Pathophysiology and Pharmacologic Control of Osseous Mandibular Condylar Resorption
Pathophysiology and Pharmacologic Control of Osseous Mandibular Condylar Resorption
复制标题
DOI：
10.1016/j.joms.2011.07.018
复制
发表时间：
2012-08-01
影响因子：
1.9
通讯作者：
Milam, Stephen B.
中科院分区：
文献类型：
--
作者：
Gunson, Michael J.;Arnett, G. William;Milam, Stephen B.
目的：当发生下颌骨髁状突骨吸收时，可以有许多不同的诊断：炎性关节炎、TMJ压迫、创伤、激素失衡等。虽然每种诊断都有自己的原始激发事件，但关节骨丢失的病理生理途径是相同的。本文的目的是对有关髁状突吸收以及药物治疗控制关节侵蚀和吸收的相关文献进行综述。材料和方法：应用PubMed数据库检索相关文献，检索相关关键词的各种组合。结果：文献显示，与关节吸收相关的常见细胞水平事件包括细胞因子、自由基、激素失衡和/或强烈的磷脂分解代谢激活成骨细胞。然后，成骨细胞激活破骨细胞的招募，并促进破骨细胞释放基质降解酶。对关节侵蚀的研究主要集中在阐明骨破坏途径中的重要步骤，并通过药理学手段进行干预。使用抗氧化剂、四环素、omega-3脂肪酸、非类固醇抗炎药和炎性细胞因子抑制剂来帮助预防和控制关节骨丢失，包括下颌骨髁状突吸收，已经取得了成功。结论：通过了解已知的导致髁状突吸收的途径和个体的易感性，有针对性的药物治疗可能能够干扰这些途径，防止进一步的髁状突吸收。基础临床研究和随机临床试验仍然需要，但目前的科学是令人鼓舞的。(C)2012年美国口腔颌面外科协会《口腔颌面外科杂志》70：1918-1934,2012
Purpose: When osseous mandibular condylar resorption occurs there can be many different diagnoses: inflammatory arthritis, TMJ compression, trauma, hormone imbalances, and others. While each diagnosis has its own original inciting event, the pathophysiological pathway for articular bone loss is the same. The aim of this article is to review the relevant literature on condylar resorption and the use of pharmacotherapy to control arthritic erosions and resorption.Materials and Methods: The literature search was performed using PubMed database with various combinations of related keywords. Preference was given to clinical trials when reviewing articles.Results: The literature reveals that common cellular level events associated with articular resorption include the activation of osteoblasts by cytokines, free radicals, hormone imbalances and/or potent phospholipid catabolites. The osteoblast then activates the recruitment of osteoclasts and promotes the release of matrix degrading enzymes from the osteoclast. Research into articular erosions has focused on elucidating the important steps in the bone destructive pathways and interfering with them by pharmacological means. The use of antioxidants, tetracyclines, omega-3 fatty acids, non-steroidal anti-inflammatories and inflammatory cytokine inhibitors to aid in preventing and controlling articular bone loss including osseous mandibular condylar resorption has been successful.Conclusion: By understanding the known pathways that lead to condylar resorption and the individual patient's susceptibilities, targeted pharmacotherapy might be able to disturb these pathways and prevent further condylar resorption. Basic clinical investigations and randomized clinical trials are still required, but the present science is encouraging. (C) 2012 American Association of Oral and Maxillofacial Surgeons J Oral Maxillofac Surg 70:1918-1934, 2012