Teriparatidin ilaçlarla ilişkili çene osteonekrozu tedavisindeki etkinliği: hayvan çalışması

Yıl 2020, Cilt: 7 Sayı: 2, 155 - 162, 01.08.2020

Cihan Topan , Erdem Kılıç , Eser Kılıç Saim Özdamar , Emin Kaymak

https://doi.org/10.15311/selcukdentj.377192

Öz

Amaç: Bu çalışmanın amacı, bifosfanat uygulamasını takiben
diş çekimi sonrasında çene kemiklerinde oluşan osteonekrozun tedavisinde
teriparatidin etkinliğinin deneysel olarak araştırılmasıdır.

Gereç ve Yöntemler: Wistar Albino ırkı 48 adet dişi rat rastgele
4 gruba ayrıldı: I-Kontrol grubu; II-Zoledronik asit (ZA); III-ZA ve
teriparatid; IV-ZA ve antibiyotik. Osteonekroz oluşturmak için kontrol grubu
dışındaki tüm gruplara 8 hafta boyunca zoledronik asit enjekte edildi. ZA
enjeksiyonlarından bir hafta sonra tüm hayvanların alt çene sol azı dişleri
çekildi ve çekim soketlerinde kemik defekti oluşturuldu. Bu işlemden sonra üçüncü
gruptaki ratlara 2 ay boyunca subkutan olarak teriparatid, dördüncü gruptaki
ratlara 2 hafta boyunca intraperitoneal antibiyotik enjekte edildi. Hayvanlar radyolojik,
histolojik, biyokimyasal ve klinik değerlendirmeler için sakrifiye edildi.

Bulgular: Teriparatid uygulamasının biyokimyasal ve radyolojik
açıdan kemik iyileşmesine istatistiksel olarak anlamlı bir etkisinin olmadığı
tespit edilmiştir (p>0,05). Teriparatidin, osteonekroz geliştikten sonra
klinik olarak iyileşmeye tam anlamıyla olumlu etkisinin olmadığı ama oluşan osteonekroz
tablosunun daha da ilerlemesini engellediği gözlenmiştir. Ayrıca, ilacın
histolojik olarak yumuşak doku ve kemik dokusu iyileşmesinde olumlu etkilerinin
olduğu tespit edilmiştir.

Sonuç: Bifosfanat
uygulamasını takiben diş çekimi işleminin osteonekroz gelişimine sebep olduğu
gözlenmiştir. Ayrca, teriparatid uygulamasının bu lezyonların tedavisinde
kısmen olumlu etkileri olduğu tespit edilmiştir. Bu tedavinin optimum doz ve
süresinin belirlenmesi için geniş grupları içeren ileri deneysel ve klinik
çalışmalara ihtiyaç vardır.

Anahtar Kelimeler: Bifosfonat, osteonekroz, teriparatid

Anahtar Kelimeler

Bifosfonat, osteonekroz, teriparatid

Teriparatide’s potential role in the treatment of medication-related osteonecrosis of the jaw: an animal study.

Öz

Background: We aimed to investigate the efficacy of
teriparatide experimentally on rats after the development of osteonecrosis with
bisphosphonate usage.

Methods: Rats
were divided randomly into four groups: I-Control group; II-Zoledronic acid
(ZA); III-ZA and teriparatide; IV-ZA and antibiotic. Osteonecrosis was
generated by injecting zoledronic acid to all groups except control group for 8
weeks. A week after ZA injections, mandibular left molar extraction was
performed and bone defect were created in the same regions of all animals. Afterwards,
teriparatide was subcutaneously injected to rats in the third group; antibiotic
was intraperitoneally injected to rats in the fourth group. Animals were
sacrificed for the radiological, histological, biochemical and clinical
evaluations.

Results: Teriparatide
therapy has not a statistically significant effect on radiological and
biochemical aspects of bone healing (p>0.05). Teriparatide has not a
positive effect clinically on bone healing after the development of
osteonecrosis. However, application of this drug
prevents further deterioration of osteonecrosis period clinically. Moreover,
teriparatide has positive effects on soft tissue and bone healing histologically. 

Conclusions: Bisphosphonate
uptake that followed by tooth extraction has been identified to induce the
development of osteonecrosis. On the other hand teriparatide therapy has
partially positive effects in the treatment of these lesions. However, further
experimental and clinical studies including large groups
are required for the determination optimum dose and duration of this treatment
modality.  

Keywords: Bisphosphonate,
osteonecrosis, teriparatide

Anahtar Kelimeler

Bisphosphonate, osteonecrosis, teriparatide

Kaynakça

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