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As diferentes abordagens dos pacientes com osteonecrose
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A osteonecrose dos maxilares (ONJ) representa uma complicação oral grave e um desafio clínico significativo na medicina dentária moderna. Esta patologia progressiva possui uma etiologia multifatorial, frequentemente associada a terapias sistémicas essenciais, como o uso de medicamentos antirreabsortivos (Brzak B.L. et al., 2023). A osteonecrose dos maxilares relacionada com medicamentos (MRONJ) é uma complicação pouco frequente da terapêutica antirreabsortiva (ART) em doentes que recebem doses mais elevadas e mais frequentes de inibidores dos osteoclastos (Sharma et al., 2023). A patogénese da MRONJ ainda não é completamente conhecida, o que torna complexas a avaliação do risco, a sua prevenção e o respetivo tratamento. Os médicos dentistas desempenham um papel fundamental na identificação e tratamento de
doentes em risco de MRONJ, na implementação de estratégias preventivas e no reconhecimento da MRONJ (Patel & Seoudi, 2024). Clinicamente, a condição acarreta uma morbilidade considerável, manifestando-se por alterações ósseas e tecidulares que podem evoluir para complicações severas (Byrne et al., 2024).
O presente trabalho propõe analisar criticamente, através de uma revisão da literatura, as abordagens contemporâneas de diagnóstico, prevenção e tratamento da osteonecrose dos maxilares.
A revisão da literatura da última década evidencia avanços significativos na compreensão dos mecanismos etiológicos e nas modalidades de tratamento, os quais contribuem para uma melhor gestão clínica, mas também a adoção crescente de protocolos de prevenção e de estratificação de risco.
Serão igualmente discutidas as diferentes modalidades de tratamento, desde as conservadoras até às cirúrgicas, bem como a relevância de uma abordagem multidisciplinar para a gestão otimizada desta complexa afeção, seguindo as recomendações clínicas (guidelines) sempre que possível.
Osteonecrosis of the jaws (ONJ) represents a serious oral complication and a significant clinical challenge in modern dentistry. This progressive condition has a multifactorial etiology and is frequently associated with essential systemic therapies, such as the use of antiresorptive drugs (Brzak B.L. et al., 2023). Medication-related osteonecrosis of the jaw (MRONJ) is an infrequent complication of antiresorptive therapy (ART) in patients receiving higher and more frequent doses of osteoclast inhibitors (Sharma et al., 2023). The pathogenesis of MRONJ is still not fully understood, which makes risk assessment, prevention, and treatment complex. Dentists play a fundamental role in identifying and managing patients at risk of MRONJ, in implementing preventive strategies, and in recognizing established MRONJ (Patel & Seoudi, 2024). Clinically, this condition entails considerable morbidity, manifesting as bone and soft tissue alterations that may progress to severe complications (Byrne et al., 2024). The present work aims to critically analyze, through a literature review, contemporary approaches to the diagnosis, prevention, and treatment of osteonecrosis of the jaws. The literature from the last decade shows significant advances in the understanding of etiological mechanisms and treatment modalities, which contribute to improved clinical management, as well as the increasing adoption of prevention and risk-stratification protocols. Different treatment modalities, ranging from conservative to surgical approaches (Frutuoso et al., 2024), will also be discussed, as well as the relevance of a multidisciplinary approach for the optimized management of this complex condition, following clinical recommendations (guidelines) whenever possible.
Osteonecrosis of the jaws (ONJ) represents a serious oral complication and a significant clinical challenge in modern dentistry. This progressive condition has a multifactorial etiology and is frequently associated with essential systemic therapies, such as the use of antiresorptive drugs (Brzak B.L. et al., 2023). Medication-related osteonecrosis of the jaw (MRONJ) is an infrequent complication of antiresorptive therapy (ART) in patients receiving higher and more frequent doses of osteoclast inhibitors (Sharma et al., 2023). The pathogenesis of MRONJ is still not fully understood, which makes risk assessment, prevention, and treatment complex. Dentists play a fundamental role in identifying and managing patients at risk of MRONJ, in implementing preventive strategies, and in recognizing established MRONJ (Patel & Seoudi, 2024). Clinically, this condition entails considerable morbidity, manifesting as bone and soft tissue alterations that may progress to severe complications (Byrne et al., 2024). The present work aims to critically analyze, through a literature review, contemporary approaches to the diagnosis, prevention, and treatment of osteonecrosis of the jaws. The literature from the last decade shows significant advances in the understanding of etiological mechanisms and treatment modalities, which contribute to improved clinical management, as well as the increasing adoption of prevention and risk-stratification protocols. Different treatment modalities, ranging from conservative to surgical approaches (Frutuoso et al., 2024), will also be discussed, as well as the relevance of a multidisciplinary approach for the optimized management of this complex condition, following clinical recommendations (guidelines) whenever possible.
Descrição
Dissertação para obtenção do grau de Mestre no Instituto Universitário Egas Moniz
Palavras-chave
Osteonecrose dos maxilares Osteonecrose dos maxilares relacionada com medicamentos Terapêutica antirreabsortiva Estratégias de tratamento da osteonecrose dos maxilares