Osteonecrose: revisão de literatura e caso clínico

Abstract

Introduction : Osteonecrosis is an alteration that affects the jaws , and is due to an adverse effect of the use of bisphosphonates , a group of medicines used for the prevention and treatment of osteoporosis , bone metastases , multiple myeloma, and Paget’s disease . The bisphosphonate is incorporated into the bone matrix and the osteoclast in the form of pyrophosphate , remaining there for an indefinite period of time and with residual mineralized matrix . Proposition : Literature review on osteonecrosis and a case report . Material and methods: Databases from Science Direct , Elsevier , Journals of Capes , Pub Med, and clinical record . Case report: a 72 year-old married woman with leucoderma . The patient had an ulcerated lesion in the left ventral surface of the tongue , with three months’ duration and no resolution. She referred to the use of drugs for hypertension , stroke, labyrinthitis , osteoporosis, and alendronate sodium – 70 mg per week for 5 years . The physical examination revealed an ulcerative lesion and ​​an area of fistulation in the right upper alveolar ridge next to the 16 th tooth , for three months , when the tooth was extracted. She presented painful symptoms on palpation and regional lymphadenopathy . The diagnosis was osteonecrosis . A digital panoramic radiography and a computed tomography were performed. The final diagnosis was traumatic injury ( tongue) and osteonecrosis caused by bisphosphonate . The patient was referred to surgical treatment and antibiotic therapy . After eight months she had not done the surgery yet , having eliminated several bone debris during this period . Conclusion : Dentists should be aware of the adverse effects of bisphosphonates as well as the need of early diagnosis of osteonecrosis and its prevention .