Osteonecrose dos maxilares associada ao uso de bifosfonatos: relato de caso clínico

Abstract

Biphosphonates are drugs used for the management of bone diseases and the control of metastasis of malignant tumors that act in the osteoclastic activity. Since 2003 is reported a complication associated with the use of this drugs, the bisphosphonaterelated osteonecrosis of the jaw. This complication is defined as an area of exposed bone or bone that can be probed through an intraoral or extraoral fistula in the maxillofacial region that has not healed with 8 weeks in a patient who was taking or had been exposed to bisphosphonate therapy and had not had radiotherapy to the craniofacial region. Its etiology is not fully defined, however it is known that major risk fator its appearance is related to local factors such as invasive procedures, maladaptive prosthesis and the presence of inflammatory dental disease. Systemic factors such as smoking, alcohol or systemic diseases may also be related. In the present study, a patient who was under treatment with bisphosphonates sought care after observing some lesions in her mouth that did not heal over time. After the clinical and complementary examination, she was diagnosed with bisphosphonate-related osteonecrosis of the jaw. The proposed treatment for the patient was bone debridement associated with antibiotic therapy and adjuvant therapies, such as graft with L-PRF (Leukocyte-Platelate-Rich Fibrin) and hyperbaric oxygen therapy. The patient reported an improvement in pain after hyperbaric oxygenation sessions prior to the surgical procedure. After the surgical intervention, there was a control of the necrotic areas after adequate healing of the surgical site. Thus, we concluded that bone debridement associated with adjuvant therapies offers an adequate therapeutic management of bisphosphonate-related osteonecrosis of the jaw