Resumo

Bisphosphonates are usually prescribed for treating metabolic and neoplastic bone disorders. Intravenous bisphosphonate formulations containing nitrogen are the ones most often associated with osteonecrosis of the jaw. The available therapies range from conservative procedures to invasive procedures. The literature was systematically reviewed to determine the therapies available and their efficacy. Related studies published originally in any language from January 2003 to April 2017 and indexed in the MEDLINE (National Library of Medicine) and Cochrane databases were analyzed. The following phrases were searched: "Bisphosphonate-Associated Osteonecrosis of the Jaw" OR "Bisphosphonate Osteonecroses" OR "Bisphosphonate Osteonecrosis" OR "Bisphosphonate-Induced Osteonecrosis of the Jaw" OR "Bisphosphonate-Related Osteonecrosis of the Jaw" AND "treatment" OR "therapy" OR "therapeutics" OR "treatment outcome." The inclusion criteria were randomized controlled clinical trials, pertinent retrospective studies, systematic reviews, and meta-analyses. The levels of evidence of the studies were assessed independently by two referees, experts in the area. This review confirms that the therapeutic approaches are based only on expert recommendations and opinions. Hence, preventive guidelines are mandatory because there is no gold standard in the therapy of bisphosphonate-related osteonecrosis of the jaw. (Rev Port Estomatol Med Dent Cir Maxilofac. 2017;58(3):133-138) © 2017 Sociedade Portuguesa de Estomatologia e Medicina Dentária. Published by SPEMD. This is an open access article under the CC BY-NC-ND license

Abstract

Os bisfosfonatos são normalmente prescritos no tratamento de distúrbios ósseos metabólicos e neoplásicos. A associação de nitrogênio com bisfosfonatos intravenosos é a forma mais frequentemente associada à osteonecrose dos maxilares. As terapias disponíveis variam desde tratamentos conservadores a procedimentos invasivos. O objetivo desta revisão foi determinar os tratamentos disponíveis e a sua eficácia. Foram analisados estudos publicados de Janeiro de 2003 a Abril de 2017 indexados na MEDLINE e Cochrane com as palavras chave: Bisphosphonate-Associated Osteonecrosis of the Jaw” OU “Bisphosphonate Osteonecroses” OU “Bisphosphonate-Induced Osteonecrosis of the Jaw” OU “Bisphosphonate-Related Osteonecrosis of the Jaw” E “treatment” OU “therapy” OU “therapeutics” OU “treatment outcome”. Os critérios de inclusão foram ensaios clínicos randomizados controlados, estudos retrospectivos pertinentes,análises sistemáticas e meta-análises.Os níveis de evidência dos estudos foram avaliados por dois árbitros especializados. Esta revisão confirma que as abordagens terapêuticas são baseadas em recomendações/ opiniões de especialistas. Por isso a prevenção é obrigatória porque não há uma terapia gold-standard na Osteonecrose dos maxilares induzida por bifosfanatos. (Rev Port Estomatol Med Dent Cir Maxilofac. 2017;58(3):133-138) © 2017 Sociedade Portuguesa de Estomatologia e Medicina Dentária. Published by SPEMD. This is an open access article under the CC BY-NC-ND license