İlaçlara Bağlı Çene Kemiği Osteonekrozu: Patofizyoloji, Risk Faktörleri ve Önleyici Tedbirlere Dental Yaklaşım

Öz

İlaçlara bağlı çene kemiği osteonekrozu (MRONJ) antirezorptif ve bazı antianjiyojenik ilaçların yan etkisi sonucu çene kemiklerinin ilerleyen yıkımı ile tanımlanan bir patolojidir. MRONJ gelişiminde birden fazla patofizyolojik sürecin ve çok sayıda risk faktörünün rol oynadığı bilinmekle birlikte, farklı faktörlerin MRONJ gelişimindeki etki mekanizmaları ve MRONJ gelişimine yol açma oranları da değişkenlik göstermektedir. Osteonekroz gelişiminde rol oynayan patofizyolojik süreçler ile risk faktörleri arasındaki ilişkinin hekimler tarafından anlaşılması, antirezorptif ve/veya antianjiyojenik ilaç tedavisi planlanan hastalarda ilaca başlanmadan önce gerekli önlemlerin alınması açısından büyük önem taşımaktadır. MRONJ oluşumunun önlenmesi için kabul gören temel strateji, antirezorptif ve/veya antianjiyojenik ilaç tedavisi öncesinde hem klinik hem de radyografik olarak kapsamlı bir değerlendirme yapılarak fokal enfeksiyon veya travma odaklarının saptanması ve ortadan kaldırılmasıdır. Buna göre, MRONJ gelişiminin önlenebilmesi ve antirezorptif ve/veya antianjiyojenik ilaç kullanan hastalarda mevcut risk faktörlerinin saptanabilmesi diş hekimlerinin MRONJ’un patofizyolojisi ve risk faktörleri konusunda yeterli ve güncel bilgiye sahip olması ile mümkündür. Bu derlemenin amacı, MRONJ gelişiminde rol oynayan patofizyolojik süreçleri ve risk faktörlerini yanı sıra MRONJ’u önlemek amacıyla alınabilecek tedbirleri diş hekimliği açısından güncel literatür rehberliğinde irdelemektir.

Anahtar Kelimeler

• Patofizyoloji
• risk faktörleri
• osteonekroz
• önleme ve kontrol

Medication-Related Osteonecrosis of the Jaws: Dental Aspects of Pathophysiology, Risk Factors and Preventive Measures

Abstract

Medication-related osteonecrosis of the jaw (MRONJ) is defined as a progressive destruction of the jawbones, which occurs as a result of the adverse effects of antiresorptive drugs. Although multiple pathophysiological processes and numerous risk factors have been reported to contribute to the development of MRONJ, pathophysiological mechanisms of different factors cause varying rates of MRONJ development in different patients. Understanding the relationship between pathophysiological processes and risk factors is crucial for healthcare providers to take necessary precautions before initiating antiresorptive drug therapy. Accordingly, the identification and elimination of focal infections and/or trauma sites by a comprehensive clinical and radiographic examination prior to antiresorptive drug therapy has been accepted as the primary strategy for preventing MRONJ. Therefore, it is particularly imperative for dental professionals to possess adequate and recent knowledge regarding the pathophysiology and risk factors of MRONJ for the adequate identification of the existing risk factors in patients undergoing antiresorptive therapy and the effective prevention of the development of MRONJ. The aim of this review was to evaluate the pathophysiological processes and risk factors involved in the development of MRONJ and to discuss preventive measures from a dental perspective and in the guidance of the current literature.

Keywords

• Pathophysiology
• prevention and control
• risk factors
• osteonecrosis

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