DENOSUMABE E OSTEONECROSE DOS MAXILARES: O QUE O CIRUGIÃO-DENTISTA PRECISA SABER?

Abstract

Introduction: Denosumab is an antiresorptive drug indicated for the treatment of osteoporosis and metastatic bone diseases. Its use is associated with the development of adverse reactions in different organs, such as osteonecrosis of the jaws, which is an adverse event of interest to the dental field. Objective: Conduct a bibliographic survey on the mechanism of action of Denosumab in bone tissue and to highlight the importance of the dentist in the prevention, diagnosis and treatment of osteonecrosis in the jaws. Methodology This is an integrative review carried out in two stages: initially, a systematic search was carried out for articles published between the years 2012 to 2022, on osteonecrosis in patients using Denosumab in the data platforms Pubmed, Scielo, VHL and Google Scholar . Then, a selection of relevant parts for the research was made, an analytical reading and the organization of the collected information pertinent to each research theme was carried out. Results: The Denosumab acts by inhibiting the binding of the RANKL cytokine to its RANK receptor, this mechanism of action reduces the process of excessive bone resorption. Osteonecrosis can present at different staging levels and are characterized as an area of necrotic bone exposure in the maxillofacial region, lasting for more than eight weeks and without a history of radiotherapy or evident metastatic disease in the jaws. Some factors predispose the development of osteonecrosis, including: surgical dental procedures. There is still no definitive treatment protocol, however, supporting therapeutic modalities are administered according to the patient's clinical condition. Conclusions: The clinical examination must be thorough, paying attention to any changes in the oral cavity, pre existing diseases and medications used by the patient. In all cases, guidelines on oral hygiene and adequacy of the oral environment should be carried out prior to oncological treatment and the use of antiresorptive drugs.