Özet

Denosumab insan monoklonal antikorlarından biridir ve osteoporoz, kemik metastazı gibi hastalıkların tedavisinde kullanılmaktadır. Osteoklast aktivitesini inhibe ederek, kemik rezorpsiyonunu azaltıp, kemik densitesini artırarak etkisini gösterir. Denosumabın yan etkilerinden bir tanesi de çene kemiklerinde osteonekroza sebep olmasıdır. İlaçla ilişkili çene kemiği osteonekrozu (MRONJ), diş çekimi, protez travması, periodontal hastalık ve dental implant tedavisi gibi birçok lokal risk faktörüne bağlıdır. Literatürde, MRONJ hastalarında dental implant tedavisi halen tartışma konusudur. Bu vaka raporunun amacı, dental implant tedavisi sonrası gözlenen denosumabla ilişkili çene kemiği osteonekrozunun (DRONJ) ilaç tatili sonrası başarılı cerrahi tedavisini sunmaktır. Cerrahide, ultrasonik kemik cerrahisinin L-PRF ile birlikte uygulanması, ilaç tatili sonrası DRONJ hastalarının tedavisinde, sert ve yumuşak doku iyileşmesinde etkili olabilecek alternatif bir tedavi yöntemidir.

Anahtar Kelimeler

Denosumab, Trombositten Zengin Fibrin, Osteonekroz, Dental İmplant, Ultrasonik Kemik Cerrahisi

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Abstract

Denosumab is one of the human monoclonal antibodies and is used in the treatment of osteoporosis and bone metastasis. It acts by inhibiting osteoclast activity, reducing bone resorption, and increasing bone density. A severe side effect of denosumab is the osteonecrosis of the jaw. Medication related osteonecrosis of the jaw (MRONJ) depends on many local risk factors such as tooth extraction, prosthetic trauma, periodontal disease and the dental implant therapy. Dental implant treatment is still a matter of debate in MRONJ patients in literature. The aim of this case report is to present the successful surgical management of denosumab related osteonecrosis of the jaw (DRONJ) observed after dental implant treatment following the discontinuation of medication. Use of ultrasonic bone surgery in combination with L-PRF is an alternative treatment method that can be effective in exposed bone coverage and hard and soft tissue healing following the discontinuation of medication in DRONJ patients.

Keywords

Denosumab, Platelet Rich Fibrin, Osteonecrosis, Dental Implant, Ultrasonic Bone Surgery

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