An Approach for the Prevention, Diagnosis, and Treatment of Jaw Osteonecrosis: Report of a Case Associated with Zoledronic Acid.

BACKGROUND Osteonecrosis of the jaw is a condition manifesting as necrotic bone for 8 weeks or more, with no history of radiotherapy. It is linked to the use of antiresorptive drugs, such as bisphosphonates and denosumab. We discuss in this case report the importance of infection control during clinical procedures in patients taking antiresorptives. CASE REPORT Our case report describes a 52-year-old woman who had received zoledronic acid injections for 7 years, who presented with osteonecrosis of the jaw in the region of teeth 24, 25, and 26, with no local trauma. The report proceeds to describe the extraction of these teeth. After the dental extractions, she did not have any recurrence of the lesion, and she is currently in follow-up care. CONCLUSIONS Osteonecrosis of the jaw can be prevented through infection control and local trauma prevention. Patients who are taking antiresorptive drugs must receive special care from dental surgeons and doctors, and receive the necessary oral treatments before starting drug therapy.

Denosumab Related Osteonecrosis of Jaw: a Case Report.

BACKGROUND: This case report shows an affected postmenopausal patient with medicaments related osteonecrosis of the jaw injury associated with increased use of bisphosphonates and Prolia® (denosumab) for the treatment of osteoporosis. The mechanism of action of the receptor activates the denosumab of the nuclear-kB factor binding and makes nuclear-kB Factor, reducing bone volume and reabsorption in the trabecular and cortical bones and, consequently, decreasing an incidence of fractures and maintaining a bone formation. The bone physiology regulated by the hormones calcitonin, parathormone and vitamin D also undergoes interference. METHODS: The injury was located around a dental implant in region #24 and #25 and the patient complained of pain, bleeding, oedema, and halitosis for more than two months, that the dental implant had been installed five years before. According to the clinical findings, the patient presented the exposed and necrotic bone in the region of #24 and #25 and with the radiographs found, it was observed as extensive bone destruction adjacent to the dental implant. RESULTS: Patient was referred to the maxillofacial surgeon that performed the removal of bone sequestration and dental implant in the region affected. After that, the patient has been accompanied for a year. CONCLUSIONS: Patients taking medications for osteoporosis or cancer need to receive special attention from the dentist. Invasive procedures on the jaw bone of patients taking these medications may cause osteonecrosis of the jaw. When diagnosed, osteonecrosis of the jaw should be treated surgically in conjunction with antibiotic therapy and patients should be monitored.