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Impacto da terapêutica anti-reabsortiva na reabilitação oral com implantes dentários
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Advisor(s)
Abstract(s)
A terapêutica anti-reabsortiva é constituída por cinco classes farmacológicas – bifosfonatos, denosumab, terapia de substituição hormonal, moduladores seletivos dos recetores de estrogénio e calcitonina. É utilizada para tratamento de patologias como a osteoporose, neoplasias e metástases ósseas, doença de Paget e osteogénese imperfeita.
Os implantes dentários são atualmente reconhecidos como a melhor opção de tratamento para substituição de dentes ausentes, apresentando altas taxas de sucesso, para além de inúmeras vantagens relativamente a outras alternativas protéticas.
Uma vez que a terapia anti-reabsortiva interfere no metabolismo ósseo, e o sucesso dos implantes está dependente do processo de osteointegração, que por sua vez depende do turnover ósseo, pode pressupor-se que estes fármacos influenciem as taxas de sucesso dos implantes. Desta forma, o objetivo desta revisão literária prende-se com a avaliação do impacto que a terapia anti-reabsortiva pode ter na reabilitação oral com implantes dentários, designadamente na sobrevivência, perda óssea marginal e desenvolvimento de osteonecrose dos maxilares relacionada com medicação. Esta patologia surge como uma complicação rara associada ao uso de bifosfonatos e denosumab, sendo uma das principais causas de perda de implantes. Doses orais de bifosfonatos não parecem ser responsáveis por aumentos da taxa de falha de implantes, nem proporcionam diferenças significativas a nível da osteointegração e da perda óssea marginal, apresentando taxas de sucesso e sobrevivência elevadas. Pelo contrário, doses intravenosas de bifosfonatos estão associadas a maiores taxas de insucesso.
Os artigos incluídos revelam a falta de evidência científica disponível acerca deste tema, especialmente em relação à terapia de substituição hormonal, aos moduladores seletivos dos recetores de estrogénio e à calcitonina, demonstrando a necessidade urgente de mais estudos.
Anti-resorptive therapy includes five pharmacological classes – bisphosphonates, denosumab, hormonal replacement therapy, selective estrogen receptor modulators and calcitonin. It is used to treat pathologies such as osteoporosis, cancer and bone metastases, Paget's disease and osteogenesis imperfecta. Dental implants are considered the best treatment option for replacing missing teeth, having high success rates and numerous advantages over other prosthetic alternatives. Since anti-resorptive therapy interferes with bone metabolism, and implant success depends on the osseointegration process, which in turn depends on bone turnover, it can be assumed that these drugs influence implant success rates. Thus, the aim of this literature review is to assess the impact that anti-resorptive therapy can have on oral rehabilitation with dental implants, namely on survival rates, marginal bone loss and development of medication-related osteonecrosis of the jaws. This pathology appears as a rare complication associated with the use of bisphosphonates and denosumab, being one of the main causes of implant loss. Oral doses of bisphosphonates do not seem to be responsible for the increases in the implant failure rates, nor do they provide differences in the level of osseointegration and marginal bone loss, presenting high success and survival rates. In contrast, intravenous doses of bisphosphonates are associated with bigger failure rates. The included articles reveal the lack of available evidence on this topic, especially in relation to hormonal replacement therapy, selective estrogen receptor modulators and calcitonin, demonstrating the urgent need for further studies.
Anti-resorptive therapy includes five pharmacological classes – bisphosphonates, denosumab, hormonal replacement therapy, selective estrogen receptor modulators and calcitonin. It is used to treat pathologies such as osteoporosis, cancer and bone metastases, Paget's disease and osteogenesis imperfecta. Dental implants are considered the best treatment option for replacing missing teeth, having high success rates and numerous advantages over other prosthetic alternatives. Since anti-resorptive therapy interferes with bone metabolism, and implant success depends on the osseointegration process, which in turn depends on bone turnover, it can be assumed that these drugs influence implant success rates. Thus, the aim of this literature review is to assess the impact that anti-resorptive therapy can have on oral rehabilitation with dental implants, namely on survival rates, marginal bone loss and development of medication-related osteonecrosis of the jaws. This pathology appears as a rare complication associated with the use of bisphosphonates and denosumab, being one of the main causes of implant loss. Oral doses of bisphosphonates do not seem to be responsible for the increases in the implant failure rates, nor do they provide differences in the level of osseointegration and marginal bone loss, presenting high success and survival rates. In contrast, intravenous doses of bisphosphonates are associated with bigger failure rates. The included articles reveal the lack of available evidence on this topic, especially in relation to hormonal replacement therapy, selective estrogen receptor modulators and calcitonin, demonstrating the urgent need for further studies.
Description
Dissertação para obtenção do grau de Mestre no Instituto Universitário Egas Moniz
Keywords
Terapia anti-reabsortiva Implantes dentários Osteonecrose dos maxilares Tecido ósseo