The Challenge Treatment of Medication Related Osteonecrosis of the Jaw: A Case Report

Bisphosphonates toxicological effect on alveolar bone could be associated to medication related osteonecrosis of the jaw. (MRONJ) Oral surgical procedures as; tooth extractions, implants placements or trauma are suggested risk factors. The aim of this paper is to describe a case of MRONJ and recurrence after the first right mandibular molar extraction. A 54 years old man was referred to the Department of Surgery and Integrated Clinic of Aracatuba Dental School, Univ. Estadual Paulista - UNESP with a medical history of myeloma multiple and treated with zoledronic acid during 3 years. Her dental history consisted of a mandibular molar extraction 3 years after having finished zoledronic acid intake. After the dental extraction the patient developed a clinical features of MRONJ that was treated with antibiotics, sequestrectomy, hyperbaric oxygen, with apparently total resolution for about five month. The post-operative 6th month the patient complained of recurrent pain, exudates and swelling. Antibiotic were prescribed in addition to surgical debridement. Even though mucosal coverage was achieved during the second surgical procedures, healing occurred without signs of infection but without complete gingival coverage until the second year postoperative. MRONJ is a challenge complication and there is not a gold standard treatment.