Condutas clínicas odontológicas em paciente irradiado em cabeça e pescoço e descrição de casos de aplicação de i-prf em áreas de osteoradionecrose

Abstract

Radiotherapy is a therapeutic modality used for the treatment of various tumors. Despite advances in this therapy, tissue adjacent to tumor lesions still receives doses of radiation that can affect its regenerative potential. Post-radiotherapy dental treatment should be performed with proper planning and minimally invasive to provide predictability and prevent the onset of osteoradionecrosis (ORN) lesions. These lesions are difficult to treat due to their pathophysiology, which involves the process of radiation-induced fibrosis causing tissue hypovascularization, hypoxia and hypocellularity. Therapeutic modalities have been proposed for its treatment, but they still have limitations and there is no established treatment that offers an adequate curative process. The objective of this work is to approach the dental management of the patient irradiated in the head and neck region and to describe cases of injection of injectable platelet-rich fibrin (i-PRF) in ORN lesions. This work was divided into two objectives: (1) Literature review with the objective of describing the dental procedures performed outside the hospital environment in post-radiotherapy patients, which demonstrated that dental treatment in irradiated patients is possible, as long as it is performed thorough assessment of the patient's oral and systemic health, avoiding invasive procedures; (2) Application of the i-PRF protocol in 5 ORN lesions with the aim of evaluating its effect on the soft tissue pattern adjacent to these lesions and it was concluded that i-PRF can serve as a first less invasive attempt to improve the soft tissue pattern, but further studies are needed to assess its effect in the treatment of ORN lesions. In general, this study demonstrated that radiotherapy is a complicating factor in the maintenance of oral health, and specific treatment protocols for these patients need to be applied or developed so that dental treatment is not the trigger for the occurrence of ORN. These lesions are difficult to treat, and the use of i-PRF can be a facilitating agent in the preparation for resective surgeries, but further evidence is still lacking.