Spontaneous Bisphosphonate-related Osteonecrosis Associated with a Tooth that Had a Necrotic Pulp: A Case Report
Iranian Endodontic Journal,
Vol. 15 No. 3 (2020),
1 July 2020
,
Page 188-194
https://doi.org/10.22037/iej.v15i3.27849
Abstract
This study reports the endodontic treatment performed in a patient who presented with spontaneous bone exposure in the mandible while using intravenous bisphosphonate medication (ZometaÒ, Novartis Pharmaceuticals Co., Basel, Switzerland). A 63-year-old female patient was referred to a private dental clinic at Fortaleza, Brazil. The patient reported that one year before, she had undergone chemotherapy for the treatment of lung cancer and associated bone metastasis. Among the medications administered was the zolendronic acid, with dosage of 4 mg every 21 days. In the oral exam, the presence of extensive bone exposure was observed in the lingual region near tooth 37. The patient reported severe pain on palpation in the region; in the pulpal sensitivity test with cold stimulus, there was an absence of pain, characteristic of pulp necrosis. Radiographically, no periapical lesion was observed. Thus, endodontic treatment was performed, and instrumentation with Reciproc R25 files in the mesial root canals and R40 in the distal canal was done, alongside with abundant 2.5% sodium hypochlorite irrigation. Interappointment medication with calcium hydroxide was maintained for 15 days. In the second session, there was the spontaneous detachment of the exposed cortical bone fragment. The root canals were filled with gutta-percha and Endosequence BC Sealer cement. After two years, complete tissue repair was observed, and the patient presented with normal periapical tissues and the tooth in masticatory function. It may be concluded that a possible relationship between pulp and periapical infections and osteonecrosis exists in patients who use bisphosphonates.
- Bisphosphonates; Bisphosphonate-related Osteonecrosis of the Jaw; Endodontic Treatment; Pulp Necrosis
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References
Hinchy NV, Jayaprakash V, Rossitto RA, Anders PL, Korff KC, Canallatos P, Sullivan MA. Osteonecrosis of the jaw - prevention and treatment strategies for oral health professionals. Oral Oncol. 2013;49:878-86.
Kalra S, Jain V. Dental complications and management of patients on bisphosphonate therapy: A review article. J Oral Biol Craniofacial Res. 2013;3:25-30.
Moraes PC, Silva CAB, Soares AB, Passador-Santos F, Corrêa MEP, de Araújo NS, de Araújo VC. Tooth alterations in areas of bisphosphonate-induced osteonecrosis. Clin Oral Investig. 2015;19:489-95.
Hsiao A, Glickman G, He J. A retrospective clinical and radiographic study on healing of periradicular lesions in patients taking oral bisphosphonates. J Endod. 2009;35:1525-8.
Moinzadeh AT, Shemesh H, Neirynck NA, Aubert C, Wesselink PR. Bisphosphonates and their clinical implications in endodontic therapy. Int Endod J. 2013;46:391-8.
Woo SB, Hande K, Richardson PG. Osteonecrosis of the jaw and bisphosphonates. N Engl J Med. 2005;7:99-102.
Khosla S, Burr D, Cauley J. Bisphosphonate-associated osteonecrosis of the jaw: report of a task force of the American Society of Bone and Mineral Research. J Bone Min Res. 2007;22:1479-91.
Wigler R, Steinbock N, Berg T. Oral cutaneous sinus tract, vertical root fracture, and bisphosphonate-related osteonecrosis: a case report. J Endod. 2013;39:1088-90.
Marx RE, Sawatari Y, Fortin M. Bisphosphonate-induced exposed bone (osteonecrosis/osteopetrosis) of the jaws: Risk factors, recognition, prevention, and treatment. J Oral Maxillofac Surg. 2005;63:1567-75.
Arce K, Assael LA, Weissman JL, Markiewicz MR. Imaging findings in bisphosphonate-related osteonecrosis of jaws. J Oral Maxillofac Surg. 2009;67:75-84.
Popovic KS, Kocar M. Imaging findings in bisphosphonate-induced osteonecrosis of the jaws. Radiol Oncol. 2010;44:215-9.
Ruggiero SL, Mehrotra B, Rosenberg T. J. Osteonecrosis of the jaws associated with the use of bisphosphonates: a review of 63 cases. J Oral Maxillofac Surg. 2004;62:527-34.
Sarathy AP, Bourgeois SL Jr, Goodell GG. Bisphosphonate-associated osteonecrosis of the jaws and endodontic treatment: two case reports. J Endod. 2005;31:759-63.
Borromeo GL, Tsao CE, Darby IB, Ebeling PR. A review of the clinical implications of bisphosphonates in dentistry. Aust Dent J. 2011;56:2-9.
Goodday RH. Preventive strategies for patients at risk of medication-related osteonecrosis of the jaw. Oral Maxillofac Surg Clin North Am. 2015;27:527-36.
Edwards BJ, Migliorati CA. Osteoporosis and its implications for dental patients. J Am Dent Assoc. 2008;139:545-52.
Gallego L, Junquera L, Pelaz A, Díaz-Bobes C. Rubber dam clamp trauma during endodontic treatment: a risk factor of bisphosphonate-related osteonecrosis of the jaw? J Oral Maxillofac Surg. 2011;69:e93-5.
Nase JB, Suzuki JB. Osteonecrosis of the jaw and oral bisphosphonate treatment. J Am Dent Assoc. 2006;137:1115-9.
Sen OG, Bilgin B, Koçak S, Sağlam BC, Koçak MM. Evaluation of apically extruded debris using continuous rotation, reciprocation, or adaptive motion. Braz Dent J. 2018;29: 245-8.
Caviedes-Bucheli J, Castellanos F, Vasquez N, Ulate E, Munoz HR. The influence of two reciprocating single-file and two rotary-file systems on the apical extrusion of debris and its biological relationship with symptomatic apical periodontitis: A systematic review and meta-analysis. Int Endod J. 2016;49:255-70.
Sharma S, Hackett R, Webb R, Macpherson D, Wilson A. Severe tissue necrosis following intra-arterial injection of endodontic calcium hydroxide: a case series. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2008;105:666-9.
Candeiro GT, Moura-Netto C, D'Almeida-Couto RS, Azambuja-Júnior N, Marques MM, Cai S, Gavini G. Cytotoxicity, genotoxicity and antibacterial effectiveness of a bioceramic endodontic sealer. Int Endod J. 2016;49:858–64.
Iglecias EF, Freire LG, de Miranda Candeiro GT, Dos Santos M, Antoniazzi JH, Gavini G. Presence of voids after continuous wave of condensation and single-cone obturation in mandibular molars: A micro-computed tomography analysis. J Endod. 2017;43:638-42.
Dereci O, Ohran EO, Irmak O, Ay S. The effect of the duration of intravenous zolendronate medication on the success of non-surgical endodontic therapy: a retrospective study. BMC Oral Health. 2016;16:9.
Sedghizadeh PP, Kumar SK, Gorur A, Schaudinn C, Shuler CF, Costerton JW. Identification of microbial biofilms in osteonecrosis of the jaws secondary to bisphosphonate therapy. J Oral and Maxillofac Surg. 2008;66:767–75.
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