under certain circumstances, can lead to the development of osteonecrosis after a tooth extraction, due to a combination of factors, including decreased vascularization in the area, alterations in bone remodeling, and impaired tissue healing. Once the diagnosis of osteonecrosis is confirmed, immediate action should be taken. Initially, non-surgical measures should be implemented. A reassessment of the disease is done after the completion of treatments to determine if there is progression or stabilization of the condition. Subsequently, the patient's medical condition, social habits, and oral hygiene should be reevaluated to determine if surgical therapy is necessary. The objective of this work is to alert and guide dentists regarding osteonecrosis situations, elucidating it’s etiological factors and risk factors, and providing guidance on the appropriate therapy to be adopted.
Bisphosphonates are medications that inhibit osteoclastic activity and are used in the treatment of a wide range of conditions, from oncological diseases to degenerative boné diseases. For this narrative review, a bibliographic search was conducted in the Pubmed and B-on databases. The keywords "Bisphosphonates," "Tooth extractions," and "Osteonecrosis" were defined and combined using the boolean operator "AND." Inclusion and exclusion criteria were established to determine the eligibility of articles to be included in this review. Only 12 articles were included. In addition to these, 10 articles found through manual search and guidelines from relevant international societies on this topic were also used. The use of bisphosphonates, under certain circumstances, can lead to the development of osteonecrosis after a tooth extraction, due to a combination of factors, including decreased vascularization in the area, alterations in bone remodeling, and impaired tissue healing. Once the diagnosis of osteonecrosis is confirmed, immediate action should be taken. Initially, non-surgical measures should be implemented. A reassessment of the disease is done after the completion of treatments to determine if there is progression or stabilization of the condition. Subsequently, the patient's medical condition, social habits, and oral hygiene should be reevaluated to determine if surgical therapy is necessary. The objective of this work is to alert and guide dentists regarding osteonecrosis situations, elucidating it’s etiological factors and risk factors, and providing guidance on the appropriate therapy to be adopted.