O uso dos bifosfonatos como adjuvantes no tratamento das doenças periodontais: uma revisão de literatura
DOI:
https://doi.org/10.34119/bjhrv9n1-079Keywords:
bifosfonatos, doença periodontal, terapia adjuvante, osteonecroseAbstract
A doença periodontal é uma condição inflamatória crônica multifatorial, caracterizada pela destruição progressiva dos tecidos de suporte dentário e pela perda óssea alveolar, configurando um importante desafio terapêutico na prática odontológica contemporânea. Diante da participação ativa da resposta imunoinflamatória do hospedeiro e do desequilíbrio entre os processos de reabsorção e formação óssea, terapias adjuvantes capazes de modular esses mecanismos têm sido investigadas, com destaque para os bifosfonatos, em razão de sua ação antirreabsortiva e potencial efeito anti-inflamatório. Nesse contexto, esta revisão teve como propósito analisar o uso dos bifosfonatos como agentes adjuvantes no tratamento das doenças periodontais, considerando seus efeitos clínicos e os riscos associados à sua aplicação. Foi realizada uma revisão integrativa da literatura nas bases de dados PubMed e Biblioteca Virtual em Saúde (BVS), utilizando os descritores “Bisphosphonates”, “Periodontal Disease” e “Treatment”, combinados pelo operador booleano AND. Após a aplicação dos critérios de elegibilidade e leitura na íntegra, nove estudos compuseram a amostra final. Os achados indicaram que bifosfonatos como o alendronato e o ácido zoledrônico apresentam efeitos osteoprotetores e anti-inflamatórios, com redução de mediadores inflamatórios, incluindo IL-1β, TNF-α e MMP-8, além de influência positiva sobre o sistema RANK/RANKL/OPG e melhora de parâmetros clínicos periodontais, especialmente quando utilizados por via tópica. Por outro lado, o uso sistêmico em doses elevadas foi associado ao risco de osteonecrose dos maxilares, reforçando a necessidade de cautela na indicação clínica. Dessa forma, os bifosfonatos despontam como uma alternativa adjuvante promissora na terapia periodontal, desde que empregados de maneira criteriosa e respaldados por evidências clínicas adicionais que confirmem sua segurança e eficácia a longo prazo.
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