| Abstract | Medikamentozna osteonekroza čeljusti predstavlja odumiranje koštanog dijela čeljusti kod pacijenata na antiresoptivnoj ili antiangiogenoj terapiji. Osteonekroza nastaje kao komplicirani spoj pripadajućih lijekova, općeg stanja organizma, prisutnosti lokalne upale i vrste dentalnih zahvata. Lijekovi koji najčešće dovode do nastanka osteonekroze su antiresoptivni lijekovi: bisfosfonati i denosumabi. Osteonekroza isključivo pogađa čeljusne kosti vjerojatno zbog najveće stope remodelacije u odnosu na ostale kosti u tijelu i tanke sluznice koja doprinosi lakšem prodoru mikroorganizma iz oralnog miljea u kost. S obzirom na kliničku sliku, osteonekroza se može podijeliti u četiri stadija. Kod uznapredovalih slučajeva prisutne su i patološke frakture koje znatno narušavaju kvalitetu pacijentova života. Terapija osteonekroze usmjerena je na podizanje kvalitete pacijentova života koju postižemo uklanjanjem boli, upale, neugodnog mirisa te konačnom protetskom sanacijom zubala. Nekrotični se dio kosti najčešće odstrani kirurškim putem. Defekt, koji nastaje nakon kirurškog uklanjanja, sanira se na različite načine. Jedna od novijih metoda saniranja defekta je upotreba PRGF-endoret tehnologije. PRGF dobiva se iz pacijentove krvi što ga čini 100% autolognim „lijekom“. On sadrži brojne faktore rasta kao što su trombocitni faktor rasta (PDGF), transformirajući faktor rasta β (TGF-β), inzulinski faktor rasta (IGF), fibroblastni faktor rasta (FGF), epidermalni faktor rasta (EGF), vaskularno endotelni faktor rasta (VEGF), angiopoietin-1. Na taj način PRGF potiče proliferaciju stanica i sintezu kolagena što dovodi do bržeg i adekvatnijeg cijeljenja rane. Osteonekroza čeljusti može se prevenirati pravilnom edukacijom doktora dentalne medicine o lijekovima te protokolima o postupanju s pacijentima na terapiji dotičnim lijekovima. Isto tako, važna je edukacija i motivacija pacijenata. |
| Abstract (english) | Medication-related osteonecrosis of the jaw represents the dying of the osseous part of the jaw in patients under antiresorptive and antiangiogenic therapy. The emergence of osteonecrosis is a complicated combination of appropriate drugs, general state of the organism, presence of local inflammation and types of dental treatments. The most common drugs which usually lead to the emergence of osteonecrosis are antiresorptive drugs: bisphosphonates and denosumabs. Osteonecrosis affects jaws exclusively, probably because of the highest rate of remodelling in regard to other bones in human body and a thin mucosa which contributes to the easier penetration of microorganisms from oral media into the bone. Considering the clinical picture, osteonecrosis can be divided in four stages. In advanced cases pathological fractures are present and they significantly distort patient's quality of life. The therapy for osteonecrosis is focused on raising the patient's quality of life, which is achieved by alleviating pain, inflammation, unpleasant smell and finally, a prosthetic remedy to the oral cavity. The necrotic part of the bone is usually surgically removed. Defects that occur after the surgical removal are sanitized in different ways. One of the latest methods of sanitizing defects is the use of PRGF-Endoret technology. PRGF is derived from a patient's blood, which makes it a 100% autologous “drug”. It contains numerous growth factors, such as platelet-derived growth factor (PDGF), transformative growth factor β (TGF-β), insulin growth factor (IGF), fibroblast growth factor (FGF), epidermal growth factor (EGF), vascular endothelial growth factor (VEGF), angiopoietin-1. In that way, PRGF stimulates cell proliferation and collagen synthesis, which in turn leads to faster and more adequate wound healing. Osteonecrosis of the jaw can be prevented with proper education of doctors of dental medicine on drugs as well as with protocols on how to treat patients who are taking the mentioned drugs. Also, patients’ education and motivation are very important. |
