Tratamento radical e conservador dos ameloblastomas: uma revisão sistemática

Abstract

Despite the knowlegde about ethiopathogenesis of ameloblastomas, course of treatment for these lesions causes controversy. Among treatment options there are radical therapies (marginal or partial resections), conservative therapies (marsupializations, enucleations) as well as those that use adjuvant therapies for remaining bone surface (cryotherapy, peripheral osteotomy). This review aimed to compare radical and conservative procedures regarding their effectiveness in treating ameloblastoma. The PRISMA recommendations were followed for designing the review protocol and registration was carried out in PROSPERO. The databases (Pubmed, Embase, Scopus, Web of Science, SciELO, LILACS and Open Grey) were used to search for retrospective/prospective studies in addition to case series. The files were processed according to eligibility criteria, bias analysis and individual quality by two reviewers. The search comprised 21,472 studies, of which 82 met eligibility criteria. The data gathered showed lower recurrence rates for radical therapies, especially when followed by reconstructive procedures, where functional and aesthetics impacts were also reduced. Cases of recurrence after conservative therapies were frequent, but authors advocate its use in pediatric or small lesions cases, preserving the continuiy of jaw bones and their functions. Furthermore, use of adjuvant therapies at surgical site led to a reduction in recurrence rates when compared to isolated conservative therapies. Finally, tratment plan for ameloblastomas deserves professional attention to the details of each case before defining surgical therapy, providing cure and quality of life to patients.