Turkiye Klinikleri Journal of Dental Sciences

.: ORIGINAL RESEARCH
Nitrojen İçeriği, Bifosfonata Bağlı Çene Kemiği Osteonekrozunun Nedeni mi? Fareler Üzerinde Deneysel Çalışma
Is Nitrogen Containing the Reason of Bisphosphonated Induced Osteonecrosis of Jaws? An Experimental Study on Rats
Sabit DEMİRCANa,b
aBeykent Üniversitesi Meslek Yüksekokulu, Ağız Sağlığı Bölümü, İstanbul, TÜRKİYE
bİstanbul Üniversitesi Diş Hekimliği Fakültesi, Ağız, Diş ve Çene Hastalıkları ve Cerrahisi ABD, İstanbul, TÜRKİYE
Turkiye Klinikleri J Dental Sci. 2020;26(2):153-8
doi: 10.5336/dentalsci.2019-66637
Article Language: TR
Full Text
ÖZET
 Amaç: Bifosfonatlar kemik rezorpsiyonu üzerine inhibe edici etkileri nedeni ile iskelet sistemiyle ilgili rahatsızlıklarda sıklıkla kullanılmaktadır. Bifosfonatların ciddi bir yan etkisi, bifosfonata bağlı gelişen çene kemiği osteonekrozudur. Bu yan etki çoğunlukla nitrojen içeren bisfofonatlar ile görülse de nitrojen içermeyen bifosfonatlarla bildirilen olgular vardır. Çalışmamızda, nitrojen içeren (NBP) ve içermeyen (non-NBPs) bifosfonat kullanımının sıçan çekim yarası ve yumuşak doku iyileşmesine etkilerinin histopatolojik olarak incelenmesini amaçladık. Gereç ve Yöntemler: Bu amaçla 48 adet Sprague-Dawley cinsi sıçan 3 gruba ayrılarak çalışma yapılmıştır. Birinci gruba nitrojen içeren bifosfonat (zoledronik asit), ikinci gruba ise nitrojen içermeyen bifosfonat (etidronik asit) 7, 14 ve 21. günlerde subkutan olarak enjekte edilmiştir. Üçüncü grup ise kontrol grubu olarak tayin edilmiştir. Dördüncü haftanın sonunda tüm sıçanların sağ birinci mandibular molar dişi çekilmiş, palatinal diş etinde 5 mm uzunluğunda, 1 mm derinliğinde kesi gerçekleştirilmiştir. Çalışmaya dâhil edilen tüm denekler 6 hafta sonunda sakrifiye edilmiş ve elde edilen örnekler histopatolojik incelemeye tabi tutulmuştur. Bulgular: Sonuçlarımız, NBP kullanımının çekim soketi ve çevresinde mikroorganizma kolonizasyonunu arttırdığını, osteoklast sayısını ve damarlanmayı baskıladığını, çekim soketi iyileşmesini geciktirdiğini göstermiştir. Çalışmamızda 6 hafta sonunda NBP ile açığa çıkmış nekroze kemik dokusu izlenmiş, ancak non-NBP ile açığa çıkmış kemik veya ülserasyon görülmemiştir. Sonuç: Bu sonuçlar, nitrojen içeren bifosfonatların içermeyenlere kıyasla daha yüksek oranda osteonekroz ve gecikmiş yara iyileşmesine neden olduklarını göstermektedir.

Anahtar Kelimeler: Çenelerin bisfofonat ilişkili osteonekrozu; yara iyileşmesi
ABSTRACT
 Objective: Bisphosphonates that inhibit bone resorption are frequently used to treat skeletal-related events. A severe adverse effect caused by such drugs is bisphosphonate related osteonecrosis of the jaws. Bisphosphonate related osteonecrosis of the jaws mostly reported with nitrogen containing bisphosphonates, but there is reports with non-nitrogen containing bisphosphonates induced osteonecrosis. In this study, our aim is to examine the effects of systemic use of both nitrogen containing (NBP) and non-nitrogen containing bisphosphonates (non-NBPs) on healing of rats extraction sockets and soft tissue wounds histo-pathologically. Material and Methods: Therefore 48 Sprague-Dawley rats are separated into 3 groups. Animals in Group 1 injected with a NBP (zoledronic acid) and animals in Group 2 injected with a non- NBP (etidronic acid) on day 7, 14 and 21. Group 3 assigned as a control group. After 28 days, palatinal gingiva incised 5 mm long, 1 mm depth and left mandibular first molar tooth of rats extracted. After 4 weeks of surgical operations all rats sacrificed and the obtained samples examined histo-pathologically. Results: Our results showed that systemic application of NBP increases the colonization of microorganisms on and near the extraction socket; inhibits vascularization, healing of extraction socket and decreases the amount of osteoclasts. In present study we observed that 6 exposed bone with NBP; however etidronate didn't caused exposed bone or ulceration. Conclusion: These results suggests NBPs have much risk for osteonecrosis and delayed wound healing than non-NBPs.

Keywords: Biphosphonate-associated osteonecrosis of jaw; wound healing
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