Turkiye Klinikleri Journal of Dental Sciences

.: REVIEW
İlaç Kullanımına Bağlı Gelişen Çene Osteonekrozu: Tanımı, Önlenmesi, Tedavisi ve Güncel Yaklaşımlar
Medication Related Osteonecrosis of the Jaws: Definition, Prevention, Treatment and Current Approaches
Damla SİVRİa, Sibel ÇEBİ ATAKa, Sedat ÇETİNERa, Kübra ÖZTÜRKb , Begüm OKURc
aGazi Üniversitesi Diş Hekimliği Fakültesi, Ağız, Diş ve Çene Cerrahisi ABD, Ankara, TÜRKİYE
bNuh Naci Yazgan Üniversitesi Diş Hekimliği Fakültesi, Ağız, Diş ve Çene Cerrahisi ABD, Kayseri, TÜRKİYE
cÖzel Dentgroup Diş Kliniği, Ankara, TÜRKİYE
Turkiye Klinikleri J Dental Sci. 2020;26(3):462-71
doi: 10.5336/dentalsci.2019-72332
Article Language: TR
Full Text
ÖZET
 İlaç kullanımına bağlı gelişen çene osteonekrozu [medication related osteonecrosis of the jaw (MRONJ)] hakkında ilk makale 2003 yılında yayımlandı. MRONJ, kemik metastazı veya osteoporoz için antirezorptif veya antianjiyojenik ilaç alan hastalarda 8 haftadan uzun süre devam eden, maksillofasiyal alanda mevcut olan nekrotik kemikle karakterizedir. Osteonekroza, en sık çene kemikleri olmak üzere kalça ve diz kemiklerinde de rastlanmaktadır. MRONJ'ye neden olan ilaçlar, metastaz yapan malignansilerde, osteoporoz ve Paget hastalığının tedavisinde tercih edilmektedir. MRONJ vakalarının patofizyolojisi, henüz tam olarak aydınlatılamamış olmakla birlikte bu durum, kemiğin 'remodeling' mekanizmasının değişmesi veya kemik rezorpsiyonunun baskılanması, enfeksiyon, immün sistem yetmezliği, anjiyogenezin inhibisyonu, yumuşak doku toksisitesi, kronik mikrotravmalar ve D vitamini yetersizliğiyle açıklanabilmektedir. Önerilen cerrahi ve konservatif tedavi rejimlerinin uygulanması değişken başarı oranları sağlamıştır. Semptomatik tedavilerin başarısız kaldığı vakalarda, cerrahi debridman, enfekte dişin çekimi, oluşmuş nekrotik kemiğin rezeksiyonu gibi cerrahi girişimler gerekli olabilir. Cerrahi girişimlerin başarı şansını artırmak için piezocerrahi, lazer cerrahisi, plateletten zengin plazma uygulanması, lökosit ve plateletten zengin fibrin (L-PRF) kullanımı, ozon terapisi gibi yöntemler de ek tedavi olarak uygulanabilmektedir. MRONJ tedavisinde belki de en önemli basamak, risk grubundaki hastaları bilinçlendirmek ve MRONJ oluşumunu önlemektir. Mevcut literatürün en iyi kanıt incelemesine dayanan bu derleme, MRONJ'nin önlenmesi, yönetilmesi ve tedavi edilmesine yardımcı olacak açık pratik kılavuzlar ve yeni tedavi yöntemleri sunmaktadır. MRONJ'ye multidisipliner bir yaklaşım benimsenmeli, hastanın yaşam kalitesi ön planda tutulmalıdır.

Anahtar Kelimeler: Çenenin bifosfonatla ilişkili osteonekrozu; osteonekroz; bifosfonatlar
ABSTRACT
 The first article about medication related osteonecrosis of the jaw (MRONJ) was published in 2003. MRONJ is characterized by exposed necrotic bone in the maxillofacial area that persists for more than eight weeks in patients taking antiresorptive or antiangiogenic drugs for bone metastasis or osteoporosis. Osteonecrosis is most commonly seen in the bones of the jaw, hip and knee. Drugs that cause MRONJ are preferred for the treatment of metastasis malignancies, osteoporosis and Paget disease. Although the pathophysiology of MRONJ cases has not been fully elucidated yet, this may be explained by the alteration of bone remodeling mechanism or suppression of bone resorption, infection, inhibition of angiogenesis, soft tissue toxicity, immune system failure, chronic microtrauma and vitamin D deficiency. The application of the recommended surgical and conservative treatment regimens have returned variable success rates. In cases where symptomatic treatments fail; surgical procedures such as surgical debridement, extraction of infected tooth, resection of the necrotic bone may be necessary. To increase the chances of success of surgical interventions; piezosurgery, laser surgery, platelet rich plasma application, leukocyte and platelet rich fibrin use, ozone therapy can also be applied as additional treatment. This review, based on best evidence review of currently available literature provides clear practical guidelines and new treatment methodes to help to prevent, manage and treat MRONJ. All inclusive, a multidisciplinary approach to MRONJ should be adopted, prioritizing patient's quality of life.

Keywords: Biphosphonate-associated osteonecrosis of the jaw; osteonecrosis; bisphosphonates
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4.8. "Turkiye Klinikleri" may give links through the "SITE" to other websites and/or "CONTEXT"s and/or folders that are outside of their control and owned and run by third parties. These links are provided for ease of reference only and do not hold qualification for support the respective web SITE or the admin or declaration or guarantee for the information inside. "Turkiye Klinikleri" does not hold any responsibility over the web-sites connected through the links on the "SITE", folders and context, the services or products on the websites provided through these links or their context.

4.9. "Turkiye Klinikleri" may use the information provided to them by the "USERS" through the "SITE" in line with the terms of the "PRIVACY POLICY" and "USER CONTRACT". It may process the information or classify and save them on a database. "Turkiye Klinikleri" may also use the USER's or visitor's identity, address, e-mail address, phone number, IP number, which sections of the "SITE" they visited, domain type, browser type, date and time information to provide statistical evaluation and customized services.

5. PROPRIETARY RIGHTS

5.1. The information accessed through this "SITE" or provided by the users legally and all the elements (including but not limited to design, text, image, html code and other codes) of the "SITE" (all of them will be called as studies tied to "Turkiye Klinikleri"s copyrights) belongs to "Turkiye Klinikleri". Users do not have the right to resell, process, share, distribute, display or give someone permission to access or to use the "Turkiye Klinikleri" services, "Turkiye Klinikleri" information and the products under copyright protection by "Turkiye Klinikleri". Within hereby "Terms of Use" unless explicitly permitted by "Turkiye Klinikleri" nobody can reproduce, process, distribute or produce or prepare any study from those under "Turkiye Klinikleri" copyright protection.

5.2. Within hereby "Terms of Use", "Turkiye Klinikleri" reserves the rights for "Turkiye Klinikleri" services, "Turkiye Klinikleri" information, the products associated with "Turkiye Klinikleri" copyrights, "Turkiye Klinikleri" trademarks, "Turkiye Klinikleri" trade looks or its all rights for other entity and information it has through this website unless it is explicitly authorized by "Turkiye Klinikleri".

6. CHANGES IN THE TERMS OF USE

"Turkiye Klinikleri" in its sole discretion may change the hereby "Terms of Use" anytime announcing within the "SITE". The changed terms of the hereby "Terms of Use" will become valid when they are announced. Hereby "Terms of Use" cannot be changed by unilateral declarations of users.

7. FORCE MAJEURE

"Turkiye Klinikleri" is not responsible for executing late or never of this hereby "Terms of Use", privacy policy and "USER Contract" in any situation legally taken into account as force majeure. Being late or failure of performance or non-defaulting of this and similar cases like this will not be the case from the viewpoint of "Turkiye Klinikleri", and "Turkiye Klinikleri" will not have any damage liability for these situations. "Force majeure" term will be regarded as outside of the concerned party's reasonable control and any situation that "Turkiye Klinikleri" cannot prevent even though it shows due diligence. Also, force majeure situations include but not limited to natural disasters, rebellion, war, strike, communication problems, infrastructure and internet failure, power cut and bad weather conditions.

8. LAW AND AUTHORISATION TO FOLLOW

Turkish Law will be applied in practicing, interpreting the hereby "Terms of Use" and managing the emerging legal relationships within this "Terms of Use" in case of finding element of foreignness, except for the rules of Turkish conflict of laws. Ankara Courts and Enforcement Offices are entitled in any controversy happened or may happen due to hereby contract.

9. CLOSING AND AGREEMENT

Hereby "Terms of Use" come into force when announced in the "SITE" by "Turkiye Klinikleri". The users are regarded to agree to hereby contract terms by using the "SITE". "Turkiye Klinikleri" may change the contract terms and the changes will be come into force by specifying the version number and the date of change on time it is published in the "SITE".

 

30.03.2014

Privacy Policy

We recommend you to read the terms of use below before you visit our website. In case you agree these terms, following our rules will be to your favor. Please read our Terms of Use thoroughly.

www.turkiyeklinikleri.com website belongs to Ortadoğu Advertisement Presentation Publishing Tourism Education Architecture Industry and Trade Inc. and is designed in order to inform physicians in the field of health

www.turkiyeklinikleri.com cannot reach to user’s identity, address, service providers or other information. The users may send this information to the website through forms if they would like to. However, www.turkiyeklinikleri.com may collect your hardware and software information. The information consists of your IP address, browser type, operating system, domain name, access time, and related websites. www.turkiyeklinikleri.com cannot sell the provided user information (your name, e-mail address, home and work address, phone number) to the third parties, publish it publicly, or keep it in the website. Gathered information has a directing feature to be a source for the website’s visitor profile, reporting and promotion of the services.

www.turkiyeklinikleri.com uses the taken information:

-To enhance, improve and maintain the quality of the website

-To generate visitor’s profile and statistical data

-To determine the tendency of the visitors on using our website

-To send print publications/correspondences

-To send press releases or notifications through e-mail

-To generate a list for an event or competition

By using www.turkiyeklinikleri.com you are considered to agree that;

-Ortadoğu Advertisement Presentation Publishing Tourism Education Architecture Industry and Trade Inc. cannot be hold responsible for any user’s illegal and immoral behavior,

-Terms of use may change from time to time,

-It is not responsible for other websites’ contents it cannot control or the harms they may cause although it uses the connection they provided.

Ortadoğu Advertisement Presentation Publishing Tourism Education Architecture Industry and Trade Inc. may block the website to users in the following events:

-Information with wrong, incomplete, deceiving or immoral expressions is recorded to the website,

-Proclamation, advertisement, announcement, libelous expressions are used against natural person or legal identity,

-During various attacks to the website,

-Disruption of the website because of a virus.

Written, visual and audible materials of the website, including the code and the software are under protection by legal legislation.

Without the written consent of Ortadoğu Advertisement Presentation Publishing Tourism Education Architecture Industry and Trade Inc. the information on the website cannot be downloaded, changed, reproduced, copied, republished, posted or distributed.

All rights of the software and the design of the website belong to Ortadoğu Advertisement Presentation Publishing Tourism Education Architecture Industry and Trade Inc.

Ortadoğu Advertisement Presentation Publishing Tourism Education Architecture Industry and Trade Inc. will be pleased to hear your comments about our terms of use. Please share the subjects you think may enrich our website or if there is any problem regarding our website.

info@turkiyeklinikleri.com