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Opções de reabilitação oral após osteonecrose dos maxilares tratada : pacientes com perda óssea significativa
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A osteonecrose dos maxilares relacionada com medicamentos (MRONJ) é uma complicação grave das terapêuticas antirresortivas e antiangiogénicas, definida pela AAOMS como a presença de osso exposto ou sondável durante mais de oito semanas, na ausência de antecedentes de radioterapia dos maxilares.
Quando o seu tratamento origina perda óssea significativa, a reabilitação oral constitui um desafio clínico complexo, cujas modalidades permanecem insuficientemente codificadas. Esta revisão narrativa analisa as opções disponíveis, integrando o momento da reabilitação, as soluções protéticas sem reconstrução óssea e as abordagens implantares.
A decisão de reabilitar deve basear-se na estabilidade clínica documentada, e não num prazo fixo, distinguindo as sequelas do tratamento conservador das resultantes de cirurgia ressetiva. Na ausência de reconstrução, as próteses removíveis convencionais representam frequentemente uma solução de primeira linha, desde que sejam concebidas de forma atraumática e acompanhadas de seguimento rigoroso. As próteses fixas sobre dentes remanescentes podem ser consideradas quando existe suporte periodontal estável. Quando a reconstrução óssea é necessária, as tecnologias digitais, como a planificação cirúrgica virtual, os guias impressos em 3D e as placas CAD/CAM, melhoram a precisão e a previsibilidade do tratamento reconstrutivo. Os implantes endósseos convencionais, colocados em osso nativo estabilizado ou em retalho ósseo vascularizado, apresentam resultados encorajadores, mas a sua indicação deve manter-se seletiva. Os implantes subperiosteais personalizados constituem uma opção emergente nas perdas ósseas severas, embora os dados clínicos ainda sejam limitados. A reabilitação oral após MRONJ tratada exige, portanto, uma abordagem individualizada, multidisciplinar e biologicamente prudente.
Medication-related osteonecrosis of the jaw (MRONJ) is a serious complication of antiresorptive and antiangiogenic therapies, defined by the AAOMS as the presence of exposed or probeable bone for more than eight weeks, in the absence of previous jaw radiotherapy. When its treatment results in significant bone loss, oral rehabilitation represents a complex clinical challenge whose management remains insufficiently codified. This narrative review analyses the available options, including the timing of rehabilitation, prosthetic solutions without bone reconstruction, and implant-based approaches. The decision to rehabilitate should be based on documented clinical stability rather than a fixed time interval, distinguishing the sequelae of conservative treatment from those resulting from resective surgery. In the absence of reconstruction, conventional removable prostheses often represent a first-line solution, provided they are designed atraumatically and supported by rigorous follow-up. Fixed prostheses on remaining teeth may be considered when stable periodontal support is present. When bone reconstruction is required, digital technologies, such as virtual surgical planning, 3D-printed guides and CAD/CAM plates, improve the precision and predictability of reconstructive treatment. Conventional endosseous implants, placed in stabilised native bone or vascularised bone flaps, show encouraging outcomes, but their indication must remain selective. Customised subperiosteal implants represent an emerging option in severe bone loss, although clinical data remain limited. Oral rehabilitation after treated MRONJ therefore requires an individualised, multidisciplinary and biologically cautious approach.
Medication-related osteonecrosis of the jaw (MRONJ) is a serious complication of antiresorptive and antiangiogenic therapies, defined by the AAOMS as the presence of exposed or probeable bone for more than eight weeks, in the absence of previous jaw radiotherapy. When its treatment results in significant bone loss, oral rehabilitation represents a complex clinical challenge whose management remains insufficiently codified. This narrative review analyses the available options, including the timing of rehabilitation, prosthetic solutions without bone reconstruction, and implant-based approaches. The decision to rehabilitate should be based on documented clinical stability rather than a fixed time interval, distinguishing the sequelae of conservative treatment from those resulting from resective surgery. In the absence of reconstruction, conventional removable prostheses often represent a first-line solution, provided they are designed atraumatically and supported by rigorous follow-up. Fixed prostheses on remaining teeth may be considered when stable periodontal support is present. When bone reconstruction is required, digital technologies, such as virtual surgical planning, 3D-printed guides and CAD/CAM plates, improve the precision and predictability of reconstructive treatment. Conventional endosseous implants, placed in stabilised native bone or vascularised bone flaps, show encouraging outcomes, but their indication must remain selective. Customised subperiosteal implants represent an emerging option in severe bone loss, although clinical data remain limited. Oral rehabilitation after treated MRONJ therefore requires an individualised, multidisciplinary and biologically cautious approach.
Descrição
Dissertação para obtenção do grau de Mestre no Instituto Universitário Egas Moniz
Palavras-chave
Osteonecrose dos maxilares Reabilitação oral Implantes dentários Perda óssea