Implantes en pacientes adultos medicados con bifosfonatos - drogas antirresortivas / Imiplants in adult patients medicated with biphosphonates - antiresorptive drugs

La osteonecrosis maxilar (ONM) asociada a me- dicamentos, también denominada osteonecrosis maxilar medicamentosa (ONMM), se define como un área ósea, expuesta al medio bucal, con más de ocho semanas de permanencia, que se presenta en pacientes sin antecedentes de radioterapia en cabe- za y cuello, tratados con antirresortivos y/o antian- giogénicos. La estimulación traumática provocada por la cirugía dental o la colocación de implantes dentales se ha indicado como uno de los posibles factores predisponentes a esta patología (Ferreira et al., 2020). Con el objeto de profundizar el conocimiento de la relación entre el uso de medicamentos antirresorti- vos y antiangiogénicos y los posibles riesgos en re- lación con la utilización de implantes dentales para rehabilitación en pacientes adultos mayores, se rea- lizó un estudio retrospectivo ­de corte transversal­ mediante el análisis de la información obtenida a partir de una revisión bibliográfica sistematizada de publicaciones indexadas referidos a implantes en el adulto medicado con bifosfonatos-drogas resortivas con fecha de octubre de 2021. La conclusión fue no es competencia del profesional odontólogo suspender ni alterar la frecuencia en la ingesta de la medicación señalada por el profesional médico. En estos casos, es fundamental tener en cuenta la interrelación medicina y odontología. Y todos los pacientes tratados con bifosfonatos deben ser informados sobre el posible riesgo de pérdida del implante o la posibilidad de osteonecrosis (AU)

Osteonecrosis of the jaw ONJ, associated with medications, also called MRONJ, is defined as a bone area, exposed to the oral environment, with more than eight weeks of permanence that occurs in patients, without a history of head and neck radiotherapy, treated with antiresorptive and/ or antiangiogenic. Traumatic stimulation caused by dental surgery, or the placement of dental implants has been indicated as one of the possible predisposing factors for this pathology (Ferreira et al., 2020). In order to deepen the knowledge of the relationship between the use of antiresorptive drugs and the possible risks in relation to the use of dental implants for rehabilitation in older adult patients, a retrospective cross-sectional study was carried out by analyzing the information obtained from Based on a systematic bibliographic review of indexed publications referring to Implants in adults medicated with bisphosphonates-responsive drugs dated October 2021. We conclude that it is not the responsibility of the dental professional to suspend or alter the frequency of medication intake indicated by the medical professional. In these cases, it is essential to consider the interrelation medicine and dentistry. And all patients treated with bisphosphonates should be informed about the possible risk of implant loss or the possibility of osteonecrosis (AU)

Osteonecrosis of the jaws in patients under osteoporosis treatment: a nine-year experience report

ABSTRACT Objective: This study aimed to report the experience of medication-related osteonecrosis of the jaws (MRONJ) in osteoporotic patients for nine years, and their associated initiating factors. Materials and methods: The numbers of invasive oral procedures (IOP) (tooth extraction, dental implant placement, and periodontal procedures) and removable prostheses performed from January 2012 to January 2021 were obtained from the digital records of a large public dental center. There were an estimated 6,742 procedures performed in patients under osteoporosis treatment. Results: Two cases (0.03%) of MRONJ were registered in nine years amongst patients with osteoporosis who had dental treatment at the center. From the 1,568 tooth extractions, one patient (0.06%) developed MRONJ. There was also one case from the 2,139 removable prostheses delivered (0.05%). Conclusions: The prevalence of MRONJ associated with osteoporosis treatment was very low. The protocols adopted seem to be adequate for the prevention of this complication. The findings of this study reinforce the rare frequency of MRONJ associated with dental procedures in patients submitted to the pharmacological management of osteoporosis. An integral analysis of systemic risk factors and oral preventive strategies may be considered regularly in the dental treatment of these patients.

Osteonecrosis asociada a pacientes con consumo de antirresortivos bajo tratamiento oncológico / Osteonecrosis associated to patients who take anti-resorptive drugs, undergoing oncologic treatment

La Asociación Americana de Cirugía Oral y Maxilofacial (American Association of Oral and Maxillofacial Surgeons [AAOMS]): define el concepto de osteonecrosis maxilar asociada a drogas antirresortivas (MRONJ) como: «área ósea necrótica expuesta al medio bucal con más de ocho semanas de permanencia, en presencia de tratamiento crónico con bifosfonatos en ausencia de radioterapia en cabeza y cuello¼. El objetivo de este artículo es asociar la enfermedad oncológica en relación con las drogas antirresortivas consumidas por pacientes, la prescripción de dichas drogas y el depósito de ellas en el organismo. Al mismo tiempo, la interacción médico-odontológico debe implementarse en favor de la salud de nuestros pacientes (AU)

American Association of Oral and Maxillofacial Surgeons AAOMS defined Medication Related of the Jaw (MRONJ) as «necrotic bone area exposed to the oral environment with more than eight weeks of permanence, in the presence of chronic treatment with BPs, in the absence of radiation therapy to the head and neck¼. The objective of this article is associate oncology antiresorptives treatments prescribed by physicians, their prescription and body accumulation in patients whose are treated with them. Interdisciplinary dental and physician clinical treatments must be implemented in patient favours (AU)

Dental care for patients taking antiresorptive drugs: a literature review

Antiresorptive drugs (ARDs), such as bisphosphonates or denosumab, that prevent bone resorption are widely used in patients with osteoporosis or with cancer that has metastasized to the bones. Although osteonecrosis of the jaw (ONJ) is a well-documented complication of ARD use, the benefits ARDs outweigh the complication. Thus, research has focused on finding ways to prevent or reduce the risk of developing ONJ. Dentists, as part of a multi-professional team, have a critical role in preventing ONJ. However, many dentists tend to hesitate to provide dental care to patients with ONJ, or tend to think that it is a problem to be dealt with by oral surgeons. This review gives an overview of ARD-related ONJ and provides the guidelines for dental care in patients taking ARDs to lower the risk of developing ONJ.

Pharmacological management of osteogenesis

Osteogenesis and bone remodeling are complex biological processes that are essential for the formation of new bone tissue and its correct functioning. When the balance between bone resorption and formation is disrupted, bone diseases and disorders such as Paget's disease, fibrous dysplasia, osteoporosis and fragility fractures may result. Recent advances in bone cell biology have revealed new specific targets for the treatment of bone loss that are based on the inhibition of bone resorption by osteoclasts or the stimulation of bone formation by osteoblasts. Bisphosphonates, antiresorptive agents that reduce bone resorption, are usually recommended as first-line therapy in women with postmenopausal osteoporosis. Numerous studies have shown that bisphosphonates are able to significantly reduce the risk of femoral and vertebral fractures. Other antiresorptive agents indicated for the treatment of osteoporosis include selective estrogen receptor modulators, such as raloxifene. Denosumab, a human monoclonal antibody, is another antiresorptive agent that has been approved in Europe and the USA. This agent blocks the RANK/RANKL/OPG system, which is responsible for osteoclastic activation, thus reducing bone resorption. Other approved agents include bone anabolic agents, such as teriparatide, a recombinant parathyroid hormone that improves bone microarchitecture and strength, and strontium ranelate, considered to be a dual-action drug that acts by both osteoclastic inhibition and osteoblastic stimulation. Currently, anti-catabolic drugs that act through the Wnt-β catenin signaling pathway, serving as Dickkopf-related protein 1 inhibitors and sclerostin antagonists, are also in development. This concise review provides an overview of the drugs most commonly used for the control of osteogenesis in bone diseases.