Bifosfonat Kullanan Hastalarda Diş Çekimi Öncesi Olası Çene Kemiği Nekrozunun Histopatolojik Olarak Değerlendirilmesi

Abstract

. Bisphosphonates are commonly used in treatment of diseases related to bones like osteoporosis, malignant hypercalcemia, bone metastasis of solid tumors and multiple myeloma. However, bisphosphonate-related osteonecrosis of the jaw lesions (BRONJ), which have been reported in the literature as of 2003, is an important and a common side effect of these medicines. BRONJ is an poorly understood pathologic process. The aim of the study is to determine the non-exposed stage 0 BRONJ incidence in patients with bisphosphonate story by taking biopsy material from alveolar bone region during tooth extraction and to observe the role of chronic dental inflammation in the development of stage 0 BRONJ. The study includes 50 patients, who have an indication of tooth extraction and have bisphosphonate history for various reasons. The CTX values were collected from all patients in the preoperative period. All tooth extractions performed by taking convenient measures as per a determined protocol. In order to detect if any osteonecrotic changes are present in the non-exposed bone due to bisphosphonate use, biopsies were taken from alveolar bone during tooth extraction and were sent to histopathological examination. All tooth extractions regions were applied primary closure. Wound healings have been evaluated up to 2 months postoperatively. A total of 50 patients were included to study (39 female, 11 male). The mean age was 57,4±12.1. Totally 74 teeth (29 from maxilla, 45 from mandible) were extracted. In 3 patients (%6), Stage 0 BRONJ was determined as a result of evaluation in biopsy samples made at the tooth extraction intervention. However, in these patients, all extraction sockets were healed uneventfully. Postoperatively, complete mucosal healing success rate is %96. In two patients who have vital bone specimen during tooth extraction according to the histopathologic examination, complete wound closure was failed and BRONJ was developed in follow-up period. The patients with BRONJ were treated successfully. There was no statistically significant correlation between BRONJ development risk and low CTX values. (p=0,285). It has been concluded that chronic inflammatory process may have a role but not sufficient alone for BRONJ pathogenesis in jaws which are not exposed to oral environment. Intravenous bisphosphonates and additional antiresorptive, antiangiogenic medications are considered to increase the risk of development of stage 0 BRONJ. As a result of determined and applied protocol for dentoalveolar processes, the success rate for complete mucosal healing is 96%. Therefore, it has been suggested that the applied protocol in this study is reliable for the patients using bisphosphonates to avoid BRONJ development.