Multimodal Therapy for the Management of Drug-Induced Osteonecrosis: Case Report
Resumo
Abstract
Osteonecrosis of the jaws is a complex and debilitating condition, whose characteristic is the gradual destruction of the jaws in patients exposed to predisposing factors, such as tooth extraction. The clinical manifestations vary according to the severity of the lesion, which may culminate in the exposure of necrotic bone. The objective of this study is to discuss therapeutic options in the management of osteonecrosis associated with the use of cancer medication (MRONJ) through a case report, in addition to discourse the topic, discussing the importance of the role of Dentistry in the prevention and management of the condition. A 45-year-old female patient, melanoderma, with malignant left breast neoplasm associated with metastasis in the bone and peritoneum, and using the bisphosphonate Zometa®, was diagnosed with MRONJ after teeth 26 extraction’. Multimodal therapy through the use of topical antimicrobials, Antimicrobial Photodynamic Therapy, systemic antibiotic and ozone therapy were adopted to regression of the case. The patient was follow-up for 46 months. In order to update the information regarding MRONJ, cases in maxilla, their repercussions, challenges and therapeutic options, It was carried out aditional search in eletronic databases. MRONJ is a challenging condition that deserves to be discussed in order to contribute to a better understanding of the disease, prevention and management. That way, the positive result of adjuvant therapies demonstrated in this report may contribute to the structuring of effective protocols for the management of MRONJ, in addition to enabling the development of new questions and, therefore, new studies related to the condition.
Keywords: Osteonecrosis. Maxilla. Bisphosphonate. Bisphosphonates-Related Osteonecrosis of the Jaws. Bone Density.
Resumo
A osteonecrose dos maxilares é uma condição complexa e debilitante, que tem como característica a destruição gradativa dos maxilares em pacientes expostos a fatores predisponentes, como uma extração dentária. As manifestações clínicas variam de acordo com a gravidade da lesão, podendo culminar na exposição de osso necrótico. Este trabalho tem como objetivo discutir opções terapêuticas no manejo da osteonecrose associada ao uso de medicamento (OMAM) oncológico por meio de um relato de caso, além de discorrer acerca do tema, discutindo a importância da atuação da Odontologia na prevenção e manejo da condição. Paciente 45 anos, sexo feminino, melanoderma, portadora de neoplasia maligna em mama esquerda, com metástase em osso e peritônio e sob uso do bisfosfonato Zometa® foi diagnosticada com OMAM após exodontia de unidade 26. Terapia multimodal através do uso de antimicrobiano tópico, Terapia Fotodinâmica antimicrobiana, antibioticoterapia sistêmica e ozonioterapia foram adotadas com vistas à regressão do caso e a paciente foi acompanhada por 46 meses. No intuito de atualizar informações referentes à OMAM, sobretudo casos em maxila, suas repercussões, desafios e opções terapêuticas, foi realizada uma busca adicional em bases eletrônicas. A OMAM é uma condição desafiadora que merece ser discutida a fim de contribuir com um melhor conhecimento, prevenção e manejo. Dessa forma, o resultado positivo das terapias adjuvantes demonstrado no presente relato pode contribuir com a estruturação de protocolos efetivos para o manejo da OMAM, além de possibilitar a elaboração de novos questionamentos e, portanto, novos estudos relacionados à condição.
Palavras-chave: Osteonecrose. Maxila. Bisfosfonato. Osteonecrose Associada a Bisfosfonatos. Conservadores da Densidade Óssea.
Referências
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