Medicação antirreabsortiva e antiangiogênica na Odontologia: fatores de risco, tratamento da MRONJ e informações recentes

O objetivo desta revisao foi atualizar o conhecimento basico sobre medicacoes antiangioenicas e antirreabsortivas, alem dos bifosfonatos, e discutir condutas clinicas, protocolos de tratamento e gerenciamento da osteonecrose que podem ser adotados para beneficio dos pacientes na Implantodontia. Devido a ocorrencia de novos casos de osteonecrose apos o uso de medicacoes antiangiogenicas e antirreabsortivas, a American Association of Oral and Maxillofacial Surgeons (AAOMS) sugeriu a mudanca de nomenclatura Bronj (Bisphosphonate-related osteonecrosis of the jaw) para MRONJ (Medication-related osteonecrosis of the jaw). O tipo de medicacao e a indicacao da mesma (câncer, mieloma multiplo, osteoporose/osteopenia) devem ser levados em consideracao no manejo dos pacientes. Ha controversias sobre a suspensao das medicacoes (Drug Holiday) e testes que predigam o risco de MRONJ. Novas pesquisas realizadas em cobaias procuram determinar o efeito do alendronato ministrado sistemicamente, apos a cirurgia, sobre a osteointegracao de implantes, neoformacao ossea e reabsorcao de enxerto osseo. Outra abordagem de pesquisa sobre bifosfonatos aplicados sobre a superficie dos implantes, com o objetivo de melhorar a osteointegracao, esta sendo realizada em humanos e em cobaias. A constante atualizacao dos profissionais de saude se faz necessaria para tratamentos mais eficientes e com menor risco aos pacientes. (AU) The objective of this review is to update the basic knowledge about antiangiogenic and antiresorptive medications, in addition to bisphosphonates and discuss clinical procedures, treatment protocols and management of osteonecrosis, which can be adopted for the benefit of patients seeking dental implant treatment. Due to the occurrence of new cases of osteonecrosis after using antiangiogenic and antiresorptive medications, the American Association of Oral and Maxillofacial Surgeons (AAOMS) suggested changing Bronj nomenclature (Bisphosphonate-related osteonecrosis of the jaw) to MRONJ (Medication-related osteonecrosis of the jaw). The type of medication and treatment indications (cancer, multiple myeloma, osteoporosis/osteopenia), should be taken into consideration for patient management. There is controversy about the suspension of medications (Drug Holiday) and tests to predict the risk of MRONJ. New animal model studies try to determine the effects of alendronate as systemically administered, after implant surgery, on bone formation and bone graft resorption. Other studies at human and animal investigate the role of bisphosphonates as biological coatings at implant surfaces to improve osseointegration. Continuing dental education is mandatory to provide more efficient treatments with less risk to patients. (AU)