Osteonecrose dos ossos maxilares associados ao uso de medicamentos: uma revisão sistemática
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Date
2025-07-03
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Crespo, Gabriela Umpierre
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Alves, Alessandro Menna
Hübner, Thaís Cristina
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Abstract
O câncer é um dos principais problemas de saúde pública no mundo, considerado uma das principais causas de morbidade e mortalidade. O tratamento antineoplásico, como a quimioterapia, tem como objetivo eliminar as células cancerígenas e embora eficaz, pode impactar células saudáveis, causando efeitos colaterais na cavidade oral, como a osteonecrose dos maxilares relacionadas ao uso de medicamentos (ONMRM). A ONMRM é uma patologia caracterizada pela exposição óssea persistente na região maxilofacial, associada ao uso de agentes antirreabsortivos ou antiangiogênicos, geralmente desencadeada por trauma local ou procedimentos odontológicos invasivos. A partir disso, o objetivo deste estudo foi realizar uma revisão sistemática da literatura acerca dos medicamentos associados à ONMRM. Para tal, foi realizada uma busca na literatura utilizando as bases de dados digitais Scielo e PubMed, a fim de encontrar estudos referentes ao tema. A seleção dos artigos foi feita por dois avaliadores independentes, respeitando-se a seguinte ordem: leitura dos títulos, leitura dos resumos e leitura completa dos textos. Para a coleta das informações dos artigos, foi utilizada uma tabela padronizada. Os resultados demonstraram que os medicamentos antirreabsortivos, como ácido zoledrônico, alendronato e denosumabe, são os mais frequentemente associados à ONMRM, mas também foi observado um aumento de casos relacionados a medicamentos imunossupressores, imunobiológicos e agentes alvo-dirigidos. Além disso, as manifestações clínicas e os tratamentos encontrados foram variados, destacando-se a importância da prevenção, do diagnóstico precoce e da abordagem individualizada. Conclui-se que a atuação do cirurgião-dentista é essencial no contexto multidisciplinar para minimizar os impactos desta condição e promover qualidade de vida aos pacientes oncológicos.
Cancer was one of the leading public health issues worldwide, considered one of the main causes of morbidity and mortality. Antineoplastic treatments, such as chemotherapy, aimed to eliminate cancer cells and, although effective, impacted healthy cells, causing side effects in the oral cavity, such as medication-related osteonecrosis of the jaws (MRONJ). MRONJ was a pathology characterized by persistent bone exposure in the maxillofacial region, associated with the use of antiresorptive or antiangiogenic agents, typically triggered by local trauma or invasive dental procedures. Based on this, the objective of this study was to conduct a systematic literature review on the medications associated with MRONJ. For this purpose, a literature search was performed using the digital databases Scielo and PubMed to identify studies related to the topic. The selection of articles was carried out by two independent reviewers, following this sequence: reading of titles, reading of abstracts, and full-text reading. A standardized table was used to collect information from the articles. The results showed that antiresorptive medications, such as zoledronic acid, alendronate, and denosumab, are the most frequently associated with MRONJ. However, an increase in cases related to immunosuppressive drugs, immunobiological agents, and targeted therapy agents was also observed. Furthermore, clinical manifestations and treatment approaches were varied, emphasizing the importance of prevention, early diagnosis, and individualized management. It is concluded that the role of the dentist is essential within the multidisciplinary context to minimize the impacts of this condition and to promote quality of life for oncologic patients.
Cancer was one of the leading public health issues worldwide, considered one of the main causes of morbidity and mortality. Antineoplastic treatments, such as chemotherapy, aimed to eliminate cancer cells and, although effective, impacted healthy cells, causing side effects in the oral cavity, such as medication-related osteonecrosis of the jaws (MRONJ). MRONJ was a pathology characterized by persistent bone exposure in the maxillofacial region, associated with the use of antiresorptive or antiangiogenic agents, typically triggered by local trauma or invasive dental procedures. Based on this, the objective of this study was to conduct a systematic literature review on the medications associated with MRONJ. For this purpose, a literature search was performed using the digital databases Scielo and PubMed to identify studies related to the topic. The selection of articles was carried out by two independent reviewers, following this sequence: reading of titles, reading of abstracts, and full-text reading. A standardized table was used to collect information from the articles. The results showed that antiresorptive medications, such as zoledronic acid, alendronate, and denosumab, are the most frequently associated with MRONJ. However, an increase in cases related to immunosuppressive drugs, immunobiological agents, and targeted therapy agents was also observed. Furthermore, clinical manifestations and treatment approaches were varied, emphasizing the importance of prevention, early diagnosis, and individualized management. It is concluded that the role of the dentist is essential within the multidisciplinary context to minimize the impacts of this condition and to promote quality of life for oncologic patients.
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Keywords
Osteonecrose dos maxilares; Protocolos Antineoplásicos; Neoplasias; Osteonecrosis of the jaw; Antineoplastic protocols; Neoplasms
Citation
KAUFMANN, Isadora. Osteonecrose dos ossos maxilares associados ao uso de medicamentos: uma revisão sistemática. 2025. Monografia (Graduação em Odontologia) – Universidade do Vale do Taquari - Univates, Lajeado, 26 jun. 2025. Disponível em: http://hdl.handle.net/10737/4957.