26 February 2024
: Case report 
Treatment of Medication-Related Osteonecrosis of the Jaws without Segmental Resections: A Case Series
Unusual clinical course, Challenging differential diagnosis, Unusual or unexpected effect of treatment, Diagnostic / therapeutic accidents, Rare disease, Adverse events of drug therapy, Educational Purpose (only if useful for a systematic review or synthesis)
Tito Lúcio Fernandes
1ABCDEF*, Bruno Viezzer Fernandes 1CDE, Gilson Cesar Nobre Franco 1ADG
DOI: 10.12659/AJCR.942980
Am J Case Rep 2024; 25:e942980
Table 2. Patients treated for medication-related osteonecrosis of the jaws.
| Patient | Age (years) | Sex | Medication, duration | Pathology | Site | Initial symptoms | Initial images |
|---|---|---|---|---|---|---|---|
| 1 | 85 | F | Zoledronate, 4 years | Metastatic breast | Ant Mx | Alveolar bone exposition, suppuration | Osteolysis extending to the nasal floor |
| 2 | 82 | F | Alendronate, 4 years | Osteoporosis | Post Md | Spontaneous sequestration, suppuration | Alveolar osteolysis |
| 3 | 81 | F | Alendronate, 4 years | Osteoporosis | Post Md | Suppuration | Alveolar osteolysis |
| 4 | 76 | F | Alendronate, ibandronate 20 years | Osteoporosis | Ant Md | Alveolar bone exposition, extraoral fistula | Osteolysis extending to the base of the mandible |
| 5 | 84 | F | Ibandronate, 3 years | Osteoporosis | Post Md | Gingival swelling, paresthesia | Alveolar osteolysis |
| 6 | 70 | F | Alendronate, denosumab, 13 years | Osteoporosis | Post Md | Mandibular neuralgia, gingival hyperemia | Alveolar osteolysis |
| 7 | 85 | F | Alendronate, denosumab, 11 years | Osteoporosis | Ant Md | Gingival swelling | Alveolar osteolysis |
| 8 | 67 | F | Alendronate, ibandronate, 2 years | Osteoporosis | Ant Md | Warty lesions on the floor of the mouth, alveolar bone exposition | Mandibular osteolysis |
| 9 | 58 | F | Alendronate, 20 years | Osteoporosis | Post Md | Gingival swelling, bone exposition, paresthesia | Alveolar osteolysis |
| 10 | 72 | F | Zoledronate, 10 years | Metastatic breast | Post Mx | Alveolar bone exposition | Alveolar osteosclerosis |
| 11 | 80 | F | Alendronate, 5 years | Osteoporosis | Post Mx | Alveolar bone exposition, suppuration | Osteolysis extending to the maxillary sinus |
| Ant – anterior (incisors and canines); Post – posterior (premolars and molars); Mx – maxilla; Md – mandible; PENTOCO – pentoxifylline+tocopherol; HBOT – hyperbaric oxygen therapy. | |||||||
| Patient | Stage | Triggering factor | Treatment | Adjuvant treatment | Outcome | Follow-up, (months) | |
| 1 | 3 | Prosthetic trauma | Chlorhexidine, antibiotics, sequestrectomy | No | Suture dehiscence, oronasal fistula | 20 | |
| 2 | 2 | Prosthetic trauma | Chlorhexidine, antibiotics, debridement | No | Suture dehiscence | 12 | |
| 3 | 2 | Tooth extraction | Chlorhexidine, antibiotics, sequestrectomy | No | Suture dehiscence | 52 | |
| 4 | 32 | Dental implant, prosthetic trauma | Chlorhexidine, antibiotics, marginal resection, sequestrectomy | HBOT, PENTOCO | Relapse | 46 | |
| 5 | 2 | Dental implant | Chlorhexidine, antibiotics, implant removal | No | Suture dehiscence | 11 | |
| 6 | 2 | Tooth extraction, endodontic treatment | Chlorhexidine, antibiotics, implant removal, apicoectomy | No | Suture dehiscence | 20 | |
| 7 | 2 | Tooth extraction | Chlorhexidine, antibiotics, sequestrectomy | PENTOCO | Suture dehiscence | 6 | |
| 8 | 3 | Prosthetic trauma, fall | Chlorhexidine, antibiotics, marginal resection, sequestrectomy | PENTOCO | Suture dehiscence | 20 | |
| 9 | 2 | Dental implant | Chlorhexidine, antibiotics, sequestrectomy | PENTOCO | Suture dehiscence | 12 | |
| 10 | 1 | Tooth extraction | Chlorhexidine, antibiotics, sequestrectomy | No | Suture dehiscence | 3 | |
| 11 | 3 | Prosthetic trauma | Chlorhexidine, antibiotics, marginal resection, questrectomy, buccal fat pad | PENTOCO | No intercurrence | 5 | |
| Ant – anterior (incisors and canines); Post – posterior (premolars and molars); Mx – maxilla; Md – mandible; PENTOCO – pentoxifylline+tocopherol; HBOT – hyperbaric oxygen therapy. | |||||||