Majdi Abunemer Rana, Saifuddin Shaheen Rakan, Abudullah Alghamdi Renad
Bachelor of Dental Surgery, College of Dentistry, Riyadh Elm University, Riyadh, Saudi Arabia.
Department of Periodontal Dentistry and Implantology, College of Dentistry, Riyadh Elm University, Riyadh, Saudi Arabia.
Saudi Dent J. 2023 Nov;35(7):785-796. doi: 10.1016/j.sdentj.2023.07.006. Epub 2023 Jul 6.
This systematic review aims to investigate the impact of tumor necrotic factor alpha inhibitors in suppressing bone resorption in periodontitis, and its potential to cause osteonecrosis. Extensive electronic research was conducted following the PRISMA guidelines, which connected various aspects of anti-TNF-a (anti-tumor necrosis factor-a) to periodontitis and osteonecrosis patients.
TNF-a inhibitors are broadly indicated in the treatment of autoimmune patients with possible joint resorption and increased inflammatory processes such as rheumatoid arthritis and inflammatory bowel disease, where they reduce bone loss and certain mediators. As rheumatoid arthritis and periodontitis share many characteristics, these medications may also be helpful in the treatment of coexisting periodontitis. However, besides medical benefits, anti-TNF-a also exhibits several adverse effects, ranging from dizziness to tuberculosis. Osteonecrosis is considered a recent adverse impact.
An extensive electronic systematic review following the PRISMA guidelines was performed for English-language papers using the following databases as sources of information: PubMed, Medline, Embase, Cochrane Central Register of Controlled Trials (CENTRAL), Library Genesis, Worldwide Science, National Rheumatoid Arthritis Society (NRAS), and other related articles. This systematic review is registered on the PROSPERO platform under registration number CRD42022341753.
Twenty articles were identified after the exclusion criteria were applied. These include systematic reviews, case reports, retrospective cohort studies, case report series, -analyses, clinical trials, randomised clinical trials, cross-sectional and longitudinal analyses, longitudinal observational studies, and prospective clinical trials. All these were included in the quantitative and qualitative analyses.
Anti-TNF-a drugs show promising results in treating patients with rheumatoid arthritis and periodontitis but could be considered a risk factor for osteonecrosis. Hence, patients receiving such medications should be closely monitored by the dentist and physician before, during, and after administration.
本系统评价旨在研究肿瘤坏死因子α抑制剂对抑制牙周炎骨吸收的影响及其导致骨坏死的可能性。按照PRISMA指南进行了广泛的电子检索，该指南将抗TNF-a（抗肿瘤坏死因子-a）的各个方面与牙周炎和骨坏死患者联系起来。
TNF-a抑制剂广泛用于治疗可能出现关节吸收和炎症过程增加的自身免疫性患者，如类风湿性关节炎和炎症性肠病，在这些疾病中它们可减少骨质流失和某些介质。由于类风湿性关节炎和牙周炎有许多共同特征，这些药物可能也有助于治疗并存的牙周炎。然而，除了医疗益处外，抗TNF-a还表现出多种不良反应，从头晕到肺结核。骨坏死被认为是一种新出现的不良反应。
按照PRISMA指南，对英文论文进行了广泛的电子系统评价，使用以下数据库作为信息来源：PubMed、Medline、Embase、Cochrane对照试验中央注册库（CENTRAL）、Library Genesis、Worldwide Science、国家类风湿关节炎协会（NRAS）以及其他相关文章。本系统评价已在PROSPERO平台注册，注册号为CRD42022341753。
应用排除标准后共筛选出20篇文章。这些文章包括系统评价、病例报告、回顾性队列研究、病例报告系列、分析、临床试验、随机临床试验、横断面和纵向分析、纵向观察性研究以及前瞻性临床试验。所有这些均纳入定量和定性分析。
抗TNF-a药物在治疗类风湿性关节炎和牙周炎患者方面显示出有前景的结果，但可能被视为骨坏死的一个危险因素。因此，接受此类药物治疗的患者在用药前、用药期间和用药后都应受到牙医和医生的密切监测。
