DRAMATIC OSTEONECROSIS OF THE JAW ASSOCIATED WITH ORAL BIPHOSPHONATES TREATMENT AFTER IMPLANT REMOVAL: A CASE REPORT

BACKGROUND
Osteoporosis affects millions of elderly patients. Bisphosphonates represent first-line therapy. Osteonecrosis of the jaws in patients treated with bisphosphonates is mostly associated with intravenous bisphosphonates while the incidence associated with oral bisphosphonates is not significant.
AIM
This report documents a case of bisphosphonate-related osteonecrosis of the jaw (BRONJ) after dental implant removal in an osteoporotic patient treated with alendronate and risedronate for 15 years.
MATERIAL AND METHODS
An 83-years-old patient with no significant systemic disease underwent implant removal in the first molar left hemimandible position in 2010 due to a peri-implantitis. The surgical procedure was uneventful thought preventive measures were no taken. In June 2011, the patient was referred to our department with a wide bone sequestration of the left mandibular body. A panoramic radiograph showed an increased bone marrow density with bone sequestration. Since then, the patient underwent several courses of antibiotics and conservative therapy, without relief of symptoms.
RESULTS
Since 2011, the patient has lost 13 teeth in the mandible and the osteonecrosis has disseminated to the entire jaw and the left mandible condyle. The patient has even lost the left hearing. Resective surgery under general anesthesia is not indicated due to the risk because of the age of the patient.
CONCLUSION AND CLINICAL IMPLICATIONS
Despite the low risk of BRONJ occurrence after implant surgery in oral N-BP users, the fate of dental implants in these patients remains uncertain. Therefore patients at risk must be given a full explanation of the potential risks of implant failure and BRONJ development. Osteonecrosis of the jaws in association with bisphosphonate therapy is a very serious condition with which all dentists should be familiar. Since the treatment of BRONJ is difficult, prevention is the main goal. When the osteonecrosis begins, it can be very painful to the patient, difficult to treat, and can lead to very deleterious sequelae.