ESTRATEGIAS DE MANEJO QUIRÚRGICO EN LA OSTEONECROSIS DE LOS MAXILARES ASOCIADA A MEDICAMENTOS (MRONJ)
Resumen
La osteonecrosis de los maxilares asociada a medicamentos (MRONJ) es una reacción adversa grave caracterizada por la exposición ósea persistente en pacientes bajo terapias antirresortivas o antiangiogénicas. Aunque el manejo conservador fue el estándar histórico, las evidencias contemporáneas sugieren limitaciones en este enfoque, impulsando la transición hacia protocolos quirúrgicos resolutivos. Objetivo: Analizar las evidencias científicas sobre las estrategias de manejo quirúrgico en la MRONJ y el impacto de las terapias adyuvantes en la resolución clínica. Metodología: Se trata de una revisión integradora de la literatura, estructurada en seis etapas operacionales y guiada por la estrategia PICO. La búsqueda sistemática se realizó en las bases PubMed/MEDLINE, Scopus, Web of Science y BVS/LILACS, abarcando publicaciones hasta abril de 2026. Se utilizaron descriptores controlados (MeSH/DeCS) para identificar estudios primarios en inglés, portugués o español. La selección ocurrió en dos etapas mediante el software Rayyan, resultando en una muestra final de 8 artículos. Resultados: La intervención quirúrgica temprana demostró tasas de éxito superiores al 90%. Estrategias como el desbridamiento agresivo y la osteotomía marginal, asociadas a terapias adyuvantes como L-PRF, fotobiomodulación láser y terapia fotodinámica, optimizaron la angiogénesis y la reepitelización mucosa. Consideraciones Finales: El paradigma quirúrgico, aliado al uso de adyuvantes biológicos, se presenta como la estrategia más eficaz para la resolución clínica de la MRONJ en la actualidad.
Biografía del autor/a
Odontóloga, estudiante de Maestría, Universidade Federal do Piauí (UFPI).
Odontólogo, doctorando en Biotecnología por la Universidade Estadual de Feira de Santana.
Odontólogo, con maestría y estudiante de grado en Medicina.
Graduada en Odontología por la Faculdade de Odontologia de Bauru, Universidade de São Paulo (FOB-USP), y actualmente especializándose en Endodoncia en la Faculdade de Odontologia de Bauru (FOB-USP).
Odontóloga.
Odontólogo, especialista en Salud Colectiva – Universidade Paulista (UNIP).
Odontóloga graduada por la Universidade Federal do Ceará (UFC). Actualmente especializándose en Prótesis Dentaria en el Centro Universitário Christus (Unichristus). Posee posgrado en Atención de Emergencia Prehospitalaria.
Odontóloga graduada por la Universidade Estadual da Paraíba.
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