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Master's Dissertation
DOI
https://doi.org/10.11606/D.25.2022.tde-08062022-091915
Document
Author
Full name
Mariel Ruivo Biancardi
Institute/School/College
Knowledge Area
Date of Defense
Published
Bauru, 2022
Supervisor
Committee
Bullen, Izabel Regina Fischer Rubira de (President)
Bufalino, Andreia
Soares, Mariana Quirino Silveira
Souza, Paulo Henrique Couto
Title in Portuguese
Quantificação das alterações identificadas em tomografia de feixe cônico na osteonecrose dos maxilares relacionada a medicações
Keywords in Portuguese
Osteonecrose dos maxilares
Osteonecrose medicamentosa
Tomografia computadorizada de feixe cônico
Abstract in Portuguese
A osteonecrose dos maxilares associada a medicamentos (OMAM) é um dos efeitos colaterais mais sérios advindos do uso de medicamentos antirreabsortivos e antiangiogênicos, utilizados para tratamento de diversas doenças, inclusive de tumores malignos. Tal condição está associada a alterações ósseas que podem ser detalhadamente avaliadas em exames provenientes de Tomografia Computadorizada de Feixe Cônico (TCFC). Assim sendo, o objetivo deste trabalho foi quantificar as alterações ósseas observadas em TCFC de pacientes com OMAM clinicamente diagnosticada e associá-las com os quadrantes sem OMAM, além de relacioná-las com o tipo de medicação, via de administração, tempo de uso, doença de base e uso de corticoide. Para tanto, as imagens de TCFC de 27 pacientes diagnosticados com pelo menos um quadrante com OMAM clinicamente diagnosticada, totalizando 92 quadrantes ósseos, foram analisadas simultaneamente por duas examinadoras (kappa = 1). As alterações ósseas e os parâmetros clínicos dos pacientes foram anotados e tabulados e, por meio de regressão logística multivariada, foram encontrados as seguintes associações significativas: espessamento do ligamento periodontal e reabsorção óssea com o tempo de uso da medicação; osteoesclerose, espessamento da base da mandíbula, reabsorção óssea, espessamento da lâmina dura e osso tipo 1 com medicação antiangiogênica; osso tipo 1 com medicação via endovenosa; e alvéolo persistente, espessamento da lâmina dura e osso tipo 1 com pacientes oncológicos. Finalmente, não houve diferenças entre os quadrantes com OMAM e os demais quadrantes dos maxilares sem OMAM quanto às alterações ósseas (p 0.2). Dentro dos limites do estudo, portanto, é possível indicar que as medicações antiangiogênicas ou endovenosas em pacientes oncológicos apresentaram um maior risco para OMAM. No mínimo, ocorreram em todos os quadrantes duas ou mais alterações ósseas imaginológicas, identificadas nas imagens de TCFC.
Title in English
Quantification of the alterations in cone beam computed tomography in medication-related osteonecrosis of the jaw
Keywords in English
Cone beam computed tomography
Medication related osteonecrosis
Osteonecrosis of the jaw
Abstract in English
Medication-related osteonecrosis of the jaw (MRONJ) is one of the most serious side effects resulting from the treatment with antiresorptive and antiangiogenic drugs, used to treat diseases such as malignant tumors. This condition is associated with bone alterations that can be evaluated in detail in exams from Cone Beam Computed Tomography (CBCT). Therefore, the objective of this study was to quantify the bone alterations observed in CBCT in patients that had a clinical diagnosis of MRONJ and to associate them with the quadrants without the clinical signs of MRONJ, in addition to relating them to the type of medication, route of administration, period that the medication was used, underlying disease and use of corticosteroids. The CBCT images of 27 patients diagnosed with at least one quadrant with clinical diagnosis - totaling 92 bone quadrants - were analyzed simultaneously by two examiners (kappa = 1). Bone changes and clinical parameters of the patients were recorded and tabulated and, by means of multivariate logistic regression, the following significant associations were found: periodontal ligament thickening and bone resorption with period of medication use; osteosclerosis, thickening of the base of the mandible, bone resorption, thickening of the lamina dura and type 1 bone with antiangiogenic medication; type 1 bone with intravenous medication; and persistent alveolus, thickening of the lamina dura and bone type 1 with cancer patients. Finally, there were no differences between the quadrants with MRONJ and the other quadrants of the jaws without the clinical diagnosis of MRONJ regarding bone alterations (p 0.2). Within the limits of the study, therefore, it is possible to indicate that antiangiogenic or intravenous medications in cancer patients presented a higher risk for MRONJ. At least two or more imaging bone changes that can be identified on CBCT images occurred in all quadrants.
 
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Publishing Date
2022-06-09
 
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