IntroductionOsteonecrosis of the jaws associated with the use of bisphosphonates is one of the most serious complications of long-term therapy with bisphosphonates associated to oral surgical procedures, such as dental implants placement.1 Osteonecrosis is defined as bone exposure in the maxillofacial region that does not heal within 8 weeks after its identification. It is associated with the use of an antiresorptive agent (bisphosphonate or denosumab), without history of radiation therapy for the craniofacial region.2 The treatment of this condition is extremely difficult. Currently, antibiotic therapy, minimally invasive surgery, and lower-level laser therapy (LLLT) during the early stages have been considered the gold standard for medication-related osteonecrosis of the jaw (MRONJ).
Case PresentationA 65-year-old female patient was referred to the oral and maxillofacial surgery team from Araçatuba Dental School 2 months after a dental implant installation, complaining about its mobility. During anamnesis, hypertension and diabetes were reported, both controlled by daily medication, and use of alendronate (70 mg/d for 5 years) for prevention of osteoporosis. The clinical examination showed an accentuated mobility of the dental implant in the region of tooth 16, bone exposure in the periimplant region with vestibular and palatal extensions, purulent secretion and bad odor, and absence of remission of signs and symptoms ( Figure 1A). After careful evaluation of the medical history and clinical examination, stage 2 MRONJ was diagnosed, characterized by the presence of exposure and necrotic bone associated with symptomatic infection and purulent discharge. The treatment proposed for this case was the implant removal ( Figure 1B), followed by the initiation of 3 sessions per week of LLLT in the area of necrosis over 8 weeks, associated with administration of clindamycin (300 mg every 8 houes) and regular mouthwash with chlorhexidine 0.12% for the same period. An InGaAlP laser was used (Photon lase, DMC; wavelength 810 nm, power 100 mW, frequency 50/60 Hz, and power density 0.3-0.5 W/cm²). The "alveolitis" program was used, corresponding to 50 J/cm² and applied at 3 points of the lesion (distobuccal, mesiobuccal, and palatal), 1-2 mm from the tissue, 3 times in each spot for Case Report This study aimed to report a case of medication related osteonecrosis of the jaw (MRONJ) of a 65-year-old female patient referred to the Oral and Maxillofacial Surgery team from Araçatuba Dental School, complaining about mobility of a previously dental implant placed on the posterior maxillary region. Clinical examination revealed an extensive necrosis area around the implant region. The patient reported bisphosphonate therapy with sodium alendronate for prevention of osteoporosis 5 years ago. A diagnosis of MRONJ was reached and the treatment decided was to remove the dental implant damaged and use the lower-level laser therapy (LLLT) associated with antibiotic therapy with clindamycin 300 mg and mouth rinses with chlorhexidine 0.1...