Treatment of Medication-Related Osteonecrosis of the Jaw Around the Dental Implant With a Once-Weekly Teriparatide: A Case Report and Literature Review
Managing medication-related osteonecrosis of the jaw (MRONJ) around a dental implant can be difficult. Although conservative treatment of MRONJ is recommended as the first-line form of management, many patients exhibit no improvement. The human recombinant parathyroid hormone teriparatide has recently been introduced for the management of MRONJ. Teriparatide is effective in the treatment of postmenopausal osteoporosis and is the only US Food and Drug Administration–approved anabolic agent that directly affects osteoblast function and contributes to bone remodeling. Herein we describe a case of MRONJ in an 85-year-old woman who was successfully treated with teriparatide. Teriparatide was administered once per week without any surgical interventions such as a sequestrectomy. Compared with most recently reported cases involving daily treatment with teriparatide, once-weekly administration of teriparatide may minimize side effects and patient discomfort. Once-weekly teriparatide application without sequestrectomy may be effective in the management of MRONJ around a dental implant.
Figure 1. Initial intraoral photograph showing soft-tissue erythema, swelling, and exposed necrotic bone around the dental implant. Figure 2. Initial panoramic radiograph depicting an extensive lesion with sequestrum around the dental implant. Figure 3. Panoramic radiograph 6 weeks after once-weekly teriparatide treatment showing spontaneous exfoliation of the implant and sequestrum.
Figure 4. Changes in bone turnover markers during treatment. Figure 5. Panoramic radiograph after 6 months of treatment showing complete bone healing. Figure 6. Intraoral photograph after 6 months of treatment showing complete mucosal healing without bone exposure.
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