Simpione Guilherme, Caldas Rogério J, Soares Mariana Q S, Rubira-Bullen Izabel R F, Santos Paulo S S
Master student, Bauru School of Dentistry, University of Sao Paulo, Brazil.
PhD, Bauru School of Dentistry, University of Sao Paulo, Brazil.
J Clin Exp Dent. 2020 Mar 1;12(3):e285-e290. doi: 10.4317/jced.56265. eCollection 2020 Mar.
Bisphosphonates (BP) are synthetic pyrophosphate-like substances with antiresorptive properties and specifically affect osteoclastic activity. In 2007, the American Association of Oral and Maxillofacial Surgeons (AAOMS) defined diagnostic criteria for Osteonecrosis of the Jaws Associated with Bisphosponates (BRONJ). BRONJ is mainly diagnosed by clinical features, but the detection of early bone changes by imaging may help prevent and better understand the disease. The objective of this study was to evaluate maxillary changes in CBCT in patients using BP.
All included patients were diagnosed with osteonecrosis and received bisphosphonate drugs in the last ten years. All imaging examinations were obtained by I-CAT and 3D Accuitomo. The multiplanar reconstructions were analyzed by an examiner without knowledge of the clinical aspects and location of the lesions.
The study sample consisted of 21 patients, the majority of the sample represented patients with cancer (76.2%), the other patients had osteoporosis (23.8%). Only four patients (19.04%) received alendronate, while intravenous bisphosphonates, such as zoledronate and pamidronate, represented the treatment of most of our sample. Most of our patients presented stage 1 and 2 MRONJ (85.7%), whose lesions were mainly observed in the mandible (52.4%). Fifty-seven percent of the patients had at least one bone change.
In BRONJ, bone changes vary between exposed and non-exposed areas and one aspect of the study was: persistent extraction cavities in the BRONJ lesion region and high frequency of periodontal ligament space widening in areas that are not involved in BRONJ lesions. This reflects the very important role of dental and periodontal diseases in the pathophysiology of BRONJ. Thus, preventive measures should be prioritized for patients exposed to anti-resorptive drugs. Cone-Beam computed tomography, osteonecrosis, bisphosphonate-associated osteonecrosis of the jaw.
双膦酸盐（BP）是具有抗吸收特性的合成焦磷酸盐样物质，特别影响破骨细胞活性。2007年，美国口腔颌面外科医师协会（AAOMS）定义了与双膦酸盐相关的颌骨骨坏死（BRONJ）的诊断标准。BRONJ主要通过临床特征进行诊断，但通过影像学检测早期骨变化可能有助于预防和更好地理解该疾病。本研究的目的是评估使用BP的患者在锥形束计算机断层扫描（CBCT）中的上颌变化。
所有纳入患者均被诊断为骨坏死，且在过去十年中接受过双膦酸盐药物治疗。所有影像学检查均通过I-CAT和3D Accuitomo获得。由一名不了解病变临床情况和位置的检查者对多平面重建图像进行分析。
研究样本包括21名患者，样本中的大多数患者为癌症患者（76.2%），其他患者患有骨质疏松症（23.8%）。只有4名患者（19.04%）接受阿仑膦酸盐治疗，而静脉注射双膦酸盐，如唑来膦酸盐和帕米膦酸盐，则是我们大多数样本的治疗方式。我们的大多数患者表现为1期和2期MRONJ（85.7%），其病变主要见于下颌骨（52.4%）。57%的患者至少有一处骨变化。
在BRONJ中，暴露区域和未暴露区域的骨变化有所不同，本研究的一个方面是：BRONJ病变区域存在持续的拔牙窝，以及未累及BRONJ病变的区域中牙周膜间隙增宽的频率较高。这反映了牙齿和牙周疾病在BRONJ病理生理学中的非常重要的作用。因此，对于接受抗吸收药物治疗的患者，应优先采取预防措施。锥形束计算机断层扫描、骨坏死、双膦酸盐相关颌骨骨坏死。
