Data de entrada do artigo: 04/08/2013 Data de aceite do artigo: 05/12/2013 Introdução: Os pacientes com doença renal crônica têm condições sistêmicas e orais características, que exigem precauções especiais durante o tratamento odontológico. Os medicamentos devem ser administrados com cautela e os pacientes que são submetidos à diálise devem receber atenção especial. Antes do início de qualquer tratamento odontológico, o cirurgião dentista deve consultar o médico do paciente a respeito das precauções específicas. Um plano de tratamento deve ser constituído, protegendo contra possíveis riscos. Objetivo: Descrever as manifestações sistêmicas e orais, a fisiopatologia e considerações gerais e farmacológicas para o tratamento oral de pacientes que apresentam doença renal crônica. Materiais e Métodos: Uma revisão analítica, retrospectiva e descritiva da literatura do tópico foi realizada utilizando informações e protocolos atualizados. Conclusão: Para o tratamento desses pacientes, os clínicos devem ter a capacidade de reconhecer o nível de risco, estar cientes dos protocolos farmacológicos, características do atendimento clínico e alterações psicológicas que esses pacientes podem apresentar. É importante também reconhecer as diferentes necessidades e os ajustes que devem ser feitos individualmente para cada um dos casos. Palavras-chave: nefropatias; insuficiência renal; assistência odontológica. RESUMO Introduction: Patients with chronic renal disease have specific systemic and oral conditions, which require special precautions during oral treatment. Drugs must be administered with caution and patients undergoing dialysis must receive special consideration. Before any oral treatment, the dentist should consult the patient's physician about specific precautions. A treatment plan should be built in order to protect from potential risks. Objective: To describe the physiopathology, systemic and oral manifestations, as well as overall and pharmacological considerations for the oral treatment of patients with chronic renal disease. Materials and Methods: An analytical retrospective descriptive literature review on the subject was performed using up-to-date information and protocols. Conclusion: For the treatment of patients with chronic renal disease, clinicians should be capable to recognize the level of risk in those individuals, be aware of pharmacological protocols, clinical management and psychological changes that these patients may present. It is also important to recognize the different necessities and adjustments that must be made for each case individually.

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Medication-related osteonecrosis of the jaw (MRONJ) is defined by the American Association of Oral and Maxillofacial Surgeons (AAOMS) as the presence of an exposed bone area in the maxillofacial region, present for more than eight weeks in patients treated with the use of antiresorptive or antiangiogenic agents, with no history of radiation or metastatic disease. Bisphosphonates (BF) and denosumab (DS) are widely used in adults for the management of patients with cancer and osteoporosis, and recently there has been an increase in their use in child and young patients for the management of disorders such as osteogenesis imperfecta (OI), glucocorticoid-induced osteoporosis, McCune-Albright syndrome (MAS), malignant hypercalcemia, and others. There are differences between case reports in adults compared to child and young patients related to the use of antiresorptive/antiangiogenic drugs and the development of MRONJ. The aim was to analyze the presence of MRONJ in children and young patients, and the relation with oral surgery. A systematic review, following the PRISMA search matrix based on the PICO question, was conducted in PubMed, Embase, ScienceDirect, Cochrane, Google Scholar, and manual search in high-impact journals between 1960 and 2022, publications in English or Spanish, including randomized and non-randomized clinical trials, prospective and retrospective cohort studies, cases and controls studies, and series and case reports. A total of 2792 articles were identified and 29 were included; all of them published between 2007 and 2022, identifying 1192 patients, 39.68% male and 36.24% female, aged 11.56 years old on average, using these drugs mainly for OI (60.15%); 4.21 years on average was the therapy time and 10.18 drug doses administered on average; oral surgery was observed in 216 subjects, reporting 14 cases of MRONJ. We concluded that there is a low presence of MRONJ in the child and youth population treated with antiresorptive drugs. Data collection is weak, and details of therapy are not clear in some cases. Deficiencies in protocols and pharmacological characterization were observed in most of the included articles.

The aim of this research was to analyze the facial class, presence of malocclusion, and the mandibular plane and to relate this to the mandibular condyle position. A cross-sectional study in subjects under analysis for orthognathic surgery was done. The mandibular plane, the gonial angle, and the molar class were included to compare the coronal and sagittal position of the condyle and the joint space observed in the CBCT. The measurements were obtained by the same observer at an interval of two weeks. In addition, the Spearman test was performed to determine the correlation using a p value < 0.05 to observe any significant differences. Eighty-nine male and female subjects (18 to 58 years old, 24.6 ± 10.5) were included. In the coronal section, subjects with CIII had a greater mediolateral distance (MLD, p = 0.0001) and greater vertical distance (SID, p = 0.0001) than subjects with CII. In terms of the skeletal class and the mandibular plane, it was observed that subjects in the CII group had a greater mandibular angle (open angle) (p = 0.04) than the CII group and was related to the anterior position of the condyle. The most anterior condylar position was observed in the CII group (p = 0.03), whereas a posterior condylar position was significant in CIII subjects (p = 0.03). We can conclude that the sagittal position of the TMJ was related to the mandibular plane and the skeletal class showing a higher mandibular angle and most anterior position of the condyle in CII subjects and a lower mandibular angle and most posterior position of the condyle in CIII subjects. The implications for surgical treatment have to be considered.