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 mitogen-activated protein (MAP) kinase phosphatase (MKP) family plays an important function in regulating the pro-inflammatory cytokines by deactivating MAP kinases. MKP-1 is essential for the dephosphorylation of p38 MAP kinase that regulates expression of IL-6, TNF-alpha, and IL-1 beta. We hypothesized that MKP-1 regulates inflammatory bone loss in experimental periodontitis. Wild-type and Mkp-1(-/-) mice received A. actinomycetemcomitans LPS injection in the palatal region or PBS control 3 times/wk for 30 days. Mice were killed, and maxillae were assessed by microcomputed tomography, histological analysis, and TRAP staining for measurement of bone loss, extent of inflammation, and degree of osteoclastogenesis. Results indicated that, in LPS-injected Mkp-1(-/-) mice, significantly greater bone loss occurred with more inflammatory infiltrate and a significant increase in osteoclastogenesis compared with Mkp-1(-/-) control sites or either wild-type group. Analysis of these data indicates that MKP-1 plays a key role in the regulation of inflammatory bone loss.
Assuntos
Perda do Osso Alveolar/enzimologia , Fosfatase 1 de Especificidade Dupla/fisiologia , Fosfatase Ácida/análise , Aggregatibacter actinomycetemcomitans/fisiologia , Perda do Osso Alveolar/patologia , Perda do Osso Alveolar/prevenção & controle , Animais , Biomarcadores/análise , Contagem de Células , Linhagem Celular , Tomografia Computadorizada de Feixe Cônico , Fosfatase 1 de Especificidade Dupla/imunologia , Imageamento Tridimensional , Imunidade Inata/imunologia , Interleucina-6/análise , Interleucina-6/metabolismo , Isoenzimas/análise , Leucócitos/patologia , Lipopolissacarídeos/farmacologia , Doenças Maxilares/enzimologia , Doenças Maxilares/patologia , Doenças Maxilares/prevenção & controle , Camundongos , Camundongos Knockout , Osteoclastos/patologia , Palato , Periodontite/enzimologia , Periodontite/microbiologia , Fosforilação , Fosfatase Ácida Resistente a Tartarato , Fatores de Tempo , Microtomografia por Raio-X , Proteínas Quinases p38 Ativadas por Mitógeno/análise , Proteínas Quinases p38 Ativadas por Mitógeno/metabolismoRESUMO
The treatment of esthetic areas with single-tooth implants represents a new challenge for the clinician. Placement of a single-unit implant is indicated for fractured or periodontally compromised teeth. In 1993, a modification of the forced eruption technique, called "orthodontic extrusive remodelling," was proposed as a way to augment both soft- and hard-tissue profiles at potential implant sites. This case report describes augmentation of the coronal soft and hard tissues around a fractured tooth, which was achieved by forced orthodontic extrusion before implant placement. This technique may be used to improve primary anchorage of a dental implant, fill the alveolar socket with bone, preserve interdental bone height and increase the amount of attached gingiva.