Abstract
Bisphosphonates are drugs that inhibit osteoclastic cells and are used as the first choice therapy in disorders that affect bone metabolism. In view of the benefits of BFs, the first reports of osteonecrosis of the jaws were described, which clinically presents itself as a region of bone exposure with necrosis and purulent secretion. Invasive surgical procedures, such as tooth extractions and the installation of implants can be triggering factors for osteonecrosis of the jaws, care related to these patients should be redoubled. Objective: To report the case of a patient who received a rehabilitation treatment with a dental implant and who used Alendronate, promoting a discussion on treatment management and the care protocols for these patients. Case report: Female patient, 56 years old, caucasian, with a history of surgical, chemotherapy and radiotherapy treatment of invasive ductal carcinoma in the left breast and metastatic carcinoma in the left armpit and in continuous use of Zometa® (zoledronic acid - 4mg /100mL), complained of mobility and bad odor related to element 11. Tomographic examination showed root fracture, associated with a post/crown assembly, with indication for extraction. Taking into account the risks, benefits and patient autonomy in choosing rehabilitation with implants, a minimally invasive surgery with immediate loading was planned.Conclusion: Patients who are undergoing treatment with bisphosphonates can be considered for the installation of dental implants, where each clinical situation must be evaluated individually, in order to minimize surgical trauma and the riskof development of medication-related osteonecrosis of the jaws in these individuals.
References
Advisory Task Force on Bisphosphonate-Related Ostenonecrosis of the Jaws, American Association of Oral and Maxillofacial Surgeons: American Association of Oral and Maxillofacial Surgeons position paper on bisphosphonate-related osteonecrosis of the jaws. J Oral Maxillofac Surg, v. 65, 2007.
American Dental Association Council on Scientific Affairs: Dental management of patients receiving oral bisphosphonate therapy: Expert panel recommendations. J Am Dent Assoc, v. 137, 2006.
ANESI, A. et al. From osteoclast differentiation to osteonecrosis of the jaw: Molecular and clinical insights. International journal of molecular sciences, v. 20, n. 19, p. 4925, 2019.
ATA-ALI, J. et al. What is the impact of bisphosphonate therapy upon dental implant survival? A systematic review and meta-analysis. Clinical oral implants research, v. 27, n. 2, p. e38-46, 2016.
CHADHA, G. K. et al. Osseointegration of dental implants and osteonecrosis of the jaw in patients treated with bisphosphonate therapy: a systematic review. The journal of oral implantology, v. 39, n. 4, p. 510–520, 2013.
CHAVES, R. A. DA C. et al. Bifosfonatos e Denosumabes: mecanismos de ação e algumas implicações para a implantodontia. Revista Brasileira Multidisciplinar, v. 21, n. 2, p. 66–80, 2018.
DIZ, P.; SCULLY, C.; SANZ, M. Dental implants in the medically compromised patient. Journal of dentistry, v. 41, n. 3, p. 195–206, 2013.
ENDO, Y. et al. Underlying mechanisms and therapeutic strategies for bisphosphonaterelated osteonecrosis of the jaw (BRONJ). Biol Pharm Bull, v. 40, p. 739–750, 2017.
FERREIRA, G. Z. et al. Oral rehabilitation with dental implants and the importance of a preventive evaluation for osteonecrosis of the jaws associated with medications. The journal of oral implantology, v. 46, n. 4, p. 431–437, 2020.
GA Rodan Mecanismo de ação dos bisfosfonatos contendo nitrogênio Mini. Rev Med Chem, v. 4, 2004.
GIOVANNACCI, I. et al. Medication-related osteonecrosis of the jaw around dental implants: Implant surgery-triggered or implant presence-triggered osteonecrosis? The journal of craniofacial surgery, v. 27, n. 3, p. 697–701, 2016.
GRANT, B.-T. et al. Outcomes of placing dental implants in patients taking oral bisphosphonates: a review of 115 cases. Journal of oral and maxillofacial surgery: official journal of the American Association of Oral and Maxillofacial Surgeons, v. 66, n. 2, p. 223–230, 2008.
GUAY, D. R. P. Ibandronate, an experimental intravenous bisphosphonate for osteoporosis, bone metastases, and hypercalcemia of malignancy. Pharmacotherapy, v. 26, n. 5, p. 655–673, 2006.
HEWITT, C.; FARAH, C. S. Bisphosphonate-related osteonecrosis of the jaws: a comprehensive review: Bisphosphonate-related osteonecrosis of the jaws. Journal of oral pathology & medicine: official publication of the International Association of Oral Pathologists and the American Academy of Oral Pathology, v. 36, n. 6, p. 319–328, 2007.
JACOBSEN, C.; METZLER, P.; ROSSLE, M. Osteopathology induced by bisphosphonates and dental implants: clinical observations Clin Oral Investig. Clin Oral Investig, v. 17, p. 167–175, 2013.
KWON, T. G.; LEE, C. O.; PARK, J. W. Osteonecrosis associated with dental implants in patients undergoing bisphosphonate treatment Clin. Clin Oral Implants Res, v. 25, p. 632–640, 2014.
LAZAROVICI, T. S. et al. Bisphosphonate-related osteonecrosis of the jaw associated with dental implants. Journal of oral and maxillofacial surgery: official journal of the American Association of Oral and Maxillofacial Surgeons, v. 68, n. 4, p. 790–796, 2010.
MARX, R. E. Oral and Intravenous Bisphosphonate-Induced Osteonecrosis of the Jaws Quintessence. Hanover Park, IL: [s.n.].
MATTOS, R. P.; OLIVEIRA, M.; ZANETTA- BARBOSA, D. Riscos e complicações para os ossos da face decorrentes do uso de bisfosfonatos. Rev bras odontol, v. 70, p. 114–119, 2013.
MENDES, V. et al. Impact of bisphosphonate therapy on dental implant outcomes: An overview of systematic review evidence. International journal of oral and maxillofacial surgery, v. 48, n. 3, p. 373–381, 2019.
MURAD, M. H.; ASI, N.; ALSAWAS, M. Alahdab Nova pirâmide de evidências Med Baseado em Evid. v. 21, p. 125–127, 2016.
NISI, F. L.; FERLA, D. Risk factors influencing BRONJ staging in patients receiving intravenous bisphosphonates: a multivariate analysis Int J. Int J Oral Maxillofac Surg, v. 44, p. 586–591, 2015.
OTTO, S. et al. Osteoporosis and bisphosphonates-related osteonecrosis of the jaw: not just a sporadic coincidence-a multi- centre study. J Craniomaxillofac Surg, v. 39, n. 4, p. 272–277, 2011.
OTTO, S. et al. Bisphosphonate-related osteonecrosis of the jaws - characteristics, risk factors, clinical features, localization and impact on oncological treatment. Journal of cranio-maxillo-facial surgery: official publication of the European Association for Cranio-Maxillo-Facial Surgery, v. 40, n. 4, p. 303–309, 2012.
PICHARDO E, J. C. G. et al. Dental implants as risk factors for patients with medication-related osteonecrosis of the jaws (MRONJ). British Journal of Oral and Maxillofacial Surgery, v. 58, n. 7, p. 771–776, 2020.
PICHARDO, J. P. Merkesteyn Bisphosphonate related osteonecrosis of the jaws: spontaneous or dental origin? Oral Surg Oral Med Oral Pathol Oral Radiol. v. 116, p. 287–292, 2013.
POGREL, M. A. Ruggiero Previously successful dental implants can fail when patients commence anti-resorptive therapy-a case series. Int J Oral Maxillofac Surg, v. 47, p. 220–222, 2018.
RUGGIERO, S. L. Guidelines for the diagnosis of bisphosphonate-related osteonecrosis of the jaw (BRONJ). Clinical cases in mineral and bone metabolism: the official journal of the Italian Society of Osteoporosis, Mineral Metabolism, and Skeletal Diseases, v. 4, n. 1, p. 37–42, 2007.
RUGGIERO, S. L. et al. American Association of Oral and Maxillofacial Surgeons position paper on bisphosphonate-related osteonecrosis of the jaws-2009 update. J Oral Maxillofac Surg, v. 67, n. 5, p. 2–12, 2009.
RUGGIERO, S. L. American Association of Oral and Maxillofacial Surgeons position paper on medication-related osteonecrosis of the jaw- 2014 update. Journal of Oral and Maxillofacial Surgery, n. 10, p. 1938–1956, 2014.
RUGGIERO, S. L.; DREW, S. J. Osteonecrosis of the jaws and bisphosphonate therapy. Journal of dental research, v. 86, n. 11, p. 1013–1021, 2007.
STRAMANDINOLI-ZANICOTTI, R. T. et al. Implantes dentários em pacientes usuários de bifosfonatos: o risco de osteonecrose e perda dos implantes é real? Relato de três casos clínicos. RSBO, v. 15, n. 1, p. 50– 09, 2018.
TROELTZSCH, M.; CAGNA, D.; STAHLER, P. Clinical features of peri-implant medication- related osteonecrosis of the jaw: is there an association to peri-implantitis? J Craniomaxillofac Surg, v. 44, p. 1945–1951, 2016.
WANG, H.-L.; WEBER, D.; MCCAULEY, L. K. Effect of long-term oral bisphosphonates on implant wound healing: literature review and a case report. Journal of periodontology, v. 78, n. 3, p. 584–594, 2007.
ZENG, Y. et al. A systematic review assessing the effectiveness of alendronate in reducing periprosthetic bone loss after cementless primary THA. Orthopedics, v. 34, n. 4, 2011.

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