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Osteonecrose dos maxilares associada a medicação
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Introdução: A osteonecrose dos maxilares associada a medicação (ONMM) é uma condição rara, habitualmente encontrada em pacientes submetidos a fármacos antirreabsortivos ou antiangiogénicos. Este estudo visa sintetizar relatos e séries de casos de ONMM, relativamente a características sociodemográficas e clínicas, e entender se existe alguma terapêutica mais eficaz na cura da doença.
Metodologia: Realizou-se uma pesquisa de relatos e séries de casos na base de dados PubMed- Medline, publicados em inglês, até março de 2024. Foram excluídos artigos não disponibilizados na íntegra e casos que apresentassem fatores que comprometessem a cicatrização. Realizou-se a análise descritiva e o teste exato de Fisher, através do programa SPSS®.
Resultados: Este estudo incluiu 88 artigos, num total de 151 casos. O sexo feminino foi o mais afetado (71%). A idade média no diagnóstico foi de 66.27 anos e o estádio 2 foi o mais observado (43%). O princípio ativo mais utilizado foi o ácido zoledrónico (32%). A via de administração mais comum foi a oral (26%) e o tempo médio de administração foi de 60.88 meses. A mandíbula foi a localização anatómica mais afetada (60%). A amoxicilina + ácido clavulânico (875 mg + 125 mg) e a clorexidina foram o antibiótico e o colutório mais administrados (16% e 38%, respetivamente). O desbridamento cirúrgico foi o procedimento cirúrgico mais comum (32%). A utilização de uma membrana L-PRF foi o tratamento não convencional mais comum (21%). A relação entre tratamentos não convencionais e a cura de ONMM foi a única que apresentou significância estatística.
Conclusão: A ONMM apresentou maior incidência em pacientes entre os 60 e os 70 anos e as lesões foram mais frequentemente observadas na mandíbula, corroborando a literatura existente. Este estudo destaca a potencial eficácia de tratamentos não convencionais na resolução de ONMM, sugerindo a necessidade de mais estudos para confirmar os resultados obtidos.
Introduction: Medication-related osteonecrosis of the jaw (MRONJ) is a rare condition, usually found in patients receiving antiresorptive or antiangiogenic drugs. This study aims to synthesize reports and case series of MRONJ, regarding sociodemographic and clinical characteristics, and understand whether there is a more effective therapy in curing the disease. Methodology: A search for case reports and case series was carried out in the PubMed-Medline database, published in English, until March 2024. Articles that were not fully available and cases that presented factors that compromised healing were excluded. Descriptive analysis and Fisher's exact test were performed using the SPSS® program. Results: This study included 88 articles, in a total of 151 cases. Females were the most affected (71%). The average age at diagnosis was 66.27 years and stage 2 was the most observed (43%). The most used drug was zoledronic acid (32%). The most common route of administration was oral (26%) and the average administration time was 60.88 months. The mandible was the most affected anatomical location (60%). Amoxicillin + clavulanic acid (875 mg + 125 mg) and chlorhexidine were the most administered antibiotic and mouthwash (16% and 38%, respectively). Surgical debridement was the most common surgical procedure (32%). The use of an L-PRF membrane was the most common unconventional treatment (21%). The relationship between unconventional treatments and the cure of MRONJ was the only one that showed statistical significance. Conclusion: MRONJ had a higher incidence in patients between 60 and 70 years old and the lesions were more frequently observed in the mandible, corroborating the existing literature. This study highlights the potential effectiveness of non-conventional treatments in resolving MRONJ, suggesting the need for further studies to confirm the results obtained.
Introduction: Medication-related osteonecrosis of the jaw (MRONJ) is a rare condition, usually found in patients receiving antiresorptive or antiangiogenic drugs. This study aims to synthesize reports and case series of MRONJ, regarding sociodemographic and clinical characteristics, and understand whether there is a more effective therapy in curing the disease. Methodology: A search for case reports and case series was carried out in the PubMed-Medline database, published in English, until March 2024. Articles that were not fully available and cases that presented factors that compromised healing were excluded. Descriptive analysis and Fisher's exact test were performed using the SPSS® program. Results: This study included 88 articles, in a total of 151 cases. Females were the most affected (71%). The average age at diagnosis was 66.27 years and stage 2 was the most observed (43%). The most used drug was zoledronic acid (32%). The most common route of administration was oral (26%) and the average administration time was 60.88 months. The mandible was the most affected anatomical location (60%). Amoxicillin + clavulanic acid (875 mg + 125 mg) and chlorhexidine were the most administered antibiotic and mouthwash (16% and 38%, respectively). Surgical debridement was the most common surgical procedure (32%). The use of an L-PRF membrane was the most common unconventional treatment (21%). The relationship between unconventional treatments and the cure of MRONJ was the only one that showed statistical significance. Conclusion: MRONJ had a higher incidence in patients between 60 and 70 years old and the lesions were more frequently observed in the mandible, corroborating the existing literature. This study highlights the potential effectiveness of non-conventional treatments in resolving MRONJ, suggesting the need for further studies to confirm the results obtained.
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Teses de mestrado - 2024 Saúde Oral