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Advisor(s)
Abstract(s)
Os medicamentos antirreabsortivos (ARDs) são utilizados para impedir a ação osteoclástica. Dos mais utilizados, temos os Bifosfonatos e o Denosumab, que são usados principalmente no tratamento de doenças malignas e metástases ósseas, na doença de Paget e na osteoporose. Estes medicamentos estão, no entanto, associados ao desenvolvimento da Osteonecrose dos Maxilares Associada ao uso de Medicamentos
(MRONJ), que se caracteriza e define pela presença de necrose óssea nos maxilares de doentes medicados com este grupo de drogas, entre outras.
Os ARDs estão associados a diversos fatores de risco locais e sistémicos de osteonecrose, incluindo comorbilidades como metástases, cancro ósseo, doença de Paget, diabetes e periodontite. Outros fatores incluem o uso concomitante de esteroides ou agentes antiangiogénicos, bem como a potência do fármaco, a via de administração e a duração do tratamento. Os fatores de risco locais incluem tratamentos dentários invasivos, nomeadamente cirurgia oral e de implantes.
Papadakis e os seus colaboradores descrevem estudos com casos de MRONJ como complicação em implantes previamente colocados e bem-sucedidos. O sucesso da osteointegração com implantes é possível em pacientes que recebem medicação antireabsortiva, mas estes pacientes devem estar bem informados sobre o possível risco de desenvolverem MRONJ precoce ou tardiamente, bem como sobre a importância de
manterem uma excelente saúde e higiene oral. A avaliação do risco individual de cada paciente é muito importante e um planeamento cuidadoso do tratamento são também fortemente recomendados.
Esta dissertação pretende fazer uma revisão narrativa sobre as indicações, contraindicações, os riscos e como minimizá-los, na reabilitação oral com implantes em pacientes medicados com drogas antireabsortivas.
Antiresorptive Drugs (ARDs) are used to inhibit osteoclastic activity. Among the most used are Bisphosphonates and Denosumab, which are primarily used in the treatment of malignant diseases and bone metastases, Paget9s disease, and osteoporosis. However, these drugs are associated with the development of Medication-Related Osteonecrosis of the Jaws (MRONJ), characterized and defined by the presence of bone necrosis in the jaws of patients treated with this group of drugs, among others. ARDs are associated with various local and systemic risk factors for osteonecrosis, including comorbidities such as metastases, bone cancer, Paget9s disease, diabetes, and periodontitis. Other factors include the concomitant use of steroids or antiangiogenic agents, as well as the potency of the drug, the route of administration, and the duration of treatment. Local risk factors include invasive dental treatments, particularly oral and implant surgeries. Papadakis and collaborators describe studies of MRONJ cases as complications in previously placed and successful implants. Successful osseointegration of implants is possible in patients receiving antiresorptive medication, but these patients should be well informed about the potential risk of developing early or late MRONJ, as well as the importance of maintaining excellent oral health and hygiene. The individual risk assessment of each patient is crucial, and careful treatment planning is strongly recommended. This dissertation aims to conduct a literature review of the indications, contraindications, risks, and strategies to minimize them in oral rehabilitation with implants in patients treated with antiresorptive drugs.
Antiresorptive Drugs (ARDs) are used to inhibit osteoclastic activity. Among the most used are Bisphosphonates and Denosumab, which are primarily used in the treatment of malignant diseases and bone metastases, Paget9s disease, and osteoporosis. However, these drugs are associated with the development of Medication-Related Osteonecrosis of the Jaws (MRONJ), characterized and defined by the presence of bone necrosis in the jaws of patients treated with this group of drugs, among others. ARDs are associated with various local and systemic risk factors for osteonecrosis, including comorbidities such as metastases, bone cancer, Paget9s disease, diabetes, and periodontitis. Other factors include the concomitant use of steroids or antiangiogenic agents, as well as the potency of the drug, the route of administration, and the duration of treatment. Local risk factors include invasive dental treatments, particularly oral and implant surgeries. Papadakis and collaborators describe studies of MRONJ cases as complications in previously placed and successful implants. Successful osseointegration of implants is possible in patients receiving antiresorptive medication, but these patients should be well informed about the potential risk of developing early or late MRONJ, as well as the importance of maintaining excellent oral health and hygiene. The individual risk assessment of each patient is crucial, and careful treatment planning is strongly recommended. This dissertation aims to conduct a literature review of the indications, contraindications, risks, and strategies to minimize them in oral rehabilitation with implants in patients treated with antiresorptive drugs.
Description
Dissertação para obtenção do grau de Mestre no Instituto Universitário Egas Moniz
Keywords
Implantologia Terapêutica antirreabsortiva Remodelação óssea Osteointegração