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A utilização de concentrados de plaquetas (PCS) na prevenção de desenvolvimento de osteonecrose dos maxilares relacionada com medicação (MRONJ) em pacientes sujeitos a cirurgia oral : uma revisão sistemática
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Advisor(s)
Abstract(s)
Introdução: A osteonecrose dos maxilares relacionada com medicação (MRONJ) é uma condição caracterizada por uma área de osso necrótico em doentes expostos a medicação antiangiogénica ou antirreabsortiva. O risco de desenvolvimento desta patologia pode aumentar após cirurgia oral e têm vindo a ser avaliadas estratégias de prevenção da MRONJ. Os concentrados de plaquetas (PCs) contém elementos capazes de remodelar a matriz óssea e estimular a angiogénese, podendo ser utilizados para fins terapêuticos em vários campos da medicina, incluindo na medicina dentária.
Objetivos: Avaliar, através de uma revisão sistemática com meta-análise, a evidência disponível relativamente à utilização de PCs na prevenção da MRONJ após cirurgia oral.
Materiais e métodos: B-on, PubMed, Scopus, Embase, Web of Science e Cochrane foram pesquisadas até abril de 2023. Foi utilizado o algoritmo de pesquisa “Osteonecrose dos Maxilares” AND “Concentrados de Plaquetas” NOT “case report” e efetuada uma pesquisa manual nas referências bibliográficas dos artigos selecionados. Foram utilizadas duas ferramentas de risco de viés: Tool to Assess Risk of Bias in Cohort Studies by the CLARITY Group at McMaster University e JBI Critical Appraisal Checklist for Studies
Reporting Prevalence Data. Os gráficos do risco de viés foram produzidos nos programas Microsoft Excel e Robvis tool e as meta-análises e meta-regressões no software OpenMetaAnalyst for Sierra (10.12).
Resultados: Em dez estudos elegíveis com um total de 828 pacientes, 16 apresentaram MRONJ. Não se encontraram diferenças de risco de desenvolvimento de MRONJ significativas após cirurgia oral com ou sem a aplicação de PCs. Contudo, a via intravenosa de administração da medicação antirreabsortiva mostrou ser um fator significativo de aumento da incidência de MRONJ relativamente à via oral.
Conclusão: Devido a limitações, os resultados não são suficientes para provar a eficácia dos PCs na prevenção de MRONJ após cirurgia oral. São necessários mais estudos randomizados e de maiores dimensões.
Introduction: Medication-related osteonecrosis of the jaw (MRONJ) is a condition characterized by an area of necrotic bone in patients exposed to antiangiogenic or antiresorptive medication. The risk of developing this condition may increase after oral surgery and strategies to prevent MRONJ have been evaluated. Platelet concentrates (PCs) contain elements capable of remodeling the bone matrix and stimulating angiogenesis, and can be used for therapeutic purposes in various fields of medicine, including dentistry. Aim: Evaluate, through a systematic review with meta-analysis, the available evidence regarding use of PCs in the prevention MRONJ. Methodology: B-on, PubMed, Scopus, Embase, Web of Science and Cochrane were searched until April 2023. The search algorithm “Osteonecrosis of the jaw” AND “Platelet Concentrates” and a manual search was performed in the references of the selected articles. Two risk of bias tools were used: Tool to Assess Risk of Bias in Cohort Studies by the CLARITY Group at McMaster University and JBI Critical Appraisal checklist for studies reporting prevalence data. Risk of bias plots were produced using Microsoft Excel and Robvis tool, and meta-analyses and meta-regressions in OpenMetaAnalyst for Sierra (10.12) software. Results: In ten eligible studies with a total of 828 patients, 16 had MRONJ. No significant differences in risk of developing MRONJ were found after oral surgery with or without the application of CPs. However, the intravenous route of administration of antiresorptive medication was shown to be a significant factor in increasing the incidence of MRONJ relative to the oral route. Conclusions: Due to limitations, the results are not sufficient to prove the effectiveness of PCs in preventing MRONJ after oral surgery. More randomized and larger studies are needed.
Introduction: Medication-related osteonecrosis of the jaw (MRONJ) is a condition characterized by an area of necrotic bone in patients exposed to antiangiogenic or antiresorptive medication. The risk of developing this condition may increase after oral surgery and strategies to prevent MRONJ have been evaluated. Platelet concentrates (PCs) contain elements capable of remodeling the bone matrix and stimulating angiogenesis, and can be used for therapeutic purposes in various fields of medicine, including dentistry. Aim: Evaluate, through a systematic review with meta-analysis, the available evidence regarding use of PCs in the prevention MRONJ. Methodology: B-on, PubMed, Scopus, Embase, Web of Science and Cochrane were searched until April 2023. The search algorithm “Osteonecrosis of the jaw” AND “Platelet Concentrates” and a manual search was performed in the references of the selected articles. Two risk of bias tools were used: Tool to Assess Risk of Bias in Cohort Studies by the CLARITY Group at McMaster University and JBI Critical Appraisal checklist for studies reporting prevalence data. Risk of bias plots were produced using Microsoft Excel and Robvis tool, and meta-analyses and meta-regressions in OpenMetaAnalyst for Sierra (10.12) software. Results: In ten eligible studies with a total of 828 patients, 16 had MRONJ. No significant differences in risk of developing MRONJ were found after oral surgery with or without the application of CPs. However, the intravenous route of administration of antiresorptive medication was shown to be a significant factor in increasing the incidence of MRONJ relative to the oral route. Conclusions: Due to limitations, the results are not sufficient to prove the effectiveness of PCs in preventing MRONJ after oral surgery. More randomized and larger studies are needed.
Description
Dissertação para obtenção do grau de Mestre no Instituto Universitário Egas Moniz
Keywords
Osteonecrose dos maxilares Concentrados de plaquetas Prevenção Cirurgia oral