O uso dos bisfosfonatos e as medidas profiláticas e terapêuticas para a osteonecrose dos maxilares: uma revisão sistemática de estudos in vivo em modelo animal

Abstract

Bisphosphonate-Associated Osteonecrosis of the Jaw is a pathological condition characterized by the presence of exposed necrotic bone in the oral cavity or bone that can be probed through an intraoral or extraoral fistula, persistent for more than 8 weeks; in patients on previous or current drug therapy with bisphosphonates, with no history of radiotherapy. Objective: to understand the relationship between the use of bisphosphonates and the development of osteonecrosis of the jaws, as well as to provide information on new therapeutic options to combat or prevent this pathology. Method: systematic review of in vivo studies in an animal model, using two search strategies {(Diphosphonates and Osteonecrosis and Jaw and Bone Remodeling) and (Bone Remodeling and Bisphosphonate-Associated Osteonecrosis of the Jaw)} from 2017 to 2022 in the databases from Medline, PMC and EBSCO data, with a final sample of 21 articles. Conclusion: Dental surgeons need to better understand the pathophysiology of ONB and its forms of prevention and treatment, due to the risk related to performing invasive surgical procedures in patients undergoing therapy with BFs. In addition to hygiene control, removal of infectious foci, antibiotic therapy, debridement and surgical resection, other methods have emerged, such as the use of membranes (Mucograft collagen matrix or PRP), combined therapies (doxycycline+PDT+β-TCP), growth factors (bFGF or A-Heal + ABMDO), elements derived from adipose tissue (ASCs or sEV-AT), biodegradable Mg implants and intermittent injections of PTH, combining anti-inflammatory, antimicrobial, pro-angiogenic and osteopromotive properties.