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Previous issue date: 2016-03-04 / Bisphosphonates are antiresorptive drugs widely used to treat bone disorders. They have been associated with the development of bisphosphonate-related osteonecrosis of the jaw (BRONJ), a side effect involving gnathic bones that causes necrosis, pain, suppuration, swelling, fistula, tooth mobility, paresthesia and halitosis. This disease is characterized by high morbidity and refractory behavior. The aim of this study was to analyze clinical, radiographic and hematological aspects of patients under bisphosphonate therapy. Records of patients taking bisphosphonates were analyzed according to the occurrence of BRONJ: BRONJ group (n=27) and non-BRONJ group (n=108). Results showed that age did not significantly differ between the groups. The non-BRONJ group had higher prevalence of women, osteoporosis and use of oral bisphosphonate than the BRONJ group, whereas this one had higher prevalence of men, metastasis and intravenous bisphosphonate than the non-BRONJ group. Alkaline phosphatase and erythrocyte sedimentation rate (ESR) were significantly higher in the BRONJ group, whereas fasting serum glucose, C-terminal telopeptide of collagen I (CTX), parathormone (PTH), calcium and phosphorus did not significantly differ. The BRONJ group showed association with smoking, tooth extraction, anemia and leukocytosis; gastric and autoimmune disorders were significantly more prevalent in the non-BRONJ group. On radiographic analysis, persisting alveolar socket, osteolysis, bone sclerosis and narrowing of the mandibular canal were significantly more prevalent in the BRONJ group. Thickening of the lamina dura, periradicular radiolucency, widening of the periodontal ligament space and bone sequestrum did not significantly differ between the groups. Positive correlation was observed between age and ESR, ESR and widening of the periodontal ligament space, and alkaline phosphatase and persisting alveolar socket. Also, bone sclerosis was correlated with persisting alveolar socket and osteolysis, and osteolysis with sequestrum and periradicular radiolucency. Conclusion: In the present study it was observed association of BRONJ with males, intravenous bisphosphonate, bone metastasis, smoking, anemia, leukocytosis persistent alveolar socket, osteolysis, bone sclerosis, narrowing of the mandibular canal and sequestrum. There was no association of BRONJ with patients? age, and serum levels of calcium, phosphorus, alkaline phosphatase, PTH and CTX. / Os bisfosfonatos s?o drogas antirreabsortivas amplamente empregadas no tratamento de doen?as do metabolismo ?sseo. Tais f?rmacos t?m como efeito adverso a osteonecrose maxilar relacionada aos bisfosfonatos (BRONJ), condi??o que acomete os ossos gn?ticos, gerando necrose, dor, supura??o, tumefa??o, f?stula, mobilidade dent?ria, parestesia e halitose. A enfermidade caracteriza-se por significativa morbidade e resist?ncia ao tratamento. O presente estudo teve por objetivo analisar aspectos cl?nicos, radiogr?ficos e hematol?gicos em pacientes sob terapia com bisfosfonatos. Os prontu?rios dos pacientes foram revisados, e as vari?veis analisadas de acordo com a ocorr?ncia de BRONJ: grupo BRONJ (n=27) e grupo n?o-BRONJ (n=108). A idade dos pacientes n?o diferiu significativamente entre os grupos. O grupo n?o-BRONJ exibiu maior preval?ncia de mulheres, osteoporose e uso de bisfosfonatos orais do que o grupo BRONJ, enquanto este teve preval?ncia de homens, met?stase e uso de bisfosfonato intravenoso significativamente maior que o n?o-BRONJ. Fosfatase alcalina e eritrossedimenta??o (VHS) foram significativamente mais elevadas no grupo BRONJ, enquanto glicose, interligadores C terminais do col?geno tipo I (CTX), paratorm?nio (PTH), c?lcio e f?sforo n?o diferiram significativamente entre os grupos. O grupo BRONJ teve associa??o com tabagismo, exodontia, anemia e leucocitose; desordens autoimunes e g?stricas foram significativamente mais prevalentes no grupo n?o-BRONJ. Na an?lise radiogr?fica, persist?ncia de alv?olo dent?rio, oste?lise, osteoesclerose e estreitamento do canal mandibular foram significativamente mais prevalentes no grupo BRONJ. Espessamento da l?mina dura, radiolusc?ncia perirradicular, alargamento do espa?o do ligamento periodontal e sequestro ?sseo n?o diferiram entre os grupos. Foi observada correla??o positiva entre idade e VHS, VHS e alargamento do espa?o do ligamento periodontal, e entre fosfatase alcalina e persist?ncia de alv?olo dent?rio. Al?m disso, osteoesclerose foi correlacionada com persist?ncia de alv?olo dent?rio e oste?lise; e oste?lise com sequestro ?sseo e radiolusc?ncia perirradicular. Conclus?o: No presente estudo, foi observada associa??o de BRONJ com sexo masculino, bisfosfonatos intravenosos, met?stases ?sseas, tabagismo, exodontia, anemia, leucocitose, persist?ncia de alv?olo dent?rio, oste?lise, esclerose ?ssea, estreitamento do canal mandibular e sequestro ?sseo. N?o houve associa??o de BRONJ com idade dos pacientes, n?veis s?ricos de c?lcio, f?sforo, fosfatase alcalina, PTH e CTX.
| Identifer | oai:union.ndltd.org:IBICT/oai:tede2.pucrs.br:tede/6734 |
| Date | 04 March 2016 |
| Creators | Koth, Valesca Sander |
| Contributors | Cherubini, Karen |
| Publisher | Pontif?cia Universidade Cat?lica do Rio Grande do Sul, Programa de P?s-Gradua??o em Odontologia, PUCRS, Brasil, Faculdade de Odontologia |
| Source Sets | IBICT Brazilian ETDs |
| Language | Portuguese |
| Detected Language | English |
| Type | info:eu-repo/semantics/publishedVersion, info:eu-repo/semantics/masterThesis |
| Format | application/pdf |
| Source | reponame:Biblioteca Digital de Teses e Dissertações da PUC_RS, instname:Pontifícia Universidade Católica do Rio Grande do Sul, instacron:PUC_RS |
| Rights | info:eu-repo/semantics/openAccess |
| Relation | -8096554818733665164, 600, 600, 600, 4673435736271820140, -2070498469879244349 |
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