Maluf, G., Caldas , RJ, Fregnani, ER et al. Kasus langka osteonekrosis rahang terkait bevacizumab terkait dengan implan gigi. Penyok Implan Int J 5, 34 (2019). https://doi.org/10.1186/s40729-019-0188-0
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Diterima: 01 Juli 2019
Diterima: 30 Agustus 2019
Diterbitkan: 01 Oktober 2019
DOI: https://doi.org/10.1186/s40729-019-0188-0
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Klinik Swasta, Brasilia, DF, BrasilGustavo MalufBrasilia, BrasilGustavo MalufDepartment of Stomatology, Bauru Dental School, USP–University of São Paulo, Bauru, SP, BrazilRogério Jardim CaldasDepartemen Kedokteran Mulut, Rumah Sakit Sírio-Libanês, São Paulo, SP, BrasilEduardo Rodrigues FregnaniDepartment of Stomatology, Bauru Dental School, USP–University of São Paulo, Bauru, SP, BrazilP...
Otto S, Schreyer C, Hafner S, dkk. Osteonekrosis rahang terkait bifosfonat—karakteristik, faktor risiko, gambaran klinis, lokalisasi, dan dampak pada pengobatan onkologis. J Craniomaxillofac Surg. 2012;40:303–9 .Agrillo A, Filiaci F, Ramieri V, dkk. Osteonekrosis rahang terkait bifosfonat (BRONJ): Pengalaman 5 tahun dalam pengobatan 131 kasus dengan terapi ozon. Eur Rev Med Pharmacol Sci. 2012...
Pakosch D, Papadimas D, Munding J, dkk. Osteonekrosis mandibula karena agen anti-angiogenik, bevacizumab. Oral Maxillofac Surg. 2013;17:303–6.
Corbella S, Taschieri S, Samaranayake L, Tsesis I, dkk. Pilihan perawatan implan setelah pencabutan gigi yang retak vertikal. Sebuah proposal untuk klasifikasi klinis defek tulang berdasarkan tinjauan sistematis literatur. Clin Implan Oral Res. 2014;25:9...
Watters AL, Epstein JB, Agulnik M. Komplikasi oral dari terapi kanker yang ditargetkan: tinjauan literatur naratif. Oral Oncol. 2011;47:441–8.
Herbst RS, O'Neill VJ, Fehrenbacher L, et al. Studi fase II tentang kemanjuran dan keamanan bevacizumab dalam kombinasi dengan kemoterapi atau erlotinib dibandingkan dengan kemoterapi saja untuk pengobatan kanker paru-paru sel kecil yang berulang atau re...
Osteonekrosis rahang terkait Bevacizumab
Tulang meruncing
Tomografi komputer
Osteonekrosis rahang terkait pengobatan
Faktor pertumbuhan endotel vaskular A
Berbagi data tidak berlaku untuk artikel ini karena tidak ada kumpulan data yang dibuat atau dianalisis selama penelitian saat ini.
Temuan kasus ini menunjukkan bahwa pemasangan implan gigi merupakan faktor risiko osteonekrosis rahang pada pasien yang terpapar bevacizumab. Oleh karena itu, studi prospektif acak harus didorong untuk menentukan rejimen bevacizumab yang lebih aman yang mempertimbangkan baik operasi mulut dan risiko implan gigi untuk pengelolaan osteonekrosis dalam pengaturan klinis.
MRONJ adalah efek samping obat dengan predileksi pada mandibula [24] , yang dapat dikaitkan dengan vaskularisasi mandibula yang relatif rendah dibandingkan dengan rahang atas [13] Infeksi gigi, intervensi bedah, pengobatan kortikosteroid, dan kemoterapi telah digambarkan sebagai faktor risiko osteonekrosis [25]. pasien mengalami osteonekrosis stadium 2 dengan infeksi gigi di area mandibula, bahkan...
Pemberian agen antiangiogenik jangka panjang tidak secara langsung menunjukkan risiko tinggi MRONJ [16], meskipun beberapa penulis telah menetapkan interval 7-, 14-, dan 28 hari dari suspensi bevacizumab untuk bedah mulut [17,18,19] Dalam kasus ini, obat antiangiogenik dihentikan selama 28 hari sebelum penempatan implan; namun, ini tidak cukup untuk mencegah MRONJ. Permukaan implan Straumann® SLa...
Sebuah meta-analisis menunjukkan bahwa penempatan implan gigi pada pasien yang terpapar bifosfonat tidak mengurangi tingkat keberhasilan implan gigi [11], meskipun pasien ini mungkin mengalami komplikasi Berdasarkan analisis ini, penilaian risiko harus dilakukan berdasarkan kasus per kasus, karena MRONJ jarang terjadi tetapi salah satu di antara komplikasi serius terapi bifosfonat [11] Namun, stud...
Lima minggu pascaoperasi, nyeri, drainase sekret purulen, dan tulang terbuka di sekitar implan diamati (Gbr. 4), meskipun tidak ada implan yang menunjukkan mobilitas. Sepuluh sesi terapi ozon yang terkait dengan levofloxacin dilakukan. Setelah 4 minggu terapi dengan minyak ozon (Philozon®, Balneário Cambori, SC, Brasil), tidak ada rasa sakit atau drainase dari sekresi purulen. Namun, sekuestrasi...
Seorang wanita bule berusia 54 tahun mengeluhkan rasa tidak enak dan nyeri di mulut. Riwayat medisnya termasuk kanker payudara dengan metastasis, yang didiagnosis pada tahun 2007. Pasien tidak memiliki penyakit penyerta dan tidak ada riwayat merokok. Telah dilakukan mastektomi radikal dengan diseksi aksila. Pasien tidak memiliki riwayat radioterapi kepala sebelumnya. dan leher atau penggunaan bifo...
Pengobatan keganasan sering kali melibatkan penggunaan terapi bertarget untuk mengontrol pertumbuhan dan kelangsungan hidup keganasan sel dengan mengganggu agen molekuler spesifik yang terlibat dalam karsinogenesis [1]. Bevacizumab adalah antibodi monoklonal manusiawi rekombinan yang dirancang untuk secara selektif mengikat dan menghambat aktivitas biologis semua isoform faktor pertumbuhan endotel...
Fig. 7. Panoramic radiograph at 7-month follow-up
Fig. 6. Image obtained 7 months postoperatively showing no lesions
Fig. 5. a, b Histological image of the lesion
Fig. 4. Bone exposure surrounding the implants with drainage of purulent secretion
Fig. 3. Panoramic radiograph after dental extractions with subsequent dental implants
Fig. 2. a, b Tomographic findings: lesions, measurements, and bone quality
Fig. 1. Initial clinical image showing oral infection foci
Maluf, G., Caldas, R.J., Fregnani, E.R. et al. A rare case of bevacizumab-related osteonecrosis of the jaw associated with dental implants.
Int J Implant Dent 5, 34 (2019). https://doi.org/10.1186/s40729-019-0188-0
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Received: 01 July 2019
Accepted: 30 August 2019
Published: 01 October 2019
DOI: https://doi.org/10.1186/s40729-019-0188-0
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The requirements of the Helsinki Declaration were observed, and the patient gave informed consent for all surgical procedures.
Written informed consent was obtained from the patient for the publication of this report and all accompanying images.
Gustavo Maluf, Rogério Jardim Caldas, Eduardo Rodrigues Fregnani, and Paulo Sérgio da Silva Santos declare that they have no competing interests.
Private Clinic, Brasília, DF, Brazil
Gustavo Maluf
Brasília, Brasil
Gustavo Maluf
Department of Stomatology, Bauru Dental School, USP–University of São Paulo, Bauru, SP, Brazil
Rogério Jardim Caldas
Department of Oral Medicine, Hospital Sírio-Libanês, São Paulo, SP, Brazil
Eduardo Rodrigues Fregnani
Department of Stomatology, Bauru Dental School, USP–University of São Paulo, Ba...
Otto S, Schreyer C, Hafner S, et al. Bisphosphonate-related osteonecrosis of the jaws—characteristics, risk factors, clinical features, localization and impact on oncological treatment. J Craniomaxillofac Surg. 2012;40:303–9.
Agrillo A, Filiaci F, Ramieri V, et al. Bisphosphonate-related osteonecrosis of the jaw (BRONJ): 5 year experience in the treatment of 131 cases with ozone therapy. Eur ...
Pakosch D, Papadimas D, Munding J, et al. Osteonecrosis of the mandible due to anti-angiogenic agent, bevacizumab. Oral Maxillofac Surg. 2013;17:303–6.
Corbella S, Taschieri S, Samaranayake L, Tsesis I, et al. Implant treatment choice after extraction of a vertically fractured tooth. A proposal for a clinical classification of bony defects based on a systematic review of literature. Clin Oral I...
Watters AL, Epstein JB, Agulnik M. Oral complications of targeted cancer therapies: a narrative literature review. Oral Oncol. 2011;47:441–8.
Herbst RS, O’Neill VJ, Fehrenbacher L, et al. Phase II study of efficacy and safety of bevacizumab in combination with chemotherapy or erlotinib compared with chemotherapy alone for treatment of recurrent or refractory none small-cell lung cancer. J Cli...
Bevacizumab-related osteonecrosis of the jaw
Bone level tapered
Computed tomography
Medication-related osteonecrosis of the jaw
Vascular endothelial growth factor A
Data sharing is not applicable to this article as no datasets were generated or analyzed during the current study.
The findings of the present case indicate that insertion of dental implants is a risk factor for osteonecrosis of the jaw in patients exposed to bevacizumab. Therefore, prospective randomized studies should be encouraged to determine a safer bevacizumab regimen that considers both oral surgeries and the risk of dental implants for the management of osteonecrosis in clinical settings.
MRONJ is a side effect of drugs with a predilection for the mandible [24], which can be attributed to the relatively low vascularization of the mandible as compared to the maxilla [13]. Dental infections, surgical interventions, corticosteroid treatment, and chemotherapy have been described as risk factors for osteonecrosis [25]. In this case, the patient presented with stage 2 osteonecrosis with ...
Long-term administration of antiangiogenic agents does not directly indicate a high risk of MRONJ [16], though some authors have established 7-, 14-, and 28-day intervals of bevacizumab suspension for oral surgery [17,18,19]. In this case, the antiangiogenic medication was suspended for 28 days before implant placement; however, this was not enough to prevent MRONJ. The surfaces of Straumann® S...
A meta-analysis showed that the placement of dental implants in patients exposed to bisphosphonates did not reduce the success rate of the dental implant [11], although these patients may experience complications. Based on this analysis, a risk assessment should be performed on a case-by-case basis, since MRONJ is rare but one among serious complication of bisphosphonate therapy [11]. However, a c...
Five weeks postoperatively, pain, drainage of purulent secretion, and bone exposure around the implants were observed (Fig. 4), although none of the implants showed mobility. Ten ozone therapy sessions associated with levofloxacin were performed. After 4 weeks of therapy with ozone oil (Philozon®, Balneário Camboriú, SC, Brazil), no pain or drainage of purulent secretion were present. Bone s...
A 54-year-old Caucasian woman complained of an unpleasant taste and pain in the mouth. Her medical history included breast cancer with metastasis, which was diagnosed in 2007. The patient had no comorbidities and no history of smoking. A radical mastectomy with axillary dissection was performed. The patient had no previous history of radiotherapy of the head and neck or use of bisphosphonates. The...
The treatment of malignancies often involves the use of targeted therapies to control the growth and survival of malignant cells by interfering with specific molecular agents involved in carcinogenesis [1]. Bevacizumab is a recombinant humanized monoclonal antibody designed to selectively bind and inhibit the biological activity of all human vascular endothelial growth factor (VEGF-A) isoforms. It...