biphosphonates

Устранение  бисфосфонатами остеонекроза челюсти (BRONJ -бисфосфонат остеонекроза челюсти)
 
Бисфосфонаты представляют собой группу лекарственных средств, влияющих на костный метаболизм. Оральный ВР успешно используется для профилактики и лечения остеопороза, а также при лечении болезни Педжета, несовершенный остеогенез, в управлении гигантских клеток поражения челюстей также рекомендуется.

Вводится внутривенно для лечения гиперкальциемии при злокачественных новообразованиях от костных метастаз  до различных видов рака, при лечении множественной миеломы и недавно  используется  у пациентов с остеопорозом.

Без сомнения, качество и  продолжительность жизни пациентов с различными видами заболеваний костей, повышается у пациентов с лекарствами BP.

Остеонекроз челюсти относится к применению бисфосфонатов препаратов  осложнение, которое происходит только в челюсти, где происходит некроз и обнажение кости в полости рта.

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Cases Treated in our Clinic

Case 1

Case 1

 

69 year old lady came to our clinic for the first time in 2007, citing in her medical history rheumatoid arthritis and osteoporosis. She did not smoke or made alcohol use. For 22 years (since 1991) she was receiving alendronate orally. In her dental history it is indicated removal of wisdom tooth No.28 in 2005 without healing. Her biggest complaint was pain and swelling in the left maxilla. During the clinical examination, swelling and pain on the left upper jaw with erythema mucosa, suppuration, intraoral communication and granulation tissue was identified

Patient was diagnosed with osteomyelitis actinomycosis consistent with BRONJ disease stage 3.

Immediate discontinuation of bisphosphonate was effected, surgical debridement, washes with chlorhexidine and antibiotics by mouth for seven months. The wound was completely closed two months later. Patient presented recurrent pain, swelling, and suppuration intraoral fistula. Surgical debridement was effected and antibiotics from the mouth was given. Also hyperbaric oxygen therapy (30 dives) was effected. Due to persistence of the disease hemimaxillectomy was effected in October 2010 and close of the wound in two layers using fat graft. Since then patient presents complete cure as seen in clinical and radiographic picture 2½ years later. The Patient presented clinical and radiological features of BRONJ disease stage 3 and made use of bisphosphonates orally. Initially with conservative treatment, outcomes were poor, based on treatment protocols for stage 3 disease. The disease was fired after three years of drug discontinuation. This case shows that the risk for appearance of BRONJ disease increases with the duration of oral therapy. There is a correlation between the initial duration of use of bisphosphonates BP and the time required for healing after stopping the drug (in this case three years).

This incident presented unusual BRONJ disease after tooth extractions because of oral bisphosphonate use that required treatment similar with that required in severe BRONJ due to intravenous bisphosphonate use.

 


Case 2

 

Case 2

Lady 70 years old came to our clinic for the first time in February 2016 complaining of pain and necrosis in the anterior and left mandible. Patient is suffering from multiple myeloma in the last seven years (2009) and amyloidosis and takes Revlimin, Dexamed, Calcium and Zometa IV systematically. She does not smoke nor consume alcohol. Dental findings indicate automatic necrosis in the lower jaw and mobility of teeth 31, 41 is indicated . In the panoramic radiograph inflammation around the teeth 31, 41 and bone necrosis are apparent .

BRONJ disease stage 2 was diagnosed. Zometa was stopped and tooth removal of teeth 31, 41 was effected as well as surgical debridement of the dead bone. Antibiotic (Dalacin 300mg x 4 daily) was administered followed by washes with chlorhexidine 2% for weeks. After five weeks the area showed healing while it did not present any recurrence 6 months later.

 


Case 3

Case 3

 

Male 63 years old was admitted to hospital for the first time in February 2016 complaining of intense pain in the jaw and weakness in chewing. Medical history included lung cancer with metastases in the liver and bones is indicated. He was granted Zometa IV for a year, and the administration of Zometa IV was paused in February 2015. During the clinical examination intraoral fistula with suppuration and granulomatous tissue in the upper jaw right and necrotic bone in the upper jaw left were identified . In the mandible, patient presents bilateral necrosis and extraoral fistula left. In the panoramic radiography and 3D Cone Beam tomography bone necrosis is observed, along with pathological fracture in the left mandible and turbidity in the right maxillary antrum.

BRONJ disease stage 3 was diagnosed and debridement was held, as well as closure of the intraoral fistulaPatient showed complete cure 4 months later.

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