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
Unduh kutipan
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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Persyaratan Deklarasi Helsinki dipatuhi, dan pasien memberikan persetujuan untuk semua tindakan bedah prosedur.Informed consent tertulis diperoleh dari pasien untuk publikasi laporan ini dan semua gambar yang menyertainya.Gustavo Maluf, Rogério Jardim Caldas, Eduardo Rodrigues Fregnani, dan Paulo Sérgio da Silva Santos menyatakan bahwa mereka tidak memiliki kepentingan yang bersaing.
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
Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were m...
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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...
Implant size
Frequency
Percent
4.5 × 11
7
21.21
4...
Implant site
Frequency
Percentage
15
2
6.06
14
...
Variable
Number
Mean (percentage)
Standard deviation
Age (years)
16
...
May, M.C., Andrews, P.N., Daher, S. et al. Prospective cohort study of dental implant success rate in patients with AIDS.
Int J Implant Dent 2, 20 (2016). https://doi.org/10.1186/s40729-016-0053-3
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Received: 01 February 2016
Accepted: 12 July 2016
Published: 28 September 2016
DOI: https://doi.org/10.1186/s40729-016-0053-3
Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were...
Triangle Implant Center, 5318 NC Highway 55, Suite 106, Durham, NC, 27713, USA
Michael Clayton May & Uday Nitin Reebye
University of North Carolina, Chapel Hill, NC, USA
Paul Nielsen Andrews
Boston University, Boston, MA, USA
Shadi Daher
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Kolhatkar S, Mason SA, Janic A, Bhola M, Haque S, Winkler JR. Surgical crown lengthening in a population with human immunodeficiency virus: a retrospective analysis. J Periodontol. 2012;83(3):344–53.
Download references
United Nations AIDS Report. 2014. http://www.unaids.org/sites/default/files/media_asset/GARPR_2014_guidelines_en_0.pdf. Accessed 07 Oct 2015.
Centers for Disease Control and Prevention: Statistics. 2013. http://www.cdc.gov/hiv/statistics/basics/index.html. Accessed 09 Oct 2015.
Centers for Disease Control and Prevention: Statistics. 2011. http://www.cdc.gov/hiv/pdf/statistics_2011_hiv_surveillan...
Acquired immune deficiency syndrome
Cluster of differentiation 4
Centers for Disease Control and Prevention
Highly active antiretroviral therapy
Human immunodeficiency virus
Pneumocystis pneumonia
Our study found a slightly higher failure rate of 10 % in patients with AIDS, compared to widely accepted failure rates in healthy patients at 5–7 %. A cohort sample size of 33 may be considered small for statistical power; however, the results from this study could lead to larger future prospective cohort studies with additional funding to recruit a larger cohort and comparison groups. The ad...
Regarding dental procedures, a retrospective cross-sectional study of 101 HIV patients was done from 2003 to 2005. Complication rate was found to be 2.2 % overall and 4.8 % after invasive dental procedures. No relationship was found between complications and immunological values [14]. Another study examining healing response after surgical crown lengthening in 21 patients with HIV was analyzed, ...
Generally speaking, the use of antibiotics in dental implantology has been controversial. Amongst the reasons for early (preloading) implant failure are bacterial contamination, systemic disease, chemotherapy, overheating of bone, poor recipient site bone quality, and poor bone to implant contact upon surgery. After the prosthetic phase of the implant restoration, loading forces exceeding the bone...
Since the AIDS epidemic reared its head in the 1980s, the nature of this disease has quickly evolved from a devastatingly debilitating disease to one of chronicity. These patients are requesting for and are entitled to the optimal restorative treatment plans, many of which include dental endosteal implants. Several authors have delved into the realm of implantology in the HIV-positive patient, but...
Descriptive statistics are presented in Table 1. Sixteen (n = 16) patients met our inclusion criteria and were included in our study. The sample included 12 males and 4 females. The mean age at enrollment was 36.2 years (sd 8.83 years). The mean CD4 count at the time of placement was 141.25 (sd 35.5). A total of 33 implants were placed in the 16 patients, including 5 mandibular implants and...
Standard descriptive statistics were used to examine the distribution of key variables (age, gender, CD4 count at baseline and follow-up, and failure rate) in the sample. Due to the small sample size in this study (n = 16), the relationship of CD4 count and failure will be examined graphically and cases which failed are discussed individually in the “Results” section. A bar chart is presen...
Our study is a prospective study looking at the failure rates in root-formed implants in AIDS patients at 5 years post-surgical placement of the implant fixtures. Patients recruited for the study had to meet inclusion criteria which included diagnosis of AIDS measured by a pre-operative cluster of differentiation 4 (CD4)
The Joint United Nations Programme on HIV/AIDS estimates that 36.9 million (34.3–41.4 million) people are living with human immunodeficiency virus (HIV) infection [1]. In America, the Centers for Disease Control and Prevention (CDC) estimated that 1.2 million people aged 13 or older were HIV infected by the end of 2012 [2] and the cumulative population of persons surviving for more than 36 mont...
Oral health care of patients with acquired immune deficiency syndrome (AIDS) due to human immunodeficiency virus (HIV) is a growing area of concern, taking into consideration the increased life expectancy of patients resulting from antiretroviral therapy. There is insufficient literature regarding the impact of dental implants in AIDS patients. This study investigated the long-term clinical outcom...
Figure 2. Number of implants and failures by quartiles of CD4
Figure 1. Kaplan-Meier survival curve for individual implants, n = 33
Table 3 Frequency table of implant size
Implant size
Frequency
Percent
4.5 × 11
7
21.21
4.5 × 8
1
3.03
4 × 11
10
30.3
4 × 8
13
39.39
5 × 11
1
3.03
5 × 8
1
3.03
Total
33
100
Table 2 Frequency table of implant site
Implant site
Frequency
Percentage
15
2
6.06
14
1
3.03
13
3
9.09
12
4
12.12
11
7
21.21
21
4
12.12
22
1
3.03
23
3
9.09
24
1
3.03
25
2
6.06
35
1
3.03
33
1
3.03
43
1
3.03
45
1
3.03
46
1
3.03
Total
33
100
Table 1 Descriptive statistics (n = 16 patients)
Variable
Number
Mean (percentage)
Standard deviation
Age (years)
16
36.19
8.83
Sex
Male
12
(75)
–
Female
4
(25)
–
CD4 count (cells/mm3)
16
141.25
35.5
No. of implants
33
–
–
No. of implants that failed
3
(9.1) (% failed)
–
Average time to failure (days)
29.7
–
...
Discussion
Since the AIDS epidemic reared its head in the 1980s, the nature of this disease has quickly evolved from a devastatingly debilitating disease to one of chronicity. These patients are requesting for and are entitled to the optimal restorative treatment plans, many of which include dental endosteal implants. Several authors have delved into the realm of implantology in the HIV-pos...
Results
Descriptive statistics are presented in Table 1. Sixteen (n = 16) patients met our inclusion criteria and were included in our study. The sample included 12 males and 4 females. The mean age at enrollment was 36.2 years (sd 8.83 years). The mean CD4 count at the time of placement was 141.25 (sd 35.5). A total of 33 implants were placed in the 16 patients, including 5 mandibular imp...
Methods
Our study is a prospective study looking at the failure rates in root-formed implants in AIDS patients at 5 years post-surgical placement of the implant fixtures. Patients recruited for the study had to meet inclusion criteria which included diagnosis of AIDS measured by a pre-operative cluster of differentiation 4 (CD4)
Background
The Joint United Nations Programme on HIV/AIDS estimates that 36.9 million (34.3–41.4 million) people are living with human immunodeficiency virus (HIV) infection. In America, the Centers for Disease Control and Prevention (CDC) estimated that 1.2 million people aged 13 or older were HIV infected by the end of 2012 and the cumulative population of persons surviving for more than 36...
Abstract
Background
Oral health care of patients with acquired immune deficiency syndrome (AIDS) due to human immunodeficiency virus (HIV) is a growing area of concern, taking into consideration the increased life expectancy of patients resulting from antiretroviral therapy. There is insufficient literature regarding the impact of dental implants in AIDS patients. This study in...