Tratamento da osteonecrose medicamentosa dos maxilares: estudo de série de casos

Abstract

The aim of this study was to retrospectively evaluate the treatment outcome of a consecutive series of 11 patients diagnosed with medication-related osteonecrosis of the jaws (MRONJ). All patients were female with a mean age of 74.8 years. Nine patients were medicated for osteoporosis with oral bisphosphonates and two patients were treated for metastatic breast cancer with zoledronate. The mean time of exposure to bone antiresorptive drugs before developing the disease was 6.7 years. MRONJ prevailed in the mandible, with the occurrence of a pathological fracture in one patient. Most patients were classified as MRONJ stage 2, and the most frequent triggering factors were tooth extraction and dental implant therapy. All patients underwent conservative therapies and surgical treatments, but none of them required segmental surgical resection. Adjunctive treatment of MRONJ was used in five patients, with the administration of pentoxifylline with tocopherol and hyperbaric oxygen therapy. Mean treatment and follow-up periods were 5 and 21.3 months respectively. There was complete resolution of the disease in all patients without recurrence in the operated sites. MRONJ can lead to serious local sequelae in its more advanced stages, such as mandibular fractures, and distant complications, although rare, can occur with hematogenous dissemination of the infectious agent. One of the patients in the case series had a pathological mandibular fracture related to stage 3 of the disease, in addition to an atypical fracture and osteomyelitis of the femur. It was concluded that MRONJ must be diagnosed early and can be treated with conservative therapies and minimally invasive surgeries even in advanced stages, avoiding segmental surgical resections and extensive bone reconstructions.