RESUMO
Bisphosphonate-related osteonecrosis of the jaws is characterized by alveolar bone exposure, especially after mucosal trauma or after surgical procedures, in patients who have previously received or who are currently receiving bisphosphonates without a history of radiation therapy in the maxillofacial region. The condition is refractory to treatment, and attempts at debridement are not completely effective in eradicating the necrotic bone. We report here a case of a severe osteonecrosis of the jaws in a 77-year-old male patient, who had been subjected to chemotherapy and treatment with zoledronic acid and corticosteroid. The patient also had comorbidities such as diabetes and periodontal disease, which might have contributed to the lesion development. Bisphosphonate-related osteonecrosis of the jaws has become a reality in dental clinical practice. Although palliative treatment aiming at controlling pain, infection and injury progression is indicated, the therapeutic strategy is still challenging. So far, the best approach available is prevention, based on oral care before, during, and after bisphosphonate therapy(AU)
La osteonecrosis de los maxilares asociada al uso de bifosfonatos se traduce en la aparición de hueso alveolar expuesto y necrótico, especialmente después de un trauma de la mucosa o después de procedimientos quirúrgicos, en pacientes que han recibido previamente o que están recibiendo bifosfonatos pero sin historia de radioterapia a región máxilofacial. La afección es refractaria al tratamiento, y los intentos de desbridamiento no son totalmente eficaces en la erradicación del hueso necrótico. Se presenta aquí un caso de una grave osteonecrosis de los maxilares en un paciente masculino de 77 años de edad, que había sido sometido a quimioterapia y tratamiento con ácido zoledrónico y corticosteroides. El paciente también tenía comorbilidades como diabetes y enfermedad periodontal, que pueden haber contribuido al desarrollo de la lesión. El creciente número de casos de esta enfermedad en la literatura ha llamado la atención. Dado que el enfoque terapéutico sigue siendo difícil, la prevención es la mejor estrategia disponible(AU)
Assuntos
Humanos , Masculino , Idoso , Literatura de Revisão como Assunto , Doenças Maxilares/prevenção & controle , Osteonecrose da Arcada Osseodentária Associada a Difosfonatos/tratamento farmacológicoRESUMO
The present study evaluated the effectiveness of two reciprocating systems for the removal of root-filling material during endodontic retreatment. One hundred extracted mandibular premolars were prepared and root-filled with gutta-percha and sealer. Root fillings were removed with K-files according to the following techniques: Group A--hand instrumentation; Group B--Endo-Gripper system driven by compressed air; Group C--INTRAmatic 29CH + INTRA-LUX 3LD driven by compressed air; Group D--Endo-Gripper system driven by electric engine; Group E--INTRAmatic 29CH + INTRA-LUX 3LD driven by electric engine. The amount of filling debris on root canal walls was assessed radiographically and analysed using Auto CAD 2000 software. One-way anova and Duncan's test revealed statistically significant differences only in the middle third (P = 0.01); the best results being reached in group D. The apical third displayed the greatest amount of filling material debris, regardless of the technique used.