Análise do potencial de sucesso das reconstruções maxilo-mandibulares em pacientes submetidos à ressecção decorrente de osteonecrose dos maxilares relacionada a medicamentos: uma revisão de escopo

Abstract

Antiresorptive medications such as bisphosphonates and denosumab are commonly used in the management of osteometabolic conditions. Medication-related osteonecrosis of the jaw (MRONJ), a potential consequence of antiresorptive medication use, may require aggressive treatments such as resection of the affected area. Autogenous bone graft reconstruction is one treatment approach for patients who have undergone maxillomandibular resection due to MRONJ. Objective: To systematically analyze the literature on the therapeutic success of autogenous bone graft reconstructions in patients subjected to maxillomandibular resection as a result of medication-related osteonecrosis. Methods: A scoping review was conducted following the JBI Manual and reported in accordance with PRISMA guidelines. An electronic search was performed in seven literature databases and an additional database to capture gray literature. Eligibility criteria were based on the PCC (Population, Concept, and Context) framework, with no restrictions on publication year or language. All stages were conducted by two independent reviewers, with a third reviewer resolving conflicts. Records were screened by title, abstract, and full text based on eligibility criteria. Data from selected studies were extracted and evaluated using JBI tools for risk of bias, specific to each study design. Data were analyzed and synthesized narratively, in tables, or in figures. Results: Analysis of the available literature revealed that patients' ages ranged from 66 to 78 years, with a predominance of females (82,8%). Indications for the use of antiresorptive medications included conditions such as osteoporosis, rheumatoid arthritis, multiple myeloma, and metastatic cancer. The duration of medication use ranged from 1 to 12 years, with the mandible being the most commonly affected anatomical site. Surgical treatments ranged from debridement of necrotic bone to more extensive procedures such as segmental resections and partial mandibulectomies, followed by reconstructions using titanium plates and autologous bone grafts, including fibula and iliac crest grafts. In most cases, the outcomes of surgical reconstructions were positive, with successful bone reconstruction and no recurrence of MRONJ. Conclusion: Bone resections in patients with MRONJ, combined with reconstructions using autologous grafts, have proven to be viable therapeutic options for severe cases, demonstrating high success rates and contributing to the restoration of function and quality of life in affected patients.