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

Öz

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Anahtar Kelimeler

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

Öz

İlk 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 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 İngilizce yayınlanan olgu raporları ve klinik çalışmalar incelenerek derlenmiştir

Anahtar Kelimeler

• Bisfosfonat, osteonekroz, implant

Kaynakça

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