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BİSFOSFONAT KULLANMIŞ VEYA KULLANMAKTA OLAN HASTALARDA DENTAL İMPLANT UYGULAMALARI: LİTERATÜR DERLEMESİ

THE USE OF DENTAL IMPLANTS IN PATIENTS ON BISPHOSPHONATE THERAPY: A REVIEW OF THE LITERATURE

Journal Name:

  • Atatürk Üniversitesi Diş Hekimliği Fakültesi Dergisi

Publication Year:

  • 2011

Key Words:

Keywords (Original Language):

Author NameUniversity of AuthorFaculty of Author
Abstract (2. Language): 
Bisphosphonate related osteonecrosis of the jaws, which was first described in 2003, shows similarities with an industrial disease commonly known as "phossy jaw'' which is characterized with necrotic bony areas located in the jaws of the workers producing white phosphorus based matches, about a hundred years ago. In the 19th century, bisphosphonates were used as anticorrosive agents in the textile and industry. Bisphosphonates were initially introduced to the medical usage for more than forty years ago. The main mechanism of action of bisphosphonates is to inhibit bone resorption and consequently, the bone turn-over. Bisphosphonates are either orally or intravenously administered. Oral bisphosphonates are primarily used for the treatment of osteoporosis as well as the Paget's Disease and osteogenesis imperfecta. Intravenous bisphosphonates, by being more potent, are commonly prescribed for the prevention and the treatment of bone metastases of osteolytic tumours, hypercalcemia of malignancy, and in the prevention and the treatment of the bone related complications of multiple myeloma. As a side effect, especially intravenous bisphosphonates may cause osteonecrosis of the jaws. Clinically, this situation is characterized with exposed necrotic bone located in the mandible or in the maxilla, persisting more than 8 weeks, in patients which are/were on bisphosphonate therapy, without a history of radiotherapy or corticosteroid usage. One of the common oral surgical procedures is the use of dental implants. The number of studies which evaluate the use of dental implants in patients who are/were on bisphosphonate therapy, is scarce. The purpose of this article, is to evaluate the predictibility and the success rate of the dental implants in patients who are/were on bisphosphonate therapy, regarding the literature. The risk of osteonecrosis occurence after implant placement, was also emphasized. The case reports and the clinical studies written in English and were published in Medline- on Pubmed in between the time period of 1995 January- 2011 April, were reviewed.
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Abstract (Original Language): 
ilk kez 2003 yılında bildirilen çenelerde görülen bisfosfonat nekrozu, aslında yüz yıl önce "çene kemiğinin fosforlu nekrozu'' adıyla, beyaz fosforla kibrit yapılmasında çalışan işçilerin uzun süre fosfor dumanına maruz kalmaları nedeniyle, çenelerinde iyileşmeyen kemik alanları ile tanımlanan bir meslek hastalığıyla büyük benzerlikler gösterir. 19.yy'da tekstil ve endüstri alanında antikoroziv ajan olarak kullanılan bisfosfonatların tıpta kullanımı ise kırk yılı aşkın bir geçmişe dayanmaktadır. Etki mekanizması kısaca kemik rezorpsiyonunu ve buna bağlı olarak kemik yapım-yıkım mekanizmasını inhibe etmek olan bisfosfonatların, oral ve intravenöz olmak üzere iki veriliş yolu bulunmaktadır. Oral yol ile verilen bisfosfonatlar başlıca osteoporoz olmak üzere, Paget hastalığı ve osteogenezis imperfekta gibi metabolik kemik hastalıklarında uygulanırken, intravenöz yol ile verilen ve daha etkili olan bisfosfonatlar ise sıklıkla osteolitik tümörlerin kemik metastazlarını önlemede ve tedavi etmede, maligniteye bağlı hiperkalsemide ve de multipl miyelomanın kemik komplikasyonlarını önlemede kullanılmaktadır. Özellikle intravenöz yoldan verilen bisfosfonatların en belirgin yan etkisi, çene kemiklerinde görülen osteonekrozlardır. Bisfosfonata bağlı gelişen çenelerin osteonekrozu, radyoterapi almamış, kortikosteroid kullanmayan ancak bisfosfonat kullanmış ya da kullanmakta olan hastalarda, maksilla veya mandibulada klinik olarak 8 haftadan uzun süre iyileşmeyen nekrotik alanlar ile tanımlanır. Oral cerrahi girişimlerden biri de dental implant uygulamalarıdır. Literatürde bisfosfonat kullanan hastalarda uygulanan dental implantlar ile ilgili sınırlı sayıda çalışma bulunmaktadır. Bu makalede, bisfosfonat kullanımı hikayesi olan hastalarda dental implantın uygulanabilirliğinin ve başarısının literatür dahilinde değerlendirilmesi amaçlanmış; implant uygulaması sonrasında çenelerde osteonekroz oluşma riski vurgulanmıştır. Bu yazı, Ocak 1995 - Nisan 2011 yılları arasında Medline-Pubmed düzeyinde ingilizce yayınlanan olgu raporları ve klinik çalışmalar incelenerek derlenmiştir.
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  • 3
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  • Turkish

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