Manejo de Osteonecrose Mandibular Induzida por Medicamento: Relato de Caso Clínico e acompanhamento por 3 anos
DOI:
https://doi.org/10.36557/2674-8169.2025v7n7p353-372Palavras-chave:
Antibiotico, Osteonecrose Associada aos Bifosfonatos, Tratamento conservador.Resumo
Introdução: A Osteonecrose Mandibular Induzida por Medicamentos (OMIM) é a necrose óssea gnática associada a fármacos antirresorptivos, como bifosfonatos. Caracteriza-se por exposição óssea necrótica persistente por mais de 8 semanas, frequentemente após extrações dentárias. Tais medicamentos inibem osteoclastos e angiogênese, levando à necrose e infecção. Mandíbula e maxila são locais comuns devido a microtraumas e microbiota oral. Sintomas incluem dor intensa, e fatores de risco abrangem idade avançada, uso prolongado de medicação e cirurgia dentoalveolar.
Objetivo: relatar um caso clínico de tratamento de OMIM, com acompanhamento periódico por 3 anos, com uma abordagem conservadora e contemporânea.
Relato de caso: Este relato descreve uma paciente de 68 anos, usuária de alendronato por 10 anos, que desenvolveu OMIM Estágio II após extrações dentárias, apresentando dor, fístula e exposição óssea. Após exame clínico foi solicitada tomografia computadorizada de feixe cônico (TCFC) da região, além de exame do marcador telopeptídeo C-terminal, que mostrou valor baixo (0,06 ng/ml). O tratamento conservador incluiu suspensão do alendronato e antibioticoterapia sistêmica. O acompanhamento revelou melhora clínica, nos achados da TCFC e aumento do CTx para 0,242 ng/ml, com resolução da dor e cicatrização, apesar de recorrências gerenciadas com medicação e remoção de sequestros ósseos.
Conclusão: A OMIM exige diagnóstico precoce e manejo individualizado. As estratégias de tratamento devem considerar o estágio e as características do paciente. Neste caso, a abordagem conservadora e contemporânea monstrou-se efetiva, controlando a dor e melhorando a qualidade de vida da paciente.
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Copyright (c) 2025 Mario Roberto Moraes Junior, Paula Accioly, Maíra Prado, Vanessa de Couto Nascimento
Este trabalho está licenciado sob uma licença Creative Commons Attribution 4.0 International License.
Os autores são detentores dos direitos autorais mediante uma licença CCBY 4.0.
