Introduction-口腔病理科教学网.ppt

上下顎齒槽骨有極高的骨置換率，所以上 下顎骨所含雙磷酸鹽類藥物的濃度會遠 高於身體其他部位的骨骼，也就是說，死 骨沈積的效應在上下顎骨遠比身體其他 部位來得嚴重。 * discontinuation of BP therapy, seems to be effective to restore bone turnover of the jaw and support the treatment of BRONJ. In the position papers, the discontinuation of BP is recommended for more than 3 months before tooth extraction if the patients have received oral BP therapy for more than 3 years. It is expected that bone turnover of the jaw once disturbed with BP will be recovered during a 3-month drug holiday. * Teriparatide為人類基因重組副甲狀腺素（ recombinant human parathyroidhormone ），含有34個胺基酸[rhPTH(1-34)]，和內生性副甲狀腺素（由84個胺基酸組成）具有生物活性之1 ~ 34個氮端胺基酸序列相同，為第一個直接刺激骨母細胞（osteoblast）活性，促進骨質生成的藥品。 抗骨吸收的藥物T e r i p a r a t i d e ， 非 Bisphosphonate也不是estrogen，是一種副甲狀 腺素(PTH)的合成物，含重組人體副甲狀腺荷爾 蒙片段(1-34)，亦稱rhPTH (1-34)。Teriparatide 與PTH的34個N端胺基酸具生物活性部位完全 相同，這些接受體結合的親和力相同，且在 骨骼腎臟有相同的生理作用，會增加骨的緻 密性，減少骨折的產生 * Teriparatide不會再骨骼 或其他組織中累積。PTH本身就是一種具有降 低血鈣的效果，對骨的吸收作用是間接作用 於造骨細胞(osteoblast)，在正常情況下造骨細 胞(osteoblast)是利用其細胞表面接受器nuclear factor-kappa B ligand (RANKL)與噬骨細胞前趨 體(precursor cell)的表面接受器(RANK)之間的 交互作用來增進osteoclast的聚集(recruitment)與活性(activity)以達到osteoblast與osteoclast之間的拮抗平 * Vulnerability of the jaw to bacterial infection Jaw seems to be the most liable to bacterial infection since mucosa covering the alveolar bone is very thin and vulnerable, and teeth easily become a pathway for bacteria from the outside into the bone 9. Pathophysiological mechanism of BRONJ 10. Treatment of BRONJ Stage 3 : surgical removal of the jaw which contains the necrotic bones Stage 1 or stage 2 : conservative therapy local irrigation with saline or the use of oral antimicrobial rinse. Drug holiday Discontinuation of BP therapy seems to be effective to restore bone turnover of the jaw and support the treatment of BRONJ. more than 3 months before tooth extraction if the patients have received oral BP therapy for more than 3 years. Hyperbaric oxygen The efficacy of HBO in the treatment of BRONJ has not yet been elucidated, It