Osteonecrosis de los maxilares: fisiopatología, diagnóstico y tratamiento

Medication-Related Osteonecrosis of the Jaw and Low-Level Laser Therapy as Adjuvant Treatment: A Case Report

“…It would be advisable to follow the preventive protocol, performing oral and clinical imaging before the beginning of treatment with BP to contain the outbreaks of infection; periodic dental appointments to eliminate possible traumatic factors; bone metabolism level monitoring; and advise patients on the risks of developing osteonecrosis. 4 The LLLT provided a significant improvement regarding the signs of inflammation (mainly swollen and pain), xerostomia, bacterial control, and chemotherapyinduced oral mucositis; therefore, it is effective in MRONJ patients, avoiding oral or cutaneous fistulas and healing the mucosa on the bone tissue, and improving the life quality of the patient. 8 It prevents the patient's evolution from stage 2 (exposed and necrotic bone or a fistula with evidence of infection, typically asymptomatic and symptomatic) to stage 3 (exposed and necrotic bone or fistulas with evidence of infection and with pathologic fracture or exposed necrotic bone, extraoral oral antral or oral-nasal communication, osteolysis extending to the inferior border of the mandible or sinus floor) although there was no complete healing as the extension of the injured area and poor tissue utilization during the sequestrectomy.…”

“…Depending on the time of treatment or the administered drug, the BP can remain in the body for years and it can cause ischemia and develop osteonecrosis, a rare but serious collateral effect. [2][3][4] As a result of chemotherapy or associated medications, another frequent oral complication is mucositis, the most common cause of oral pain during treatment. 5 Necrosis in patients using BP after a dental procedure presents a risk to the patient's health, and therefore it must be analyzed by an oral surgery specialist with a physician to choose the best time for the procedure, considering that MRONJ implies the reduction of the quality of life and significant morbidity in the affected ones, 6 while the early diagnosis can reduce the morbidity resulting from the lesions.…”

Fisiopatología de la osteonecrosis de los maxilares por bifosfonatos y sus respectivos tratamientos de acuerdo a sus estadíos

“…Es importante mencionar que aquellos pacientes que consumen bifosfonatos orales tienen el riesgo de padecer osteonecrosis mandibular del 1% y los que utilizan bifosfonatos intravenosos el riesgo es mayor del 95% (23).…”

No dejemos morir al hueso: interiorizándonos con los procesos óseos avasculares

“…3,6 Se debe mencionar la ON maxilar, relacionada al uso de bifosfonatos, con el tratamiento odontológico invasivo como factor de riesgo para su desarrollo. 7 Osteonecrosis de cadera/cabeza femoral La cabeza femoral es la zona más frecuente de ON, ocurre en el 15% al 80% de los pacientes con fractura de cuello femoral, así como en pacientes con tratamiento corticoideo. 8 La ON de cadera suele ser bilateral y el riesgo de la bilateralidad es mayor dentro de los dos años posteriores al diagnóstico unilateral.…”