Abstract
Objetivo: este artigo relata um caso de osteonecrose dos maxilares associada ao uso de bisfosfonatos intravenosos (BRONJ) após a extração da maxila primeiro e segundo molares direito. Relato de caso: Paciente do sexo masculino, 53 anos, com diagnóstico de mieloma múltiplo em tratamento no Instituto Arthur Siqueira Cavalcanti (HEMORIO), com bisfosfonato endovenoso (ácido zoledrônico), realizou extrações dentárias em clínica privada. Aproximadamente um mês depois, ele se queixou de dor no local da extração dentária e foi encaminhado pelo oncologista para o serviço odontológico do hospital. O exame clínico intraoral revelou extensa área com características de necrose óssea e a radiografia panorâmica revelou área radiolúcida sugestiva de sequestro ósseo. A combinação de achados clínicos e radiográficos confirmou o diagnóstico de osteonecrose dos maxilares relacionada aos bisfosfonatos (BRONJ). Conclusão: os pacientes em uso regular e contínuo de bisfosfonatos devem ser alertados sobre o possível desenvolvimento de BRONJ após procedimentos odontológicos invasivos e devem ser fornecidas orientações adequadas.
Highlights
Multiple myeloma is a cancer of plasma cells, which are the cells that produce antibodies
Since 2003, there have been reports of osteonecrosis of the jaws associated with the use of intravenous bisphosphonates, such as pamidronate and zoledronate, which are administered to patients with multiple myeloma, mostly preceded by dentoalveolar surgical procedures.[3]
This paper reports the clinical management of a patient with multiple myeloma under treatment with bisphosphonate for approximately 12 months, who developed osteonecrosis of the jaws after dental extractions
Summary
Multiple myeloma is a cancer of plasma cells, which are the cells that produce antibodies (immunoglobulins). Bisphosphonates are the major source of concern for treating patients with multiple myeloma They are stable synthetic analogs of pyrophosphate and bind selectively to active zones of bone resorption, decreasing osteoclastic activity and incorporating to the mineral structure (residual effect) over a long period. Since 2003, there have been reports of osteonecrosis of the jaws associated with the use of intravenous bisphosphonates, such as pamidronate and zoledronate, which are administered to patients with multiple myeloma, mostly preceded by dentoalveolar surgical procedures.[3]. This paper reports the clinical management of a patient with multiple myeloma under treatment with bisphosphonate (zoledronate) for approximately 12 months, who developed osteonecrosis of the jaws after dental extractions. Patient was followed-up initially every three months, every six months and annually at the hospital’s dental service
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