Keywords
How to Cite
Abstract
Medication-induced osteonecrosis of the jaw is a rare condition that can significantly affect the quality of life of affected patients. It is related to the use of antiresorptive and antiangiogenic drugs to treat other conditions such as osteoporosis and neoplasia. It is predominantly female and occurs in the age group over 60 years. It usually occurs after tooth extractions. Its treatment can be conservative or invasive. Objective: The aim of this study is to describe a case report on conservative treatment of denosumab-induced osteonecrosis of the jaw and to discuss the clinical-pathological aspects of the disease. Methodology and literature review: This case report was developed through a search for articles in the PUBMED and BVS (BBO, LILACS and MEDLINE) databases, in addition to research in books by reference authors on the subject. The most recent studies published up to 2024 were selected as a priority. Case report and discussion: This case report involves a 66-year-old female patient who underwent dental extraction procedures associated with bone grafting, and did not inform during the anamnesis that she was using denosumab to treat osteoporosis, thus developing drug-induced osteonecrosis of the jaw, diagnosed 8 weeks later. The chosen treatment was conservative, with the PENTO protocol, a combination of pentoxifylline and tocopherol, combined with low-level laser therapy. Conclusion: It is concluded that a correct and early diagnosis is essential, combined with resolutive treatment through a conservative approach, even for a lesion with a higher stage, positively impacting the patient's quality of life.
References
AAOMS, American Association Of Oral And Maxillofacial Surgeons Position Paper On Bisphosphonate-Related Osteonecrosis Of The Jaws. J Oral Maxillofac Surg 2007;65(3):369-76. 2022.
BOYCE Bf, Yao Z, Xing L.; et al... Os Osteoclastos Têm Múltiplos Papéis No Osso, Além Da Reabsorção Óssea. Crit Rev Eukaryot Gene Expr. 2009; 19(3):171-80. Doi: 10.1615/Critreveukargeneexpr.V19. I3.10. Pmid: 19883363; Pmcid: Pmc2856465.2021.
BROZOSKII, Mariana Aparecida.; et al... Osteonecrose Maxilar Associada Ao Uso De Bisfosfonatos. Rev Bras Reumatol 2012;52(2):260-270. 2012.
BOSTON, Bridget; Tech, Deepak; Capitanescu, Bogdan Et Al. / Medication-Related Osteonecrosis Of The Jaw: A Disease Of Significant Importance For Older Patients. In: Journal Of The American Geriatrics Society. 2023.
CAVALCANTE, Rafael Correia.; et al... Pentoxifylline And Tocopherol Protocol To Treat Medication-Related Osteonecrosis Of The Jaw: A Systematic Literature Review, Journal Of Cranio-Maxillofacial Surgery, Volume 48, Issue 11,2020, Pages 1080-1086, Issn 1010-5182, Https://Doi.Org/10.1016/J.Jcms.2020.09.008.
CAMPISI, G.; et al.. Medication- Related Osteonecrosis Of Jaws(Mronj) Prevention And Diagnosis: Italian Consensus Update 2020. Internacional Journal Of Environmental Research And Public Health, V.17, N.16, 2020.
CARVALHO, Vilela Ln.; et al... Osteonecrosis De Los Maxilares Relacionados Con El Uso De Medicamentos: Diagnóstico, Tratamiento Y Prevención. Rev. Ces Odont 2018; 31(2): 48-63.2018.
DANTAS, et al... Denosumabe E Osteonecrose Dos Maxilares:O Que O Cirurgião-Dentista Precisa Saber? Revista Ciência Plural. 2022.
EVERTS, Graber J; et al... Risk Factors For Vertebral Fractures And Bone Loss After Denosumab Discontinuation: A Real World Observational Study. Bone. Mar; 144:115830.Https://Pubmed.Ncbi.Nlm.Nih.Gov/33359006/.2021.
FREIBERGER, John J.; et al.. What Is The Role Of Hyperbaric Oxygen In The Management Of Bisphosphonate-Related Osteonecrosis Of The Jaw: A Randomized Controlled Trial Of Hyperbaric Oxygen As An Adjunct To Surgery And Antibiotics. Journal Of Oral And Maxillofacial Surgery, Volume 70, Issue 7, 1573 - 1583.2012.
FERNANDES, B.; et al... Estratégia Cirúrgica Para Tratamento De Fratura De Côndilo Mandibular. Archives Of Health Investigation, [S. L.], V. 10, N. 5, P. 844–847, 2021. Doi: 10.21270. 2024.
FU, Pa., Shen, Cy., Yang, S. Et Al. Uso Prolongado De Denosumabe E Sua Associação Com Eventos Relacionados Ao Esqueleto E Osteonecrose Da Mandíbula. Sci Rep 13 , 8403 . Https://Doi.Org/10.1038/S41598-023-35308-Z.2023.
HADAYA, Care , Danny Et Al. Nonsurgical Management Of Medication-Related Osteonecrosis Of The Jaws Using Local Wound. Journal Of Oral And Maxillofacial Surgery, Volume 76, Issue 11, 2332 - 2339.2018.
IE-WEN SIM Et Al.; Teriparatida Promove A Cura Óssea na Osteonecrose Da Mandíbula Relacionada A Medicamentos: Um Ensaio Randomizado Controlado Por Placebo. Journal of clinical oncologic 38, 2971-2980. Doi: 10.1200/Jco.19.02192.2020.
Lewiecki, E. M. Safety Of Long-Term Bisphosphonate Therapy For The Management Of Osteoporosis. Drugs, V. 71, N. 6, P. 791–814, abr. 2011.
MARX, Re. O Pamidronato (Aredia) E O Zoledronato (Zometa) Induziram Necrose Avascular Dos Maxilares: Uma Epidemia Crescente. J Oral Maxillofac Surg. 2003 setembro; 61(9):1115-7. Doi: 10.1016/S0278-2391(03)00720-1. Pmid: 12966493.2003.
MARX, Re, et al., Oral Bisphosphonate-Induced Osteonecrosis: Risk Factors, Prediction Of Risk Using Serum Ctx Testing, Prevention, And Treatment. J Oral Maxillofac Surg 2007;65(12):2397-410.2003.
OWOSHO, Aa, Estilo Cl, Huryn Jm, Yom Sk. Pentoxifylline And Tocopherol In The Management Of Cancer Patients With Medication-Related Osteonecrosis Of The Jaw: An Observational Retrospective Study Of Initial Case Series. Oral Surg Oral Med Oral Pathol Oral Radiol. 2016;122(4):455–9.2023.
PASETTI, Lilian Aparecida et al., Osteonecrose Dos Maxilares Relacionada Ao Uso De Medicamentos Revisão De Literatura. Research, Society And Development, V. 11, N. 13, E523111335949, 2022.
PAN KS, Boyce Am. Denosumab Treatment For Giant Cell Tumors, Aneurysmal Bone Cysts, And Fibrous Dysplasia-Risks And Benefits. Curr Osteoporos Rep. 2021 Apr;19(2):141-150. Doi: 10.1007/S11914-021-00657-Z. Epub 2021 Feb 22. Pmid: 33616817; Pmcid: Pmc9533232.2021
RECREO, Barba Paula, et al., Zoledronic Acid – Related Osteonecrosis Of The Jaws. Experimental Model With Dental Extractions In Rats, Journal Of Cranio-Maxillofacial Surgery, Volume 42, Issue 6,2014, Pages 744-750, Issn 1010-5182, Https://Doi.Org/10.1016/J.Jcms.2013.11.005.2013.
MELIAN RIVAS, Andrés Noah; ROJAS DONAIRE, Javiera Alejandra. Tratamiento conservador de osteonecrosis maxilar asociada a medicamentos refractaria mediante el uso de protocolo PENTO: reporte de un caso. Odontoestomatología, Montevideo, v. 23, n. 38, e406, 2021. Disponible en <http://www.scielo.edu.uy/scielo.php?script=sci_arttext&pid=S1688-93392021000201406&lng=es&nrm=iso>. accedido en 04 oct. 2024. Epub 30-Sep-2021. https://doi.org/10.22592/ode2021n37e406.
Ruocco, Viviann & Bergantim, Monique & Lopes, Daniel & Pim, Diego & Almeida, Gustavo & Mattos, Rodrigo & Silva, Tiago & Faloni, Ana Paula. (2023). Bifosfonatos: tipos, mecanismos de ação e efeitos colaterais. Revisão da literatura para orientação de profissionais e estudantes das áreas médica e odontológica. Revista Brasileira Multidisciplinar. 26. 94-120. 10.25061/2527-2675/ReBraM/2022.v25i3.1682.
RUGGIERO Sl, Woo Sb. Biophosponate-Related Osteonecrosis Of The Jaws. Dent Clin North Am 2008;52(1):111-28.2022.
RODAN Ga, Fleisch Ha. Bifosfonatos: Mecanismos De Ação. J Clin Invest. 15 De Junho De 1996; 97(12):2692-6. Doi: 10.1172/Jci118722. Pmid: 8675678; Pmcid: Pmc507360.1966.
SANTOS, M. Et Al. Extensive Osteonecrosis Of The Maxilla Caused By Bisphosphonates: Report Of A Rare Case. Journal Of Clinical And Experimental Dentistry, V. 11, N. 2, 2019.
SILVA. Oliveira D. et al., Uso Da Pentoxifilina E Do Tocoferol Para Tratamento Da Osteonecrose Medicamentosa Dos Maxilares. Revista Da Faculdade De Odontologia - Upf, 29(1). Https://Doi.Org/10.5335/Rfo.V29i1.15891.2024.
SEO MH, EO MY, et al., The Effects Of Pentoxifylline And Tocopherol In Jaw Osteomyelitis. J Korean Assoc Oral Maxillofac Surg.;46(1):19–27.2020.
SOUSA, Ar,. Perfil Clínico-Epidemiológico De Pacientes Com Câncer De Cabeça E~ [Pescoço Em Hospital De Referência. Rev Soc Bras Clin Med, 14 (3), 129-132. Retrieved From: Https://Pesquisa.Bvsalud.Org/Portal/Resource/Pt/Biblio-2123.2016.
TOFÉ, Vi, et al., Osteonecrose Dos Maxilares Associada Ao Denosumabe: Estudo Das Características Clínicas E Radiográficas Em Uma Série De Casos Clínicos. J Clin Exp Dent. 1º De julho De 2020; 12(7):E676-E681. Doi: 10.4317/Jced.57019. Pmid: 32904934; Pmcid: Pmc7462378.2020.
DE VASCONCELOS, Oliveira, et al., Osteonecrose Dos Maxilares Relacionada Ao Uso De Medicamentos: Características Patológicas, Diagnóstico, Prevenção E Estratégias Terapêuticas. Revista Da Faculdade De Odontologia - Upf, 28(1). Https://Doi.Org/10.5335/Rfo.V28i1.15474.2023.
WICK, A., Bankosegger, P., Otto, S. Et Al. Fatores De Risco Associados Ao Início De Osteonecrose Da Mandíbula Relacionada A Medicamentos Em Pacientes Tratados Com Denosumabe. Clin Oral Invest26,2839–2852Https://Doi.Org/10.1007/S00784-021-04261-4.2022.
This work is licensed under a Creative Commons Attribution 4.0 International License.
Copyright (c) 2024 Pedro Gabriel Azevedo Lucena , Paloma Silva de Moura, Raissa Soares dos Anjos