Aspekti terapije medikamentozne osteonekroze čeljusti

master's thesis

• Title (english): Therapy aspects of medication related osteonecrosis of the jaw
• Author: Dora Odobašić
• Mentor: Marko Vuletić (mentor)
• Committee member: Marko Vuletić (predsjednik povjerenstva)
• Committee member: Tomislav Katanec (član povjerenstva)
• Committee member: Ivana Škrinjar (član povjerenstva)
• Granter: University of Zagreb; School of Dental Medicine; (Department of Oral Surgery); Zagreb
• Defense date and country: 2022-09-23, Croatia
• Scientific / art field, discipline and subdiscipline: BIOMEDICINE AND HEALTHCARE; Dental Medicine; Oral Surgery

Abstract

Medikamentozna osteonekroza čeljusti je nuspojava terapije antiresorptivnim (bisfosfonati i denosumab) i antiangiogenim lijekovima, koji se koriste u liječenju koštanih metastaza i osteoporoze. Incidencija osteonekroze proporcionalna je dozi i potentnosti lijeka, trajanju terapije te akumulaciji lijeka u kostima. Najčešće se razvija kao posljedica intravenske primjene bisfosfonata ili supkutane aplikacije denosumaba. Najbolji način za smanjenje pojavnosti osteonekrotičnih lezija implementacija je preventivnih mjera prije i tijekom terapije navedenim lijekovima, a posebno je važno izbjegavati traumatske dentoalveolarne
zahvate te prevenirati i liječiti dentalne infekcije. Ako se lezije ipak razviju, klinički ćemo ih prepoznati kao eksponiranu nekrotičnu kost koja ne cijeli duže od osam tjedana. Mehanizam nastanka nije u potpunosti razjašnjen, već postoje brojne teorije koje se međusobno nadopunjuju. Na temelju prisustva ostalih simptoma i radioloških znakova bolesti, pacijenta svrstavamo u jedan od četiri stadija. Za svaki stadij preporučen je određeni protokol terapije. On se individualizira i prilagođava dotičnom pacijentu. Konzervativna terapija dovodi do smanjenja intenziteta simptoma, ali rijetko i do potpunog cijeljenja lezije. Stoga, najbolje rezultate možemo postići kombinacijom kontrole bakterijske kontaminacije, kirurškog zahvata i jedne od adjuvantnih metoda terapije (terapije ozonom, hiperbaričnom oksigenacijom, plazmom bogatom faktorima rasta, teriparatidom ili laserom). Na taj način nastojimo povećati kvalitetu života pacijenta i omogućiti daljnje liječenje primarne bolesti.

Abstract (english)

Medication-related osteonecrosis of the jaw is a side effect of therapy with antiresorptive (bisphosphonates and denosumab) and antiangiogenic drugs, which are used in the treatment of bone metastases and osteoporosis. The incidence of osteonecrosis is proportional to the dose and potency of the drug, the duration of therapy and the accumulation of the drug in the bones. It most often develops as a result of intravenous administration of bisphosphonates or
subcutaneous administration of denosumab. The best way to reduce the incidence of osteonecrotic lesions is to implement preventive measures before and during therapy with the mentioned drugs, and it is especially important to avoid traumatic dentoalveolar procedures and to prevent and treat dental infections. If lesions do develop, we will recognize them
clinically as exposed necrotic bone that does not heal for more than eight weeks. The mechanism of its origin has not been fully elucidated, but there are numerous theories that complement each other. Based on the presence of other symptoms and radiological signs of the disease, the patient is classified into one of four stages. A specific therapy protocol is
recommended for each stage. It is individualized and adapted to the respective patient. Conservative therapy leads to a reduction in the intensity of symptoms, but rarely to complete healing of the lesion. Therefore, the best results can be achieved by a combination of bacterial contamination control, surgery and one of the adjuvant therapy methods (ozone therapy, hyperbaric oxygenation, plasma rich in growth factors, teriparatide or laser). In this way, we strive to increase the patient's quality of life and enable further treatment of the primary disease.

• Keywords: oralnokirurški postupci; osteonekroza čeljusti uzrokovana bisfosfonatima; denosumab
• Keywords (english): Oral Surgical Procedures; Bisphosphonate - Associated Osteonecrosis of the Jaw; Denosumab
• Language: croatian
• URN:NBN: urn:nbn:hr:127:179952
• Study programme: Title: dental medicine; Study programme type: university; Study level: integrated undergraduate and graduate; Academic / professional title: doktor/doktorica dentalne medicine (doktor/doktorica dentalne medicine)
• Type of resource: Text
• File origin: Born digital
• Access conditions: Open access
• Created on: 2022-10-11 09:22:26