Successful New Dental Implant Installation in a Healed Site of Medication-Related Osteonecrosis of the Jaw: A Case Report
The purpose of this case report was to present a rare clinical case of successful new dental implant installation in the site of previously healed medication-related osteonecrosis of the jaw (MRONJ). An 80-year-old female patient with history of oral bisphosphonate (BP) therapy presented with pain and swelling of gingiva in the right posterior mandible. One of the 3 implants placed 15 years ago in the right mandibular posterior area was removed 6 months before the visit to our hospital, which led to worsening of the symptoms. After clinical and radiographic examination, the patient was diagnosed with stage 2 MRONJ. Along with antibiotic therapy, the patient underwent surgical intervention via sequestrectomy and removal of the remaining 2 implants. Adequate soft and hard tissue healing without any complications and signs of recurrence was confirmed, and implant installation with simultaneous bone grafting and prosthesis fabrication were done in the explantation sites of MRONJ. By the 7-year follow-up, no implant failure has been observed, and installation of implants was successful in the previously healed MRONJ site. Dental implant installation is possible in a patient with history of failed implant due to MRONJ. However, a careful treatment planning is needed before implantation in a previously healed site of MRONJ to reduce the potential risks of MRONJ recurrence and implant failure.
(a) Panoramic radiograph at the initial visit. The arrow in the right mandibular first molar area indicates where the implant was removed 6 months prior to the visit to our hospital. Incomplete bone healing with a resorptive pattern around the explantation site can be seen. (b) Sequestrum and involvement of the inferior alveolar nerve can be observed in the preoperative cone-beam computerized tomography (CBCT).
Postoperative panoramic radiograph after sequestrectomy and implant removal were performed in the right mandibular premolar and molar area.
Cone-beam computerized tomography (CBCT) taken at 10-month postoperative follow-up. No recurrence of medication-related osteonecrosis of the jaw (MRONJ) in the right lower premolar and molar region is shown.
Panoramic radiograph after dental implant installation in the previously treated medication-related osteonecrosis of the jaw (MRONJ) and explantation sites of the right mandibular posterior mandible.
Intraoral photograph and radiographs taken at 7-year follow-up.
Flow chart of the treatment plan used for successful implant therapy in our patient with previous history of medication-related osteonecrosis of the jaw (MRONJ).
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