Implantes em pacientes com osteonecrose dos maxilares associado ao uso de bifosfonatos. Relato de caso e revisão de literatura
Authors: Coléte Juliana Zorzi , Hadad Henrique , Momesso Gustavo Antônio Correa , Santos Filho Hélio dos , Fernandes Breno dos Reis , Garcia Júnior Idelmo Rangel 
Published: April 2019

A osteoporose é responsável por causar condições devastadoras no tecido ósseo elevando o risco de fraturas, constituindo uma problemática importante de saúde pública. É comum o uso de medicamentos, como os bifosfonatos para o controle dessa patologia. Contudo, a associação do uso desse medicamento com a osteonecrose dos maxilares vem sendo amplamente discutido na literatura, assim como a dificuldade da reabilitação desses pacientes como implantes e do protocolo de tratamento dessa condição. Assim sendo, o objetivo do presente trabalho foi realizar uma revisão de literatura para discutir as principais falhas associadas a instalação de implantes em pacientes portadores de osteonecrose dos maxilares associada ao uso de bifosfonatos (OMAB), assim como as possibilidades de tratamento, e relatar um caso clínico. As informações obtidas na revisão nos permitiu concluir que o uso de bifosfonatos orais, como o alendronato, é capaz de levar ao desenvolvimento da OMAB sendo necessária bastante precaução na reabilitação oral com implantes dentários, tanto em pacientes que fazem uso, como pacientes que apresentam risco de futura utilização de bifosfonatos para o tratamento de desordens esqueléticas.  Descritores: Osteoporose; Alendronato; Osteonecrose; Implantes Dentários.ReferênciasEsposito M, Hirsch JM, Lekholm U, Thomsen P. Biological factors contributing to failures of osseointegrated oral implants. (I). Success criteria and epidemiology. Eur J Oral Sci. 1998;106(1):527-51.Quirynen M, De Soete M, Van Steenberghe D. Infectious risks for oral implants: a review of the literature. Clin Oral Implants Res. 2002;13(1):1-19.Van Steenberghe D, Jacobs R, Desnyder M, Maffei G, Quirynen M. The relative impact of local and endogenous patient‐related factors on implant failure up to the abutment stage. Clin Oral Implants Res. 2002;13(6):617-22.Migliorati CA. Bisphosphanates and oral cavity avascular bone necrosis. J Clin Oncol. 2003;21(22)4253-54.Migliorati CA, Casiglia J, Epstein J, Jacobsen PL, Siegel MA, Woo SB. Managing the care of patients with bisphosphonate-associated osteonecrosis: an American Academy of Oral Medicine position paper. J Am Dent Assoc. 2005;136(12):1658-68.Madrid C, Sanz M. What impact do systemically administrated bisphosphonates have on oral implant therapy? A systematic review. Clin Oral Implants Res. 2009;20(Suppl 4):87-95.Black DM, Schwartz AV, Ensrud KE, Cauley JA, Levis S, Quandt SA et al. Effects of continuing or stopping alendronate after 5 years of treatment: the Fracture Intervention Trial Long-term Extension (FLEX): a randomized trial. JAMA. 2006;296(24):2927-38.Schwartz AV, Bauer DC, Cummings SR, Cauley JA, Ensrud KE, Palermo L et al. Efficacy of continued alendronate for fractures in women with and without prevalent vertebral fracture: the FLEX trial. J Bone Miner Res. 2010;25(5):976-82.Marx RE. Pamidronate (Aredia) and zoledronate (Zometa) induced avascular necrosis of the jaws: a growing epidemic. J Oral Maxillofac Surg. 2003;61(9):1115-17.Ruggiero SL, Mehrotra B, Rosenberg TJ,  Engroff SL. Osteonecrosis of the jaws associated with the use of bisphosphonates: a review of 63 cases. Journal of oral and maxillofacial surgery, 2004;62(5):527-34.Ruggiero SL. Guidelines for the diagnosis of bisphosphonate-related osteonecrosis of the jaw (BRONJ). Clin Cases Miner Bone Metab.2007;4(1):37-42.Ruggiero SL, Dodson TB, Assael LA, Landesberg R, Marx RE, Mehrotra B et al. American Association of Oral and Maxillofacial Surgeons position paper on bisphosphonate-related osteonecrosis of the jaws—2009 update. J Oral Maxillofac Surg. 2009;67(5 Suppl):2-12.Ruggiero SL, Drew SJ. Osteonecrosis of the jaws and bisphosphonate therapy. J Dent Res. 2007;86(11):1013-21.Otto S, Abu-Id MH, Fedele S, Warnke PH, Becker ST, Kolk A et al. Osteoporosis and bisphosphonates-related osteonecrosis of the jaw: not just a sporadic coincidence–a multi-centre study. J Craniomaxillofac Surg. 2011;39(4):272-77.Yarom N, Yahalom R, Shoshani Y, Hamed W, Regev E, Elad S. Osteonecrosis of the jaw induced by orally administered bisphosphonates: incidence, clinical features, predisposing factors and treatment outcome. Osteoporos Int. 2007;18(10):1363-70.Sambrook P, Cooper C. Osteoporosis. Lancet. 2006;367(9527):2010-18.Cranney A, Guyatt G, Griffith L, Wells G, Tugwell P, Rosen C. Meta-analyses of therapies for postmenopausal osteoporosis. Endocr Rev. 2002;23(4):570-78.Close P, Neuprez A, Reginster JY. Developments in the pharmacotherapeutic management of osteoporosis. Expert Opin Pharmacother. 2006;7(12):1603-15.Rodan GA, Fleisch HA. Bisphosphonates: mechanisms of action. J Clin Invest. 1996;97(12): 2692-96.Dannemann C, Grätz KW, Riener MO, Zwahlen RA. Jaw osteonecrosis related to bisphosphonate therapy: a severe secondary disorder. Bone. 2007;40(4):828-34.Kos M, Luczak K, Godzinski J, Klempous J. Treatment of monostotic fibrous dysplasia with pamidronate. J Craniomaxillofac Surg. 2004;32(1):10-15.Pastor-Zuazaga D, Garatea-Crelgo J, Martino-Gorbea R, Etayo-Pérez A, Sebastián-Lopez C. Osteonecrosis of the jaws and bisphosphonates. Report of three cases. Med Oral Patol Oral Cir Bucal. 2006;11(1):E76-9.Sato M, Grasser W, Endo N, Akins R, Simmons H, Thompson DD et al. Bisphosphonate action. Alendronate localization in rat bone and effects on osteoclast ultrastructure. J Clin Invest. 1991;88(6):2095-2105.Sahni M, Guenther HL, Fleisch H, Collin P, Martin TJ. Bisphosphonates act on rat bone resorption through the mediation of osteoblasts. J Clin Invest.1993;91(5):2004-11.Merigo E, Manfredi M, Meleti M, Corradi D, Vescovi P. Jaw bone necrosis without previous dental extractions associated with the use of bisphosphonates (pamidronate and zoledronate): a four‐case report. J Oral Pathol Med. 2005;34(10):613-17.Olson KB, Hellie CM, Pienta KJ. Osteonecrosis of jaw in patient with hormonerefractory prostate cancer treated with zoledronic acid. Urology. 2005;66(3):658.Graziani F, Cei S, La Ferla F, Cerri E, Itro A, Gabriele M. Association between osteonecrosis of the jaws and chronic high-dosage intravenous bisphosphonates therapy. J Craniofac Surg. 2006;17(5):876-79.Greenberg MS. Comment in. Intravenous bisphosphonates and osteonecrosis. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2004;98(3):259-60.Gibbs SD, O'Grady J, Seymour JF, Prince HM. Bisphosphonate-induced osteonecrosis of the jaw requires early detection and intervention. Med J Aust. 2005;183(10):549-50.Marx RE, Sawatari Y, Fortin M, Broumand V. Bisphosphonate-induced exposed bone (osteonecrosis/osteopetrosis) of the jaws: risk factors, recognition, prevention, and treatment. J Oral Maxillofac Surg. 2005;63(11)1567-75.Melo MD, Obeid G. Osteonecrosis of the jaws in patients with a history of receiving bisphosphonate therapy: strategies for prevention and early recognition. J Am Dent Assoc. 2005;136(12):1675-81.Purcell PM, Boyd IW. Bisphosphonates and osteonecrosis of the jaw. Med J Aust. 2005;182(8)417-18.Vannucchi AM, Ficarra G, Antonioli E, Bosi A. Osteonecrosis of the jaw associated with zoledronate therapy in a patient with multiple myeloma. Br J Haematol. 2005;128(6):738.Bilezikian JP. Osteonecrosis of the jaw - do bisphosphonates pose a risk? N Engl J Med. 2006;355(22):2278-81.Van Poznak C, Estilo C. Osteonecrosis of the jaw. J Oncol Pract. 2006;2(1):3-4.Santini D, Vincenzi B, Avvisati G, Dicuonzo G, Battistoni F, Gavasci M et al. Pamidronate induces modifications of circulating angiogenetic factors in cancer patients. Clin Cancer Res. 2002;8(5):1080-84.Wood J, Bonjean K, Ruetz S, Bellahcène A, Devy L, Foidart JM et al. Novel antiangiogenic effects of the bisphosphonate compound zoledronic acid. J Pharmacol Exp Ther. 2002;302(3):1055-61.Badros A, Weikel D, Salama A, Goloubeva O, Schneider A, Rapoport A et al. Osteonecrosis of the jaw in multiple myeloma patients: clinical features and risk factors. J Clin Oncol. 2006;24(6):945-52.Woo SB, Hellstein JW, Kalmar JR. Narrative [corrected] review: bisphosphonates and osteonecrosis of the jaws. Ann Intern Med.2006;144(10):753-61.Cafro AM, Barbarano L, Nosari AM, D'avanzo G, Nichelatti M, Bibas M et al. Osteonecrosis of the jaw in patients with multiple myeloma treated with bisphosphonates: definition and management of the risk related to zoledronic acid. Clin Lymphoma Myeloma. 2008;8(2):111-16.Mavrokokki T, Cheng A, Stein B,  Goss A. Nature and frequency of bisphosphonate-associated osteonecrosis of the jaws in Australia. J Oral Maxillofac Surg. 2007;65(3):415-23.Odvina CV, Zerwekh JE, Rao DS, Maalouf N, Gottschalk FA,  Pak CY. Severely suppressed bone turnover: a potential complication of alendronate therapy. J Clin Endocrinol Metab. 2005;90(3):1294-301.Bedogni A, Blandamura S, Lokmic Z, Palumbo C, Ragazzo M, Ferrari F et al. Bisphosphonate-associated jawbone osteonecrosis: a correlation between imaging techniques and histopathology. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2008;105(3):358-64.Khan AA, Sándor GK, Dore E, Morrison AD, Alsahli M, Amin F et al. Canadian consensus practice guidelines for bisphosphonate associated osteonecrosis of the jaw. J Rheumatol. 2008;35(7):1391-97.Hoff AO, Toth BB, Altundag K, Johnson MM, Warneke CL, Hu M et al.Frequency and risk factors associated with osteonecrosis of the jaw in cancer patients treated with intravenous bisphosphonates. J Bone Miner Res. 2008;23(6):826-36.Assael LA. Oral bisphosphonates as a cause of bisphosphonate-related osteonecrosis of the jaws: clinical findings, assessment of risks, and preventive strategies. J Oral Maxillofac Surg. 2009;67(5 Suppl):35-43.Lazarovici TS, Yahalom R, Taicher S, Schwartz-Arad D, Peleg O, Yarom N. Bisphosphonate-related osteonecrosis of the jaw associated with dental implants. J Oral Maxillofac Surg. 2010;68(4):790-96.Jacobsen C, Metzler P, Rössle M, Obwegeser J, Zemann W,  Grätz KW. Osteopathology induced by bisphosphonates and dental implants: clinical observations. Clin Oral Investig. 2013;17(1):167-75.López-Cedrún JL, Sanromán JF, García A, Peñarrocha M, Feijoo JF, Limeres J, Diz P. Oral bisphosphonate-related osteonecrosis of the jaws in dental implant patients: a case series. Br J Oral Maxillofac Surg. 2013;51(8):874-79.Kwon TG, Lee CO, Park JW, Choi SY, Rijal G, Shin HI. Osteonecrosis associated with dental implants in patients undergoing bisphosphonate treatment. Clin Oral Implants Res. 2014;25(5):632-40.Ramalho-Ferreira G, Faverani LP, Prado FB, Garcia IR,  Okamoto R. Raloxifene enhances peri-implant bone healing in osteoporotic rats. Int J Oral Maxillofac Surg. 2015;44(6):798-805.Bone HG, Hosking D, Devogelaer JP, Tucci JR, Emkey RD, Tonino RP. Ten years' experience with alendronate for osteoporosis in postmenopausal women. N Engl J Med. 2004;350(12):1189-99.Lerner UH. Bone remodeling in post-menopausal osteoporosis. J Dent Res. 2006;85(7):584-95.Ettinger B, Black DM, Mitlak BH, Knickerbocker RK, Nickelsen T, Genant HK et al. Reduction of vertebral fracture risk in postmenopausal women with osteoporosis treated with raloxifene: results from a 3-year randomized clinical trial. JAMA. 1999;282(7):637-45.Gallacher SJ, Dixon T. Impact of treatments for postmenopausal osteoporosis (bisphosphonates, parathyroid hormone, strontium ranelate, and denosumab) on bone quality: a systematic review. Calcif Tissue Int. 2010;87(6)469-84.