Abstract
Objective: to describe the clinical case of a patient with multiple myeloma, who developed maxillary osteonecrosis induced by anti-resorptive medication (bisphosphonate) submitted to a conservative and surgical therapeutic approach and subsequent prosthetic rehabilitation. Patients and methods: the case report is presented based on a simple review of the literature and clinical experience for the diagnosis, clinical staging of the lesion, carrying out the excision of the necrotic bone, debridement, lesion control and making a obturator prosthesis. Results: Despite the difficulty offered by the pathological condition and continuous use of medication, the treatment employed was successful, restoring health and providing a better quality of life to the patient, which allowed the obturation prosthesis to be made in the 8-month postoperative period. Conclusion: The result obtained emphasizes the importance of knowledge of the staging of the lesion for the application of the treatment protocol, in addition to recognizing patients at risk for the practice of prevention in dental treatments.
Highlights
Biphosphonates are antiresorptive drugs wich belong to a class of drugs widely used in patients with osteoporosis, Paget’s disease, metastatic cancer, multiple myeloma, in addition to reversing the hypercalcemia of the malignanci of tumors, promoting the apoptosis of the osteoclasts (Conte-Neto, Bastos, Spolidorio, Marcantonio & Marcantonio, 2012; Arantes, Silva, & Lazaretti-Castro, 2010; Griz, Bandeira, Assunção, & Bandeira, 2006; Fliefel, Tröltzsch, Kühnisch, Ehrenfeld, & Otto, 2015)
Osteonecrosis of the jaws induced by antiresorptive drugs is a complication characterized by previous use of the drug, intraoral or extraoral bone exposure for more than eight weeks, with or without cutaneous fistula (Ruggiero et al, 2014)
This case repot is presented based on a simple literature review with the descriptors (Osteonecrosis; Maxilla, Biphosphonate- Associated Osteonecrosis of the jaw) in Pubmed, Web of Science, and Embase, and included references until 20 years, similar to Conte-Neto et al (2011)
Summary
Biphosphonates are antiresorptive drugs wich belong to a class of drugs widely used in patients with osteoporosis, Paget’s disease, metastatic cancer, multiple myeloma, in addition to reversing the hypercalcemia of the malignanci of tumors, promoting the apoptosis of the osteoclasts (Conte-Neto, Bastos, Spolidorio, Marcantonio & Marcantonio, 2012; Arantes, Silva, & Lazaretti-Castro, 2010; Griz, Bandeira, Assunção, & Bandeira, 2006; Fliefel, Tröltzsch, Kühnisch, Ehrenfeld, & Otto, 2015). It can be administered orally or intravenously, according to the patient’s condition, suppressing activation and inducing osteoclast apoptosis. Maxillofacial trauma, infection and poor hygiene are predisposing factors to the development of the disease (Kos, Kuebler, Luczak, & Engelke, 2010)
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