Turkiye Klinikleri Journal of Dental Sciences

.: ORIGINAL RESEARCH
Antirezorptif Ajan Kullanan Hastalardaki Radyografik Bulgular: Retrospektif Değerlendirme: Kesitsel Çalışma
Radiographic Findings in Patients Using Antiresorptive Agents: Retrospective Assessment: Cross-Sectional Study
Aslıhan AKBULUTa
aİstanbul Medipol Üniversitesi Diş Hekimliği Fakültesi, Ağız, Diş ve Çene Radyolojisi ABD, İstanbul, TÜRKİYE
Turkiye Klinikleri J Dental Sci. 2022;28(1):41-51
doi: 10.5336/dentalsci.2021-83512
Article Language: TR
Full Text
ÖZET
 Amaç: İlaçlara bağlı çene kemiği osteonekrozu (İÇKON), antirezorptif/ antianjiyogenik ajanların sebep olduğu ciddi problemlerden biridir. Bu çalışmanın amacı, İÇKON'nin panoramik radyografi görüntülerindeki bulguları değerlendirmektir. Gereç ve Yöntemler: Bu retrospektif çalışma, 3.079 hastaya ait veriler üzerinde yapılmıştır ve bu hastalardan 'bifosfonat' veya 'denosumab' grubu antirezorptif ilaç kullanan 40 hastaya ait panoramik radyografileri değerlendirilmiştir. İlacın adı, hangi amaçla kullanıldığı, kullanım şekli ve kullanım süresi kaydedilmiştir. Panoramik radyografi bulguları; osteolizis, kortikal kemik erozyonu, fokal/diffüz kemik sklerozu, sekestr lamina dura kalınlaşması, mandibular kanalın belirginleşmesi, persistan alveoler soket, periodontal aralıkta genişleme, patolojik fraktür olarak incelenmiştir. Bulgular: Radyografik bulguların 60 yaş üstü kadın hastalarda (%85) ve alt çene posterior bölgede daha fazla (%40,8) görüldüğü saptanmıştır. Başta osteolizis (%53,9) olmak üzere, kortikal kemik erozyonu (%36,8) ve periodontal aralıkta genişleme (%34,2) en çok belirlenen bulgulardır. İlaç kullanım süresiyle radyografik bulgu sayısı arasında pozitif yönlü, orta düzeyde ve istatistiksel olarak anlamlı bir ilişki bulunmaktadır (p=0,000; p<0,05). Sekestr görülen olguların yaş ortalaması, görülmeyen olgulardan istatistiksel olarak anlamlı düzeyde yüksektir (p=0,006; p<0,05). Sonuç: İÇKON'ye dair spesifik radyografik bulguların olmamasına rağmen, panoramik radyografi diş hekimine temel radyografik bulgular hakkında değerli bilgiler sunmaktadır. Diş hekimi, antirezorptif ajan kullanan hastaların radyolojik muayenesinde osteolizis, kortikal kemik erozyonu, periodontal aralıkta genişleme, kemik skleroz, persistan alveoler soket, lamina durada kalınlaşma, sekestr ve patolojik fraktür gibi bulgular var ise osteonekroz riskini göz önünde bulundurmalıdır.

Anahtar Kelimeler: Antirezorptif ajan; bifosfonat; denosumab; çene osteonekrozu; panoramik radyografi
ABSTRACT
 Objective: Medication-related osteonecrosis of the jaws (MRONJ) is one of the serious problems caused by antiresorptive/antiangiogenic agents. The aim of the study is to evaluate the findings in the panoramic radiography of MRONJ. Material and Methods: This study was carried out on the data of 3079 patients and among these patients, panoramic radiographies of 40 patients using 'Bisphosphonate' or 'Denosumab' group antiresorptives were evaluated. The name, purpose of use, method of usage and duration of the drug used were recorded. Radiographic findings; osteolysis, cortical bone erosion, focal/diffuse bone sclerosis, sequestration, laminadura thickening, persisting alveolar sockets, periodontal space widening, pathological fracture. Results: Findings were found to be more common in female patients over 60 years of age (85%) and in the posterior region of the mandible (40.8%). Firstly osteolysis (53.9%), cortical bone erosion (36.8%), periodontal space widening (34.2%) are the most common findings. There was a positive, moderate and statistically significant relationship between the duration of drug use and the number of radiographic findings (p=0.000; p<0.05). The mean age of the cases with sequestration is statistically significantly higher than the cases with no seen (p=0.006; p<0.05). Conclusion: Although the radiographic findings of MRONJ is nonspecific, panoramic graphy provides valuable data to the dentist about basic radiographic findings. The dentist should consider the risk of osteonecrosis if there are radiographic findings osteolysis, cortical bone erosion, the periodontal space widening, focal/diffuse bone sclerosis, prominent mandibularcanal, persistent alveolar socket, lamina dura thickening, sequestration and pathological fracture in patients using antiresorptive agents.

Keywords: Antiresorptive agents; bisphosphonate; denosumab; jaw osteonecrosis; panoramic radiography
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